• Emily Downs, Scott Lim, Michael Ragosta, Kenan Yount, Leora Yarboro, Ravi Ghanta, John Kern, Irving Kron, and Gorav Ailawadi.
• Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
• J. Thorac. Cardiovasc. Surg. 2015 Nov 1; 150 (5): 1093-7.

ObjectivesPercutaneous mitral repair with the MitraClip system (Abbott Vascular, Santa Clara, Calif) has been available in trials since 2006 and is currently approved for patients with degenerative mitral valve disease at prohibitive risk for surgery. There has been concern that novel transcatheter approaches may detract from mitral valve surgical volumes. We sought to evaluate the influence of our MitraClip program on our surgical mitral valve volumes and outcomes.MethodsAll patients referred for MitraClip underwent evaluation by a multidisciplinary team. Patients were screened for surgical candidacy and suitable valve anatomy for transcatheter repair. The fate of patients referred for MitraClip as well as the overall surgical mitral volumes and outcomes were evaluated.ResultsFrom July 2007 to December 2014, 468 patients were referred for the MitraClip procedure at our institution. Of these, 156 patients (33.3%) received a MitraClip (including 45 implanted by surgeons), whereas 82 patients (17.5%) underwent surgical interventions. During this timeframe, the volume of isolated mitral valve operations increased from 50 procedures in 2007 to 93 in 2014 (80% increase; R(2) = 0.89). Importantly, operative mortality for all patients undergoing isolated mitral surgery from 2008 to 2014 was 2.6%, with an observed to expected ratio of 0.64.ConclusionsThe availability of MitraClip resulted in an increase in our mitral valve referrals. Despite seeing an increase in higher risk referrals, operative mortality for mitral surgery remained excellent. Multidisciplinary evaluation, including input from experienced mitral surgeons, is necessary to have a successful percutaneous and surgical mitral valve program.Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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