Survival Following Edge‐to‐Edge Transcatheter Mitral Valve Repair in Patients With Cardiogenic Shock: A Nationwide Analysis

Abstract

Background Edge‐to‐edge transcatheter mitral valve repair as salvage therapy in high surgical risk patients with severe mitral regurgitation presenting with cardiogenic shock (CS) has been described in small case series, but large clinical results have not been reported. This study aimed to evaluate outcomes of transcatheter mitral valve repair with MitraClip in patients with mitral regurgitation and CS using a large national database. Methods and Results From January 2014 to March 2019, we identified hospitalizations for CS in patients with mitral valve disease using data from Centers for Medicare and Medicaid Services. Those with a prior surgical or percutaneous mitral valve intervention were excluded. We compared survival between patients who underwent MitraClip during the index hospitalization and those who did not using propensity‐matched analysis. The analysis included 38 166 patients (mean age, 71±11 years, 41.6% women) of whom 622 (1.6%) underwent MitraClip. MitraClip was increasingly used during CS hospitalizations over the study period ( P <0.001). After matching, patients receiving MitraClip had significantly lower in‐hospital mortality (odds ratio, 0.6; 95% CI, 0.47–0.77; P <0.001) and 1‐year mortality (hazard ratio, 0.76; 95% CI, 0.65–0.88; P <0.001) compared with those without MitraClip. The survival benefit associated with MitraClip was consistent across subgroups of interest, with the exception of patients requiring acute mechanical circulatory support or hemodialysis at index. Conclusions In patients with mitral regurgitation presenting with CS, use of MitraClip is increasing and associated with greater in‐hospital and 1‐year survival. Further studies are warranted to optimize patient selection and procedure timing for those receiving MitraClip as a treatment option in CS.

Urgent Transcatheter Edge-to-Edge Repair for Severe Mitral Regurgitation in Patients with Refractory Cardiogenic Shock

“…This inherent limitation in the current treatment of CS and MR emphasizes the important role of less invasive options, such as percutaneous repair. Recent data suggest that urgent intervention in the acute setting is safe and effective, and is associated with improved outcome [ 12 , 13 ].…”

Cardiogenic Shock Secondary to Acute Mitral Regurgitation With Nonischemic Etiology Successfully Stabilized by Transcatheter Intervention

“…Emerging data suggest that percutaneous techniques for MV repair are valuable to surgical repair, especially in patients with high surgical risks. 2 , 7 Evidence for effectiveness of TMVEER in acute severe MR is currently limited to case reports and post hoc analysis and largely focuses on ischemic MR with delayed or lack of reperfusion. 8 …”

Mechanical Circulatory Support Devices for the Treatment of Cardiogenic Shock Complicating Acute Myocardial Infarction—A Review

“…Percutaneous transcatheter heart interventions are a viable alternative to surgery in acutely ill patients at extremely high operative risk. Minimally invasive procedures, with or without MCS support, of both mitral and aortic valves have been described in the setting of CS in small case series and registries, with high procedural success rate and improved outcomes [ 58 , 59 , 60 ]. However, the populations in those specific studies are highly heterogeneous regarding CS etiology and include only small samples of post-AMI CS patients with secondary mitral regurgitation (MR).…”

“…However, the populations in those specific studies are highly heterogeneous regarding CS etiology and include only small samples of post-AMI CS patients with secondary mitral regurgitation (MR). In a nationwide analysis evaluating the outcomes of mitral edge-to-edge repair with MitraClip, only 18% of the matched cohort had AMI, and only 15.8% underwent revascularization [ 60 ]. According to registries focusing on post-MI MR, without CS, early MR repair with transcatheter edge-to-edge repair (TEER) may be beneficial [ 61 ].…”