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Ann Thorac Surg 2010;89:72-80. doi:10.1016/j.athoracsur.2009.08.063
© 2010 The Society of Thoracic Surgeons
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Michael Argenziano
Eric Skipper
David Heimansohn
George V. Letsou
Irving Kron
John Alexander
Joseph Cleveland
Bobby Kong
Michael Davidson
Thomas Vassiliades
Karl Krieger
Pierre Tibi
Aubrey Galloway
Ted Feldman
Donald Glower
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Right arrow Minimally invasive surgery
Right arrow Valve disease

Original Articles: Adult Cardiac

Surgical Revision After Percutaneous Mitral Repair With the MitraClip Device

Michael Argenziano, MD*, Eric Skipper, MD, David Heimansohn, MD, George V. Letsou, MD, Y. Joseph Woo, MD, Irving Kron, MD, John Alexander, MD, Joseph Cleveland, MD, Bobby Kong, MD, Michael Davidson, MD, Thomas Vassiliades, MD, Karl Krieger, MD, Ed Sako, MD, Pierre Tibi, MD, Aubrey Galloway, MD, Elyse Foster, MD, Ted Feldman, MD, Donald Glower, MD EVEREST Investigators

Columbia University College of Physicians and Surgeons, New York, New York

Accepted for publication August 20, 2009.

* Address correspondence to Dr Argenziano, Columbia University College of Physicians and Surgeons, 177 Fort Washington Ave, Milstein Hospital, Suite 7-435, New York, NY 10032 (Email: ma66{at}columbia.edu).

Presented at the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.

Background: Percutaneous mitral repair with the MitraClip device (Evalve, Menlo Park, CA) has been reported. Preserving conventional surgical options in the event of percutaneous treatment failure is important. We describe surgical treatment at varying intervals after the MitraClip procedure in 32 patients.

Methods: One hundred seven patients with moderate-to-severe or severe mitral regurgitation who were either symptomatic (91%) or, if asymptomatic (9%), had evidence of left ventricular dysfunction were enrolled as part of the Endovascular Valve Edge-to-Edge REpair STudy (EVEREST) phase I registry study or as "roll-in" subjects in the EVEREST II study. Thirty-two of the 107 patients (30%) underwent surgery after an attempted MitraClip procedure.

Results: Of the 32 patients undergoing post-clip mitral valve surgery, 23 patients (72%) had one or more clips implanted and 9 patients (28%) received no clip implant. The indications for mitral valve surgery in the 23 patients with a clip included partial clip detachment (n = 10), residual or recurrent mitral regurgitation greater than 2+ (n = 9), and other (atrial septal defect [n = 2], device malfunction [n = 1], and incorrectly diagnosed mitral stenosis [n = 1]). Twenty-seven of 31 patients (87%) underwent the surgical procedure planned before surgery (planned procedure unknown in 1 patient). Four of 25 patients (16%) with planned repair underwent mitral valve replacement.

Conclusions: Standard surgical options were preserved in patients who had surgery after percutaneous repair with the MitraClip device. Successful repair was feasible in the majority of patients after the MitraClip procedure, with repair performed as late as 18 months after clip implantation.




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