gms | German Medical Science

Background: MitraClip is propagated for those high risk patients with mitral insufficiency, considered not qualifying for surgical repair. However, it is a palliative option only. A proportion of patients require consecutive surgical measures because of technical failure or inappropriate clinical improvement. Furthermore, surgical reconstruction of the valve is impossible in almost all patients after MitraClip implantation. Consequently, these patients end up with a mere replacement although repair may have been possible in the first place. We thus looked at the outcome of those patients compared with patients receiving primary mitral valve replacement (MVR) or mitral valve repair (MVP).

Methods: 23 patients were retrospectively analyzed after MVR following MitraClip between 2010 and 2016. 46 patients with corresponding demographic data and risk profile from the same period receiving primary MVR (23 patients) or MVP (23 patients) were retrieved for a matched pair analysis. Statistical analysis including Kaplan-Meyer survival was performed.

Results: Mean age was 70 ±13.1 years in all groups, log. EuroSCORE was 23% ±17.3 in all groups. Preoperative LV-EF was 44% in MC, 48% in MVR, and 44% in MVP. Postop LV-EF was 48% in all groups. 30 day mortality was 21.7% in the MitraClip group whereas it was 4.3% in the MVR and 13.0% in the MVP group. 1-year survival was 56.5% in the MitraClip group while it was 95.6% in the MVR group and 82.6% in the MVP group (Wilcoxon Test all groups: p=0.007; Chi² Test: p=0.001 MitraClip vs. MVR; p=0.054 MitraClip vs. MVP).

Conclusions: Patients who required surgical MVR after previous MitraClip fared worse than matched cohorts receiving primary MVR or MVP. Indication for MitraClip should therefore be made very cautiously in view of the excellent results gained with primary conventional surgery.