Transcatheter edge-to-edge mitral valve repair as a salvage procedure in post-MI papillary muscle rupture achieved procedural success in 87% of patients, with 70% surviving to hospital discharge.
Observational (n=23)
Yes
Is transcatheter edge-to-edge mitral valve repair (TEER) feasible and effective as a salvage procedure in patients with post-MI papillary muscle rupture?
TEER is a feasible salvage therapy or bridge to surgery for critically ill patients with papillary muscle rupture complicating acute MI.
AIMS: Acute mitral regurgitation (MR) in the setting of myocardial infarction (MI) may be the result of papillary muscle rupture (PMR). This condition is associated with high morbidity and mortality. We aim to evaluate the feasibility of transcatheter edge-to-edge mitral valve repair (TEER) in this acute setting. METHODS AND RESULTS: We analysed data from the International Registry of MitraClip in Acute Mitral Regurgitation following acute Myocardial Infarction (IREMMI) of 30 centres in Europe, North America, and the middle east. We included patients with post-MI PMR treated with TEER as a salvage procedure, and we evaluated immediate and 30-day outcomes. Twenty-three patients were included in this analysis (9 patients suffered complete papillary muscle rupture, 9 partial and 5 chordal rupture). The patients' mean age was 68 ± 14 years. Patients were at high surgical risk with median EuroSCORE II 27% (IQR 16, 28) and 20 out of 23 (87% were in cardiogenic shock). All patients were treated with vasopressors, and 17 out of 23 patients required mechanical support. TEER procedure was performed on the median 6 days after the index MI date IQR (3, 11). Procedural success was achieved in 87% of patients. The grade of MR was significantly decreased after the procedure. MR reduction to 0 or 1 + was achieved in 13 patients (57%), to 2 + in 7 patients (30%), P < 0.01. V-Wave was reduced from 49 ± 8 mmHg to 26 ± 10 mmHg post-procedure, P < 0.01. Sixteen out of 23 patients (70%) were discharged from hospital and 5 of them required reintervention with surgical mitral valve replacement. No additional death at 1 year was documented. CONCLUSIONS: TEER is a feasible therapy in critically ill patients with PMR due to a recent MI. TEER may have a role as salvage treatment or bridge to surgery in this population.
Haberman et al. (Thu,) conducted a observational in Acute mitral regurgitation with papillary muscle rupture complicating acute myocardial infarction (n=23). Transcatheter edge-to-edge mitral valve repair (TEER) was evaluated on Procedural success. Transcatheter edge-to-edge mitral valve repair as a salvage procedure in post-MI papillary muscle rupture achieved procedural success in 87% of patients, with 70% surviving to hospital discharge.