Percutaneous Treatment Options for Recurrent Mitral Valve Disease after Failed Mitral Valve Surgery

Objectives: Percutaneous treatment options have been described as an alternative to redo-surgery in high-risk patients with recurrent Mitral Regurgitation (MR) after failed Mitral Valve (MV) surgery. We aim to analyze the outcome of percutaneous MV interventions in such patients. Methods: Seventeen consecutive surgical intermediate to highrisk patients with recurrent MV disease not considered suitable for redo surgery were analyzed. Percutaneous MitraClip repair (n=11), valve-in-ring (n=3) or valve-in-valve (n=3) replacement were performed. Results: Median age was 76.0 years (53.6 to 89.4 years). Median EuroSCORE II and STS mortality score were 4.5% (0.5 to 14.4%) and 4.9% (1.5 to 20.9%), respectively. Pre-operative MR grade was moderate-severe (n=4, 24%) or severe (n=13, 76%). Interventional success was obtained in all but three cases (82%). 30 day survival rate was 100%. At last follow-up (mean 270 days, range 31 to 1559 days), the overall survival rate was 76%. MR grade was none-mild in 76% and moderate in 24% of patients. Reduction of dyspnea was achieved in all but 2 patients (88%). Conclusion: Percutaneous MV treatments after failed MV surgery are feasible and associated with a lower than expected periinterventional mortality in carefully selected patients not suitable for redo MV surgery. The interventions proved effective regarding reduction in MR and symptoms as well as lowering of pulmonary pressure. Keywords: Percutaneous mitral valve interventions; Transcatheter mitral valve replacement; MitraClip; Valve-in-ring; Valve-in-valve; Redo mitral valve surger