Mitral valve replacement after failed MitraClip™ therapy: report of two cases.

We report 2 cases of patients who were successfully treated surgically for remaining or recurrent mitral regurgitation after MitraClip (Abbott Vascular, Santa Clara, CA, USA) implantation. In one patient, intervention with MitraClip was indicated because of the extremely poor heart function and poor general status of the patient. However, the severe mitral insufficiency remained after the MitraClip treatment and valve replacement was required. In the other high-risk patient, severe mitral regurgitation recurred 3 years after a successful MitraClip treatment due to infective endocarditis. Our experience suggests that some patients who are considered "high-risk" before MitraClip treatment might be reasonable candidates for a straight forward mitral valve surgery, even in the re-intervention setting. We conclude that patients considered for MitraClip implantation should undergo detailed risk stratification, because we have to keep in mind that after failed clip implantation the perioperative risk increases and the chance of mitral repair decreases.