Outcome Mitral Surgery Secondary To Teer
Johannes Petersen, Fabianne Plaßmeier, Oliver Bhadra, Daniel Kalbacher, Andreas Schäfer, Simon Pecha, Stefan Blankenberg, Niklas Schofer, Lenard Conradi.
University Heart & Vascular Center Hamburg, Hamburg, Germany.
BACKGROUND: Transcatheter edge-to-edge repair (TEER) is used increasingly for treatment of higher risk patients. The objective of this study was to report our single-center experience and to analyze outcomes of secondary mitral valve surgery after previous TEER. METHODS: This retrospective analysis included 35 patients (73% male, EuroSCORE II of 7.6±9.7, STS-Score 2.2±1.9) receiving secondary mitral valve surgery after TEER from a total of 1341 consecutive patients treated at our institution during the same time interval between 2008 and 2021. The majority of patients (57 % (20/35)) underwent delayed surgery with a median interval of 180 days (21 - 1206 days) to the index procedure while 28 % (10/35) of patients required acute surgical intervention within 7 days after TEER and 5 patients required emergent conversion to open heart surgery within 6 hours after TEER. Overall follow-up for the study cohort was 18±17 months. RESULTS: Etiology of mitral regurgitation was functional, degenerative or mixed in 45%, 33% and 21%, respectively. Left ventricular ejection fraction was 34±14%. Overall, 1.5±1.2 clips were placed and in 54% of cases (19/35) > 2 clips had been used. 88% (31/35) and 11% (4/35) underwent mitral valve replacement and repair respectively. In 81% of cases (30/35) concomitant surgical procedures were necessary: tricuspid valve repair (n=11), atrial fibrillation ablation and/or left atrial appendage occlusion (n=7), aortic valve replacement (n=7) and atrial septum repair/closure (n=5). Further, 2 patients received a concomitant left ventricular assist device implantation out of which one patient died postoperatively. Overall, 30-day mortality was 8.5%. CONCLUSIONS:Mitral valve surgery secondary to TEER is a rare event. Surgery in this high-risk surgical cohort results most likely in a mitral valve replacement, rather than a repair. Nevertheless, acute mortality is lower than predicted by risk stratification. Most importantly, a well-functioning multidisciplinary heart team is necessary for optimal therapeutic allocation.
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