Background:
For high-risk surgical patients, the percutaneous mitral valve repair with use of the MitraClip^® (Abbott Vascular, Redwood City, Calif) is an alternative approach. This procedure involves the transcatheter placement of one or more MitraClip devices under echocardiographic and fluoroscopic guidance, with the purpose of restoring leaflet coaptation in functional or structural degenerative valvular disease.^1,2 The current gold standard for the treatment of mitral valve regurgitation (MR) is surgery especially after the first attempt of MitraClip.³ As MitraClip usage increases, so does the frequency of clip failure and  the deterioration of MR and the consequent need for Re- Clipping or surgical treatment.However Mitral valve repair after MitraClip therapy can be complex and a surgical challenge. Sometimes due to fused Leaflet with the MitraClip, is the Mitral valve repair impossible.

Aim:
The aim of the current study is to evaluate the 30 day primary results and procedure related safety of Re-Clip in patients with recurrent  severe symptomatic mitral regurgitation due to progress of the regurgitation after successful Mitralclip implantation.

Methods:
We retrospectively studied 228 patients registered in Regiomed Klinikum Coburg who undergone Mitralclip implantation in the period from April 2016 till 05 2019. Five male patients (mean age, 76.2 years old, (Rang 70-85); underwent re-clip. Baseline data, and procedural outcome and complications were assessed to identify the results and safety.

Results: All patients were symptomatic, NYHA III with severe MR with previous mitraClip implantation. Four  patients were discussed in heart team and considered inoperable or high risk patient for mitral operation. One Patient has refused the Operation.

Three patients had primary MI and two patients secondary MR. Three Patients hat ejection fraction ≥ 50%, whereas two patients hat EF between 30 and 50%.

All patients hat received mitralclip implantation successfully with improvements of MI to MI ≤ II with a mean gradient of < 5 mmHg. The 30 day mortality was zero. No procedure related complication (clip embolisation or detachment, pericardial effusion is documented. One patient developed a respiratory failure due to heart failure and is managed with intubation and mechanical ventilation.     

Conclusion:

Reclip is a safe procedure with very good primary results for patients with recurrent severe mitral regurgitation after MitraClip

References

1. Rogers JH et al. Late surgical mitral valve repair after percutaneous repair with the MitraClip system. J Card Surg. 2009;24(6):677–81.

2. Kar S. Experience with the MitraClip therapy in the EVEREST II high risk registry. EuroPCR, Barcelona, 2009 May 2. Available from: http://www.pcronline.com/Lectures/2009/Experience-with-the-MitraClip-therapy-in-the-EVEREST-II-high-risk-registry [cited 2014 Oct 17]

3. Conradi L et al. Impact of MitraClip therapy on secondary mitral valve surgery in patients at high surgical risk. Eur J Cardiothorac Surg. 2011;40(6):1521–6.

4. Geidel S et al. Complex surgical valve repair after failed percutaneous mitral intervention using the MitraClip device. Ann Thorac Surg. 2010;90(1):277–9.

5. Mauri L et al. 4-year results of a randomized controlled trial of percutaneous repair versus surgery for mitral regurgitation. J Am CollCardiol. 2013;62(4):317–28.

6. Argenziano M et al. Surgical revision after percutaneous mitral repair with the MitraClip device. Ann Thorac Surg. 2010;89(1):72–80.