Clinical Impact of Intervention Strategies After Failed Transcatheter Mitral Valve Repair

Overview

Journal EuroIntervention

Specialties Cardiology & Vascular Diseases
Pharmacology

Date 2020 Oct 19

PMID 33074154

Citations 3

Authors

Hannes Alessandrini

Ansgar Dreher

Claudia Harr

Peter Wohlmuth

Felix Meincke

Samer Hakmi

Timm Ubben

Karl-Heinz Kuck

Kambiz Hassan

Stephan Willems

Michael Schmoeckel

Stephan Geidel

Affiliations

Soon will be listed here.

Abstract

Aims: Failure of transcatheter mitral valve repair (fTMVR) therapy has a decisive prognostic influence, and complex retreatment is of higher risk. The aim of this analysis was to evaluate the survival outcome following percutaneous procedures and surgery after unsuccessful TMVR interventions for different aetiologies.

Methods And Results: Of 824 consecutive patients who had been treated with the MitraClip device at our institution, between September 2009 and May 2019, 63 (7.6%) symptomatic patients with therapy failure and persistent or recurrent mitral regurgitation (MR) underwent reinterventions. An outcome analysis for primary (PMR) and secondary mitral regurgitation (SMR) and subsequent percutaneous versus surgical treatment was carried out. MitraClip reinterventions were performed in 36 patients (57.1%; n=26 SMR, n=10 PMR), while 27 (42.9%; n=13 SMR, n=14 PMR) underwent open heart surgery. Surgical patients with PMR showed lower mortality than patients with SMR (p<0.0001) and ReClip patients with PMR (p=0.073). Atrial fibrillation (HR 2.915, 95% CI: [1.311, 6.480]), prior open heart surgery (2.820 [1.215, 6.544]) and chronic obstructive pulmonary disease (2.506 [1.099, 5.714]) increased the risk of death. The level of post-interventional MR had no relevant impact on survival.

Conclusions: We conclude that, after SMR and failed TMVR, reclipping is an appropriate treatment option for symptomatic patients. For PMR patients, surgery must be favoured over a reclipping procedure. However, patients with atrial fibrillation, prior open heart surgery and chronic obstructive pulmonary disease are at risk of reduced survival after reinterventions.

Citing Articles

Repeat Mitral Transcatheter Edge-to-Edge Repair for Recurrent Significant Mitral Regurgitation.

Shechter A, Lee M, Kaewkes D, Koren O, Skaf S, Chakravarty T J Am Heart Assoc. 2023; 12(9):e028654.

PMID: 37119061 PMC: 10227228. DOI: 10.1161/JAHA.122.028654.

Mitral valve transcatheter edge-to-edge repair.

Hausleiter J, Stocker T, Adamo M, Karam N, Swaans M, Praz F EuroIntervention. 2023; 18(12):957-976.

PMID: 36688459 PMC: 9869401. DOI: 10.4244/EIJ-D-22-00725.

How to eliminate mitral regurgitation definitively: the eternal dilemma?.

Modine T, Ben-Ali W EuroIntervention. 2021; 16(17):1384-1385.

PMID: 33875406 PMC: 9707471. DOI: 10.4244/EIJV16I17A252.

References

Goldstein D, Moskowitz A, Gelijns A, Ailawadi G, Parides M, Perrault L . Two-Year Outcomes of Surgical Treatment of Severe Ischemic Mitral Regurgitation. N Engl J Med. 2015; 374(4):344-53. PMC: 4908819. DOI: 10.1056/NEJMoa1512913. View

Kreidel F, Frerker C, Schluter M, Alessandrini H, Thielsen T, Geidel S . Repeat MitraClip Therapy for Significant Recurrent Mitral Regurgitation in High Surgical Risk Patients: Impact of Loss of Leaflet Insertion. JACC Cardiovasc Interv. 2015; 8(11):1480-1489. DOI: 10.1016/j.jcin.2015.06.019. View

Geidel S, Wohlmuth P, Schmoeckel M . Survival Prediction in Patients Undergoing Open-Heart Mitral Valve Operation After Previous Failed MitraClip Procedures. Ann Thorac Surg. 2015; 101(3):952-8. DOI: 10.1016/j.athoracsur.2015.08.086. View

Stone G, Lindenfeld J, Abraham W, Kar S, Lim D, Mishell J . Transcatheter Mitral-Valve Repair in Patients with Heart Failure. N Engl J Med. 2018; 379(24):2307-2318. DOI: 10.1056/NEJMoa1806640. View

Alfieri O, Maisano F, De Bonis M, Stefano P, Torracca L, Oppizzi M . The double-orifice technique in mitral valve repair: a simple solution for complex problems. J Thorac Cardiovasc Surg. 2001; 122(4):674-81. DOI: 10.1067/mtc.2001.117277. View

Rudski L, Lai W, Afilalo J, Hua L, Handschumacher M, Chandrasekaran K . Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology,.... J Am Soc Echocardiogr. 2010; 23(7):685-713. DOI: 10.1016/j.echo.2010.05.010. View

Alozie A, Westphal B, Kische S, Kaminski A, Paranskaya L, Bozdag-Turan I . Surgical revision after percutaneous mitral valve repair by edge-to-edge device: when the strategy fails in the highest risk surgical population. Eur J Cardiothorac Surg. 2013; 46(1):55-60. DOI: 10.1093/ejcts/ezt535. View

Feldman T, Kar S, Rinaldi M, Fail P, Hermiller J, Smalling R . Percutaneous mitral repair with the MitraClip system: safety and midterm durability in the initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) cohort. J Am Coll Cardiol. 2009; 54(8):686-94. DOI: 10.1016/j.jacc.2009.03.077. View

Foster E, Wasserman H, Gray W, Homma S, Di Tullio M, Rodriguez L . Quantitative assessment of severity of mitral regurgitation by serial echocardiography in a multicenter clinical trial of percutaneous mitral valve repair. Am J Cardiol. 2007; 100(10):1577-83. DOI: 10.1016/j.amjcard.2007.06.066. View

10.

Stone G, Adams D, Abraham W, Kappetein A, Genereux P, Vranckx P . Clinical Trial Design Principles and Endpoint Definitions for Transcatheter Mitral Valve Repair and Replacement: Part 2: Endpoint Definitions: A Consensus Document From the Mitral Valve Academic Research Consortium. J Am Coll Cardiol. 2015; 66(3):308-321. DOI: 10.1016/j.jacc.2015.05.049. View

11.

Baumgartner H, Falk V, Bax J, De Bonis M, Hamm C, Holm P . 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017; 38(36):2739-2791. DOI: 10.1093/eurheartj/ehx391. View

12.

Vahanian A, Alfieri O, Andreotti F, Antunes M, Baron-Esquivias G, Baumgartner H . Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg. 2012; 42(4):S1-44. DOI: 10.1093/ejcts/ezs455. View

13.

Neuss M, Schau T, Isotani A, Pilz M, Schopp M, Butter C . Elevated Mitral Valve Pressure Gradient After MitraClip Implantation Deteriorates Long-Term Outcome in Patients With Severe Mitral Regurgitation and Severe Heart Failure. JACC Cardiovasc Interv. 2017; 10(9):931-939. DOI: 10.1016/j.jcin.2016.12.280. View

14.

Paranskaya L, DAncona G, Bozdag-Turan I, Akin I, Kische S, Turan G . Early and mid-term outcomes of percutaneous mitral valve repair with the MitraClip®: comparative analysis of different EuroSCORE strata. EuroIntervention. 2012; 8(5):571-8. DOI: 10.4244/EIJV8I5A88. View

15.

Lang R, Badano L, Mor-Avi V, Afilalo J, Armstrong A, Ernande L . Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015; 16(3):233-70. DOI: 10.1093/ehjci/jev014. View

16.

Kreidel F, Alessandrini H, Wohlmuth P, Schmoeckel M, Geidel S . Is Surgical or Catheter-based Interventions an Option After an Unsuccessful Mitral Clip?. Semin Thorac Cardiovasc Surg. 2018; 30(2):152-157. DOI: 10.1053/j.semtcvs.2018.03.005. View

17.

Puls M, Tichelbacker T, Bleckmann A, Hunlich M, von der Ehe K, Beuthner B . Failure of acute procedural success predicts adverse outcome after percutaneous edge-to-edge mitral valve repair with MitraClip. EuroIntervention. 2014; 9(12):1407-17. DOI: 10.4244/EIJV9I12A238. View

18.

Puls M, Lubos E, Boekstegers P, von Bardeleben R, Ouarrak T, Butter C . One-year outcomes and predictors of mortality after MitraClip therapy in contemporary clinical practice: results from the German transcatheter mitral valve interventions registry. Eur Heart J. 2015; 37(8):703-12. PMC: 4761401. DOI: 10.1093/eurheartj/ehv627. View

19.

Herrmann H, Gertz Z, Silvestry F, Wiegers S, Woo Y, Hermiller J . Effects of atrial fibrillation on treatment of mitral regurgitation in the EVEREST II (Endovascular Valve Edge-to-Edge Repair Study) randomized trial. J Am Coll Cardiol. 2012; 59(14):1312-9. DOI: 10.1016/j.jacc.2011.12.023. View

20.

Argenziano M, Skipper E, Heimansohn D, Letsou G, Woo Y, Kron I . Surgical revision after percutaneous mitral repair with the MitraClip device. Ann Thorac Surg. 2010; 89(1):72-80. DOI: 10.1016/j.athoracsur.2009.08.063. View