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Percutaneous edge-to-edge repair may be an option for some patients with recurrent mitral regurgitation after surgical mitral valve repair, particularly in those unable to have a valve-in-ring procedure, researchers reported.

Clip placement was successful , with acute procedural success similarly likely between patients with primary and secondary mitral regurgitation (77% versus 90%, P=0.26), according to the study published online as a letter in the Journal of the American College of Cardiology.

Grade 3+ mitral regurgitation was reduced from 100% to 18% in the average follow-up of 15.9 months after percutaneous repair (P<0.001). What's more, improvements in functional capacity led the proportion of patients in New York Heart Association class III or higher to drop from 87% to 34% (P<0.001), Daniel Braun, MD, of University Hospital of Munich in Germany, and colleagues found.

They observed no in-hospital cardiac or cardiovascular events.

"This study demonstrates the feasibility and safety of the edge-to-edge repair technique in selected high-risk patients with recurrent mitral regurgitation after [surgical repair] with a procedural success rate slightly lower compared with previously reported real-world data with more favorable valve morphologies," Braun's group concluded.

One issue was that many patients had a surgical annuloplasty ring that could interfere with edge-to-edge repair (79%), the team noted. "Consequently, this may explain the procedural success rate of 84%. However, the presence of an annuloplasty ring may help to overcome the limitations of edge-to-edge repair by addressing and preventing subsequent annular dilation."

The study data came from a registry of 57 patients treated at 11 centers during 2010 to 2016. Participants had a mean age of 76 and a Society of Thoracic Surgeons score of 6. Percutaneous repair was performed mostly for recurrent secondary mitral regurgitation (52%), followed by primary mitral regurgitation (39%), and mixed etiology (9%).

Investigators noted the numerically better success rate for secondary mitral regurgitation and suggested that such an advantage "is conceivable because surgical mitral valve repair for secondary mitral regurgitation is focused on the reduction of ring dilation, whereas the focus for primary mitral regurgitation is repair of leaflet and chordal dysfunction, which may impair leaflet motion and subsequently proper grasping in edge-to-edge repair."

Three patients with failed clipping procedures had to have surgical valve replacement, and another patient had a transapical valve-in-ring procedure after failed clipping.

Caveats to the study, the team noted, are its retrospective nature and the loss of 17.5% of patients to follow-up.

Even so, Braun and colleagues said that "based on the described promising results, edge-to-edge repair may be considered as an alternative treatment option in selected patients at high risk for cardiac surgery, especially if valve-in-ring procedures are not an option."

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