Transcatheter Mitral Valve Repair of Recurrent Mitral Regurgitation Following Mitral Surgery

Background
Recurrent mitral regurgitation (MR) following surgical repair portends a poor prognosis with limited options besides chordal-sparing valve replacement. The aim of this study is to examine the feasibility of transcatheter mitral repair in patients with recurrent MR following surgical repair.

Methods
Twelve patients (mean age, 70±13 years; six men) with recurrent MR after mitral surgery underwent an attempt at transcatheter mitral repair with MitraClip. We examined the procedural, in-hospital, 30-day, and 1-year outcomes.

Results
Device implantation was successful in eight of the 12 patients, each of whom received a single clip. The most common location of clip implantation was either in the A2/P2 segment of the residual leaflets (5 patients) or from the A2 segment to the posterior annuloplasty ring (3 patients). The most common reason for no permanent implantation was iatrogenic mitral stenosis (3 patients). Among those with device implantation, the MR grade decreased on average from +4 to +2 (p<0.001), and symptom improvement occurred in 6 patients (NYHA class I or II; p=0.002 vs. baseline). Overall, four patients subsequently underwent surgical mitral valve replacement during a median follow-up period of 15 months (IQR, 4 to 27 months). There were no incidences of single leaflet device attachment or embolization. No procedural mortality or major adverse event occurred with MitraClip therapy or in those who later required cardiac surgery.

Conclusions
For patients with recurrent MR after mitral surgery, transcatheter mitral repair with MitraClip was effective in 50%, with the major reason for failure being worsening of mitral stenosis. While this success rate was modest, these results do suggest that a strategy of transcatheter repair for recurrent MR after surgical repair may help to avoid the need for subsequent valve replacement.