‘CLAS’ score: an objective tool to standardize and predict mitral valve repairability

  • Amber Malhotra
  • Sumbul SiddiquiEmail author
  • Vivek Wadhawa
  • Himani Pandya
  • Kartik Patel
  • Komal Shah
  • Hemang Gandhi
  • Pankaj Garg
  • Sudhir Adalti
  • Kamal Sharma
Original Article



Carpentier’s classification has been used to classify both stenotic and regurgitant lesions. However, given the extreme variability of lesions, a universal nomenclature suggestive of the complexity and the prognosis of the repair procedure for the entire spectrum of the mitral valve disease still remains elusive. We present the predictors of mitral valve repairability with the help of a four-level-based ‘CLAS’ scoring system.


A total of 394 patients undergoing mitral valve procedure were prospectively studied. The valvular apparatus was divided into four sub-units, namely Commissures (C), Leaflet (L), Annulus (A), and Subvalvular apparatus (S), and the components were scored individually and the summation scores were calculated. Based on our results, three CLAS groups were formulated.


A total of 376 (n = 394) patients underwent successful MVRep (95.43%; on-table failure in 18 patients). A total of 276 were rheumatic, 51 degenerative, 28 congenital, and 16 had infective endocarditis. Thirty-day mortality was 14 (3.72%) while delayed re-intervention rate was 8 (2.12%). The mean follow-up period was 30 months. One hundred percent patients with a CLAS score ≤ 8 had a successful repair as compared to 93.33 and 69.69%, respectively, for patients with scores between 9 and 12 and > 12, respectively. The cardio pulmonary bypass time, aortic-cross-clamp time, and ICU stay also showed a significant correlation with the patient’s ‘CLAS’ groups.


The CLAS score is highly predictive of a successful repair. We thus propose that, in the patients with a score of ≤ 8, repair should always be attempted irrespective of the pathology. The patients expected to be scored > 8 should be referred to a repair reference center.


Mitral valve repair Rheumatic heart disease Mitral regurgitation 


Compliance with ethical standards

The research protocol was approved by the Institutional Review Board and Ethics Committee. A written informed consent for participation was obtained, follow-up data was collected as a part of the valvular repair registry of the institute and was 96% complete.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Study does not involve the use of any animal.

And in case of patients, all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent has been taken from patients and none have been forced to be a part of study.


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Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2018

Authors and Affiliations

  • Amber Malhotra
    • 1
  • Sumbul Siddiqui
    • 1
    Email author
  • Vivek Wadhawa
    • 1
  • Himani Pandya
    • 2
  • Kartik Patel
    • 1
  • Komal Shah
    • 2
  • Hemang Gandhi
    • 3
  • Pankaj Garg
    • 1
  • Sudhir Adalti
    • 1
  • Kamal Sharma
    • 4
  1. 1.Department of Cardio Vascular and Thoracic SurgeryU. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad)AhmedabadIndia
  2. 2.Department of ResearchU. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad)AhmedabadIndia
  3. 3.Department of Cardiac AnesthesiaU. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad)AhmedabadIndia
  4. 4.Department of CardiologyU. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad)AhmedabadIndia

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