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Surgical revision after percutaneous mitral valve repair by edge-to-edge device: when the strategy fails in the highest risk surgical population

Selected in European of Cardio-Thoracic Surgery by Rylski

References

Authors

Alozie A, Westphal B, Kische S, Kaminski A, Paranskaya L, Bozdag-Turan I, Ortak J, Schubert J, Steinhoff G, Ince H.

Reference

Eur J Cardiothorac Surg. 2014;46:55-60

Published

July 2014

Link

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My Comment

Background

Percutaneous mitral valve (MV) repair using the edge-to-edge technique is currently applied in high-risk patients deemed not suitable for conventional surgery. The authors describe results of surgery in patients who underwent percutaneous MV repair followed by severe technique related complications requiring open surgical mitral valve repair.

Results

  • Thirteen patients underwent surgery after failed percutaneous MV repair
  • The average number of implanted clips was 2.0 (range 1-4)
  • All underwent successful surgical MV replacement
  • In-hospital mortality was 8% (1 of 13 patients died on second postoperative day due to sepsis)
  • The remaining 12 patients were discharged with excellent valve prosthesis function

My comments

The authors present excellent results following MV replacement in highest risk patients after failed edge-to-edge interventional MV repair. Only one patient did not survive the surgery, all others were discharged with well functioning MV prosthesis. The home take message is that even in patients classified as high-risk patients in a heart team approach, conventional MV replacement may be performed safely with very good results. Patients selection criteria for MV interventional vs. surgical repair seems to require further analysis, as they may help in achieving a better outcome in the overall MV repair population.

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