Repeat Mitral Transcatheter Edge‐to‐Edge Repair for Recurrent Significant Mitral Regurgitation

BACKGROUND: There are limited data on repeat mitral transcatheter edge‐to‐edge repair for recurrent significant mitral regurgitation (MR). METHODS AND RESULTS: We conducted a single‐center, retrospective analysis of consecutive patients referred to a second mitral transcatheter edge‐to‐edge repair after a technically successful first procedure. Clinical, laboratory, and echocardiographic measures were assessed up to 1 year after the intervention. The composite of all‐cause death or heart failure (HF) hospitalizations constituted the primary outcome. A total of 52 patients (median age, 81 [interquartile range, 76–87] years, 29 [55.8%] men, 26 [50.0%] with functional MR) met the inclusion criteria. MR recurrences were mostly related to progression of the underlying cardiac pathology. All procedures were technically successful. At 1 year, most patients with available records (n=24; 96.0%) experienced improvement in MR severity or New York Heart Association functional class that was statistically significant but numerically modest. Fourteen (26.9%) patients died or were hospitalized due to HF. These were higher‐risk cases with predominantly functional MR who mostly underwent an urgent procedure and exhibited more severe HF indices before the intervention, as well as an attenuated 1‐month clinical and echocardiographic response. Overall, 1‐year course was comparable to that experienced by patients who underwent only a first transcatheter edge‐to‐edge repair at our institution (n=902). Tricuspid regurgitation of greater than moderate grade was the only baseline parameter to independently predict the primary outcome. CONCLUSIONS: Repeat mitral transcatheter edge‐to‐edge repair is feasible, safe, and clinically effective, especially in non‐functional MR patients without concomitant significant tricuspid regurgitation.