TY - JOUR JO - EuroIntervention TI - Clinical impact of intervention strategies after failed transcatheter mitral valve repair AB - <p><strong>Aims:</strong> Failure of transcatheter mitral valve repair (fTMVR) therapy has a decisive prognostic influence, and complex retreatment is of higher risk. The aim of this analysis was to evaluate the survival outcome following percutaneous procedures and surgery after unsuccessful TMVR interventions for different aetiologies.</p> <p><strong>Methods and results:</strong> Of 824 consecutive patients who had been treated with the MitraClip device at our institution, between September 2009 and May 2019, 63 (7.6%) symptomatic patients with therapy failure and persistent or recurrent mitral regurgitation (MR) underwent reinterventions. An outcome analysis for primary (PMR) and secondary mitral regurgitation (SMR) and subsequent percutaneous versus surgical treatment was carried out. MitraClip reinterventions were performed in 36 patients (57.1%; n=26 SMR, n=10 PMR), while 27 (42.9%; n=13 SMR, n=14 PMR) underwent open heart surgery. Surgical patients with PMR showed lower mortality than patients with SMR (p&lt;0.0001) and ReClip patients with PMR (p=0.073). Atrial fibrillation (HR 2.915, 95% CI: [1.311, 6.480]), prior open heart surgery (2.820 [1.215, 6.544]) and chronic obstructive pulmonary disease (2.506 [1.099, 5.714]) increased the risk of death. The level of post-interventional MR had no relevant impact on survival.</p> <p><strong>Conclusions:</strong> We conclude that, after SMR and failed TMVR, reclipping is an appropriate treatment option for symptomatic patients. For PMR patients, surgery must be favoured over a reclipping procedure. However, patients with atrial fibrillation, prior open heart surgery and chronic obstructive pulmonary disease are at risk of reduced survival after reinterventions.</p> AU - Alessandrini Hannes AU - Dreher Ansgar AU - Harr Claudia AU - Wohlmuth Peter AU - Meincke Felix AU - Hakmi Samer AU - Ubben Timm AU - Kuck Karl-Heinz AU - Hassan Kambiz AU - Willems Stephan AU - Schmoeckel Michael AU - Geidel Stephan VL - 16 IS - 17 Y1 - 20/04/2021 Y1 - 2021 DOI - 10.4244/EIJ-D-20-01008 SP - 1447 EP - 1454 KW - mitral regurgitation KW - mitral valve disease KW - mitral valve repair KW - Prior percutaneous intervention PB - Europa Digital & Publishing SE - Interventions for valvular disease and heart failure UR - https://eurointervention.pcronline.com/article/clinical-impact-of-intervention-strategies-after-failed-transcatheter-mitral-valve-repair SN - 1774-024X ER -