Transcatheter Mitral Valve Repair in Cardiogenic Shock and Mitral Regurgitation: A Patient-Level, Multicenter Analysis
Richard G Jung, Trevor Simard, Christopher Kovach, Kelsey Flint, Creighton Don, Pietro Di Santo, Marianna Adamo, Luca Branca, Francesca Valentini, Tomás Benito-González, Felipe Fernández-Vázquez, Rodrigo Estévez-Loureiro, Alessandra Berardini, Nicolina Conti, Claudio Rapezzi, Elena Biagini, Simon Parlow, Risa Shorr, Amos Levi, Ana Manovel, Rosa Cardenal-Piris, Jose Diaz Fernandez, Mony Shuvy, Dan Haberman, Alessandra Sala, Mohamad A Alkhouli, Claudia Marini, Marta Bargagna, Davide Schiavi, Paolo Denti, Sinisa Markovic, Nicola Buzzatti, Vincent Chan, Mark Hynes, Thierry Mesana, Marino Labinaz, Federico Pappalardo, Maurizio Taramasso, Benjamin Hibbert, Richard G Jung, Trevor Simard, Christopher Kovach, Kelsey Flint, Creighton Don, Pietro Di Santo, Marianna Adamo, Luca Branca, Francesca Valentini, Tomás Benito-González, Felipe Fernández-Vázquez, Rodrigo Estévez-Loureiro, Alessandra Berardini, Nicolina Conti, Claudio Rapezzi, Elena Biagini, Simon Parlow, Risa Shorr, Amos Levi, Ana Manovel, Rosa Cardenal-Piris, Jose Diaz Fernandez, Mony Shuvy, Dan Haberman, Alessandra Sala, Mohamad A Alkhouli, Claudia Marini, Marta Bargagna, Davide Schiavi, Paolo Denti, Sinisa Markovic, Nicola Buzzatti, Vincent Chan, Mark Hynes, Thierry Mesana, Marino Labinaz, Federico Pappalardo, Maurizio Taramasso, Benjamin Hibbert
Abstract
Objectives: The aim of this study was to evaluate the outcome of transcatheter mitral valve repair (TMVr) in patients with cardiogenic shock and significant mitral regurgitation (MR).
Background: Patients in cardiogenic shock with severe MR have a poor prognosis in the setting of conventional medical therapy. Because of its favorable safety profile, TMVr is being increasingly used as an acute therapy in this population, though its efficacy remains unknown.
Methods: A multicenter, collaborative, patient-level analysis was conducted. Patients with cardiogenic shock and moderate to severe (3+) or severe (4+) MR who were not surgical candidates were treated with TMVr. The primary outcome was in-hospital mortality. Secondary outcomes included 90-day mortality, heart failure (HF) hospitalization, and the combined event rate of 90-day mortality and HF hospitalization following dichotomization by TMVr device success.
Results: Between January 2011 and February 2019, 141 patients across 14 institutions met the inclusion criteria. In-hospital mortality occurred in 22 patients (15.6%), at 90 days in 38 patients (29.5%), and at one year in 55 patients (42.6%). Median length of hospital stay following TMVr was 10 days (interquartile range: 6 to 20 days). HF hospitalization occurred in 26 patients (18.4%) at a median of 73 days (interquartile range: 26 to 546 days). When stratified by TMVr procedural results, successful TMVr reduced rates of in-hospital mortality (hazard ratio [HR]: 0.36; 95% confidence interval [CI]: 0.13 to 0.98; p = 0.04), 90-day mortality (HR: 0.36; 95% CI: 0.16 to 0.78; p = 0.01), and the composite of 90-day mortality and HF hospitalization (HR: 0.41; 95% CI: 0.19 to 0.90; p = 0.03).
Conclusions: TMVr may improve short- and intermediate-term mortality in high-risk patients with cardiogenic shock and moderate to severe MR. Randomized studies are needed to definitively establish MR as a therapeutic target in patients with cardiogenic shock.
Keywords: cardiogenic shock; mitral regurgitation; transcatheter mitral valve repair.
Conflict of interest statement
Author Disclosures Dr. Jung was funded by the Vanier CIHR Canada Graduate Scholarship. Dr. Benito-Gonzalez has received grants from Abbott Vascular, outside the summitted work. Dr. Estevez-Loureiro is a consultant for Abbott Vascular; and is a proctor for the MitraClip, outside the submitted work. Dr. Buzzatti has received personal fees from InnovHeart, outside the submitted work. Dr. Hibbert has received funding as a clinical trial investigator from Abbott, Boston Scientific, and Edwards Lifesciences, outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.
Source: PubMed