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Meta-Analysis
. 2021 Apr 8;32(3):380-385.
doi: 10.1093/icvts/ivaa270.

Mitral valve surgery after a failed MitraClip procedure

Francesco Melillo  1 , Luca Baldetti  1 , Alessandro Beneduce  1 , Eustachio Agricola  1   2 , Alberto Margonato  1   2 , Cosmo Godino  1
Affiliations
Meta-Analysis

Mitral valve surgery after a failed MitraClip procedure

Francesco Melillo et al. Interact Cardiovasc Thorac Surg. .

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.

Keywords: Failure; Mitral regurgitation; Percutaneous edge-to-edge; Surgery; Transcatheter mitral valve repair.

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Figures

Figure 1:
Figure 1:
CONSORT diagram of included studies.
None
See this image and copyright information in PMC

References

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