Universität zu Köln

Gerfer, Stephen ORCID: 0000-0002-6568-6766, Ivanov, Borko, Grossmann, Clara, Djordjevic, Ilija ORCID: 0000-0002-5810-8626, Gaisendrees, Christopher ORCID: 0000-0002-7232-3330, Eghbalzadeh, Kaveh, Kuhn, Elmar, Kuhn-Regnier, Ferdinand, Mader, Navid, Rahmanian, Parwis and Wahlers, Thorsten (2022). Mitral valve surgery after failed MitraClip-Operation for the inoperable? J. Card. Surg., 37 (12). S. 4219 - 4225. LONDON: WILEY-HINDAWI. ISSN 1540-8191

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Abstract

Background Percutaneous edge-to-edge mitral valve repair technique (MitraClip) is a widely used treatment for mitral regurgitation (MR) in patients assessed with high surgical risk or inoperability. Only limited experiences with this highest-risk patient population exist. Procedural failure for MitraClip or recurrent MR is a strong predictor of 1-year mortality. Open mitral valve surgery constitutes the last bailout for patients within this cohort. Methods This retrospective single-center cohort study analyzed 17 mitral valve surgery patients after failed MitraClip. We, therefore, analyzed a high-risk patient population (EuroSCORE II = 10 +/- 2.0) with persistent mitral valve regurgitation, which was mainly caused by detachment or dislocation of the MitraClip. Results Symptomatic patients with failed MitraClip need a convenient operation (mean time to mitral valve surgery = 23 +/- 44 days). The patient's collective showed many complex reoperations with the need for concomitant surgery. Considering the high-risk patient population, we showed an average 30-day all-cause mortality (18%, n = 3) accompanied by typical postoperative complications related to prolonged mechanical ventilation (44 +/- 48 h) and ICU stay (11 +/- 11 days), reflecting high-risk patients. Further, excellent valve-related outcomes were shown regarding adverse cardiac events (valve-related mortality 6%, n = 1) and postoperative echocardiographic results (moderate or severe paravalvular leak 6%, n = 1). Conclusion Failure of MitraClip represents a challenging situation limited by high-risk profiles of patients and limits the possibility of surgical valve repair, shown by a high rate of mitral valve replacement (94%, n = 16). Secondary surgery was associated with moderate 30-day and postdischarge outcomes. Therefore, a careful evaluation of patients undergoing MitraClip is of paramount importance.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Gerfer, Stephen UNSPECIFIED orcid.org/0000-0002-6568-6766 UNSPECIFIED Ivanov, Borko UNSPECIFIED UNSPECIFIED UNSPECIFIED Grossmann, Clara UNSPECIFIED UNSPECIFIED UNSPECIFIED Djordjevic, Ilija UNSPECIFIED orcid.org/0000-0002-5810-8626 UNSPECIFIED Gaisendrees, Christopher UNSPECIFIED orcid.org/0000-0002-7232-3330 UNSPECIFIED Eghbalzadeh, Kaveh UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuhn, Elmar UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuhn-Regnier, Ferdinand UNSPECIFIED UNSPECIFIED UNSPECIFIED Mader, Navid UNSPECIFIED UNSPECIFIED UNSPECIFIED Rahmanian, Parwis UNSPECIFIED UNSPECIFIED UNSPECIFIED Wahlers, Thorsten UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-658029
DOI:	10.1111/jocs.16762
Journal or Publication Title:	J. Card. Surg.
Volume:	37
Number:	12
Page Range:	S. 4219 - 4225
Date:	2022
Publisher:	WILEY-HINDAWI
Place of Publication:	LONDON
ISSN:	1540-8191
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PERCUTANEOUS REPAIR; SURGICAL REVISION; RISK; REGURGITATION; SURVIVAL; THERAPY Multiple languages Cardiac & Cardiovascular Systems; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/65802