M-TEER with mandatory mechanical circulatory support achieved procedural objectives in 83.3% of patients with structural shock, with a 6-month survival rate of 73.3%.
Observational (n=30)
No
Does M-TEER with mandatory MCS improve procedural success and survival in patients with cardiogenic shock and significant mitral regurgitation?
In patients with cardiogenic shock complicated by significant mitral regurgitation, M-TEER with mandatory mechanical circulatory support is feasible, achieving high procedural success and favorable 6-month survival.
Background: Mitral regurgitation (MR) may be a cause or contributor to cardiogenic shock (CS). The roles of mitral transcatheter edge-to-edge repair (M-TEER) and mechanical circulatory support (MCS) have not been fully delineated. This prospective registry of patients with significant MR and CS was designed to determine procedural success and survival with M-TEER performed with mandatory MCS. Methods: Over an 8-year period ending August 2024, this single hospital system prospective analysis identified consecutive patients with CS with significant MR. The primary outcome was achieving pre-defined procedural objectives: In aggregate, an absolute >2 Grade MR reduction, normalization of pulmonary venous flow pattern and final mean transvalvular gradient <5 mmHg and 6-month mortality. Results: The cohort included n = 30 patients with acute hemodynamic deterioration (mean age 74.1 + 13.7 years, 63.3% male). Mean Society of Thoracic Surgery score (MV repair) was 13.6% + 14.7%. Clinical profiles included: Chronic progressive shock/Acute shock on chronic CHF (50%), Ruptured mitral valve chordae with leaflet incompetence and intact LVEF (23.3%), Mixed etiology defined as reduced EF and ruptured chordae (13.3%) and Acute myocardial infarction (AMI) induced papillary muscle rupture (13.3%). M-TEER with mandatory MCS was performed in all 30 patients. Procedural objectives were achieved in 25 patients (83.3%). Survival to hospital discharge was 86.6% and at 3-months 80.0%. Overall, 6-month survival was 73.3%. Conclusions: In CS complicated by significant MR, M-TEER with mandatory MCS can be performed with excellent procedural success and is associated with favorable clinical outcomes.
Rizik et al. (Mi,) führten eine Beobachtungsstudie bei kardiogenem Schock mit signifikanter Mitralinsuffizienz (n=30) durch. Die Mitral-Transkatheter-Kante-zu-Kante-Reparatur (M-TEER) mit obligatorischer mechanischer Kreislaufunterstützung (MCS) wurde hinsichtlich der Erreichung vordefinierter Verfahrensziele (absolute >2 Grad MR-Reduktion, Normalisierung des pulmonalen venösen Flussmusters und endgültiger mittlerer transvalvulärer Gradient <5 mmHg) und der 6-Monats-Mortalität bewertet. M-TEER mit obligatorischer mechanischer Kreislaufunterstützung erreichte die Verfahrensziele bei 83,3 % der Patienten mit strukturellem Schock, mit einer 6-Monats-Überlebensrate von 73,3 %.