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Page 6 of 13 Echarte-Morales et al. Vessel Plus 2021;5:54 https://dx.doi.org/10.20517/2574-1209.2020.105

Table 3. Case series of percutaneous mitral valve repair with MitraClip after failing mitral valve repair
Acute procedural
Number of Age STS score Etiology of native MR Main mechanism of
Case series success (MR ≤ 2+)
patients (years) (%) PMR/SMR (%) recurrence (%)
Grasso et al. [30] 6 74.8 6.2 0 100 Leaflet tethering 100
(Carpentier IIIB)
Estévez et al. [31] 6 69.8 ** 33.3 66.7 Leaflet tethering 100
(Carpentier IIIB)
Pleger et al. [27] 7 78 7.5 0 100 Leaflet tethering 100
(Carpentier IIIB)
[28]
Niikura et al. 12 70 6.5 91.7 8.3 Recurrent leaflet prolapse 66.7
or flail (Carpentier II)
[29]
Braun et al. 57 76 6 39 52 Recurrent leaflet prolapse 84
or flail (Carpentier II)
Leaflet tethering
(Carpentier IIIB)
**Not available. STS: Society Thoracic of Surgeons; PMR: primary mitral regurgitation; FMR: secondary mitral regurgitation; MR: mitral
regurgitation.

Figure 1. Percutaneous mitral valve repair after surgical mitral valve annuloplasty. (A, B) Transesophageal echocardiogram (TEE)
showing severe mitral regurgitation after surgical mitral valve repair. (C-F) TEE showing a significative reduction of mitral regurgitation
after MitraClip deployment.

some patients, MVr is carried out by reconstruction of the MV leaflets or subvalvular apparatus with or
without concomitant annuloplasty. Among them, resection of some tissue from one or both MV leaflets is
relatively common, sometimes preventing conventional MitraClip grasping. Although this unfavorable
anatomy should prompt alternative therapies, clipping the leaflet to ring has previously been described as a
bailout approach for patients with no alternatives . Finally, the dehiscence or rupture of the annuloplasty
[34]
ring may imply a particularly challenging anatomy for PMVR, although successful procedures in this
scenario have been reported .
[35]