October 21, 2020Interactive Cardiovascular and Thoracic Surgery27 citationsOpen Access
Mitral valve surgery after a failed MitraClip procedure
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Key Result
Mitral valve surgery after a failed MitraClip procedure is associated with a 15% in-hospital mortality and a 26.5% all-cause mortality at 12 months.
Study Design
Type
Meta-Analysis (n=172)
Structured PICO
What are the clinical outcomes and mortality rates of open mitral valve surgery after a failed MitraClip procedure?
P
Population
172 patients (mean age 70.5 years) undergoing mitral valve surgery after a failed MitraClip procedure, followed for a mean of 12 months.
I
Intervention
Open mitral valve surgery (predominantly mitral valve replacement)
O
Outcome
In-hospital mortalityhard clinical
Surgical intervention after a failed MitraClip procedure is associated with high in-hospital (15%) and 1-year (26.5%) mortality, and usually requires mitral valve replacement due to severe leaflet injury.
Abstract
OBJECTIVES: Among patients undergoing transcatheter mitral valve repair with the MitraClip device, a relevant proportion (2-6%) requires open mitral valve surgery within 1 year after unsuccessful clip implantation. The goal of this review is to pool data from different reports to provide a comprehensive overview of mitral valve surgery outcomes after the MitraClip procedure and estimate in-hospital and follow-up mortality. METHODS: All published clinical studies reporting on surgical intervention for a failed MitraClip procedure were evaluated for inclusion in this meta-analysis. The primary study outcome was in-hospital mortality. Secondary outcomes were in-hospital adverse events and follow-up mortality. Pooled estimate rates and 95% confidence intervals (CIs) of study outcomes were calculated using a DerSimionian-Laird binary random-effects model. To assess heterogeneity across studies, we used the Cochrane Q statistic to compute I2 values. RESULTS: Overall, 20 reports were included, comprising 172 patients. Mean age was 70.5 years (95% CI 67.2-73.7 years). The underlying mitral valve disease was functional mitral regurgitation in 50% and degenerative mitral regurgitation in 49% of cases. The indication for surgery was persistent or recurrent mitral regurgitation (grade >2) in 93% of patients, whereas 6% of patients presented with mitral stenosis. At the time of the operation, 80% of patients presented in New York Heart Association functional class III-IV. Despite favourable intraoperative results, in-hospital mortality was 15%. The rate of periprocedural cerebrovascular accidents was 6%. At a mean follow-up of 12 months, all-cause death was 26.5%. Mitral valve replacement was most commonly required because the possibility of valve repair was jeopardized, likely due to severe valve injury after clip implantation. CONCLUSIONS: Surgical intervention after failed transcatheter mitral valve intervention is burdened by high in-hospital and 1-year mortality, which reflects reflecting the high-risk baseline profile of the patients. Mitral valve replacement is usually required due to leaflet injury.