Failed MitraClip therapy: surgical revision in high-risk patients

BACKGROUND: MitraClip implantation is a valid interventional option that offers acceptable short-term results. Surgery after failed MitraClip procedures remains challenging in high-risk patients. The data on these cases are limited by the small sample numbers. AIM: The aim of our study is to show, that mitral valve surgery could be possible and more advantageous, even in high-risk patients. METHODS: Between 2010 and 2016, nine patients underwent mitral valve surgery after failed MitraClip therapy at our institution. RESULTS: The patients' ages ranged from 19 to 75 years (mean: 61.2 ± 19.6 years). The median interval between the MitraClip intervention and surgical revision was 45 days (range: 0 to 1087 days). In eight of nine patients, the MitraClip intervention was initially successful and the mitral regurgitation was reduced. Only one patient had undergone cardiac surgery previously. Intra-operatively, leaflet perforation or rupture, MitraClip detachment, and chordal or papillary muscle rupture were potentially the causes of recurrent mitral regurgitation. There were three early deaths. One year after surgery, the six remaining patients were alive. CONCLUSIONS: Mitral valve surgery can be successfully performed after failed MitraClip therapy in high-risk patients. The initial indication for MitraClip therapy should be considered carefully for possible surgical repair.