Mitral valve replacement after MitraClip therapy.

BACKGROUND: MitraClip therapy (MCT) is becoming more popular to treat mitral regurgitation (MR) in high-risk patients. It is, however, expanding to lower risk patients with the idea that mitral valve (MV) repair can be performed if surgery will be necessary. We report our surgical experience in patients who underwent MCT and subsequently required MV surgery. METHODS: From February 2012 to September 2014, three patients out of 34 who underwent MCT (8.8%) needed surgery because of lesions resulting in new MR. Two of them had functional and the third one degenerative MR. Two patients with functional MR underwent emergency surgery for MV lesions adding a new severe MR, the third one, with degenerative MR, had surgery 377 days after MCT. RESULTS: The MV showed a perforation of the anterior leaflet in one case and P2 completely torn in the second case. MitraClip opening was difficult and caused further injury to the leaflets. The third case developed a severe MV stenosis. All three patients underwent MV replacement with a tissue valve. The postoperative course was uneventful and, after a mean of 14 months, all patients are alive and in NYHA class I or II. CONCLUSIONS: The risk of urgent or elective surgery after MCT reduces the possibility of conservative surgery, as the possibility of valve reconstruction is less likely following the severe clip implantation-induced tissue damages.