Conventional Mitral Valve Surgery in MitraClip Candidates

Objectives: The aim of this study was to evaluate the surgical outcome in patients with mitral regurgitation (MR), who were assigned for percutaneous mitral valve repair (PMVR), but were declined for PMVR by the heart team and afterwards scheduled for conventional mitral valve (MV) surgery. The clinical outcome for this group has not been well described. Methods: The reasons for declination of PMVR, perioperative and operative data, 30-day mortality and 1-year survival after conventional MV surgery were retrospectively analyzed. Results: Between August 2009 to August 2013, 118 patients were assigned for PMVR. 29 patients (mean age 77 ± 8 years; 62% male) with high surgical risk (logistic EuroSCORE 17.3 ± 10.8%) were declined for PMVR by the heart team due to contraindication according EVEREST-criteria (n = 13; 42%), relevant tricuspid regurgitation (n = 13; 42%), possibility for conventional MV repair (MVR) (n = 6; 19%), relevant coronary artery disease in 2 patients (6%) or no indication for MV intervention in 1 patient (3%). Two (6%) patients had an indication for left ventricular assist device (LVAD) implantation. Isolated minimally invasive MVR were successfully performed in 6 patients (21%), MVR with tricuspid valve repair (TVR) in 5 patients (17%), isolated MV replacement in 6 patients (21%), MV replacement with TVR in 7 patients (24%) and isolated coronary artery bypass grafting in 1 patient (3%). LVAD implantation was performed in 2 patients (7%). The 30-day mortality was 0%, and the estimated overall 1-year survival was 77.8%. The observed mortality was significantly lower than predicted by EuroSCORE. Conclusion: Conventional MV surgery in MitraClip candidates can be performed without 30-day mortality and promising 1-year survival in experienced centers. The conventional MV surgery could be considered in MitraClip candidates with surgical relevant co-morbidities and contraindication according EVEREST-criteria. Furthermore, the data underline the importance of interdisciplinary heart team decision for each MitraClip candidate.