Key result
Successful PMVR linked to ~88% lower 30-day mortality in cardiogenic shock and severe MR.
Why the study?
Severe MR during cardiogenic shock triples 1-year mortality risk, making edge-to-edge PMVR a potential option requiring evaluation for short- and mid-term clinical outcomes.
Does edge-to-edge PMVR improve survival in patients with refractory cardiogenic shock and severe mitral regurgitation?
Observational (n=31)
Yes
Does edge-to-edge PMVR improve survival in patients with refractory cardiogenic shock and severe mitral regurgitation?
Hazard Ratio: 0.12 (95% CI 0.03–0.55)
p-value: p=<.01
Edge-to-edge PMVR is a feasible bailout option for patients with refractory cardiogenic shock and severe mitral regurgitation, with successful procedures strongly predicting short- and mid-term survival.
PMVR was associated with 78% 30-day survival in refractory CS with severe MR; leaves open its comparative benefit versus medical therapy.
OBJECTIVES: The aim of this study was to evaluate the impact of edge-to-edge PMVR on short and mid-term clinical outcomes in patients with CS and severe MR. BACKGROUND: Severe mitral regurgitation (MR) in the setting of cardiogenic shock (CS) is associated with three times higher risk of 1-year mortality. In refractory CS, edge-to-edge percutaneous mitral valve repair (PMVR) can be a potential therapeutic option. METHODS: We retrospectively included consecutive patients with refractory CS and concomitant severe MR treated with MitraClip® system. CS was defined according to the criteria used in the SHOCK trial and procedural success according to Mitral Valve Academic Research Consortium (MVARC) criteria. The 30-day and 6-month mortality were the primary and secondary endpoints respectively. RESULTS: Thirty-one patients (median age 73 years [interquartile range, IQR 66-78], 25.8% female), STS mortality score 37.9 [IQR 30.4-42.4]), with CS and concomitant severe MR treated with edge-to-edge PMVR were retrospectively enrolled. Procedural success was 87.1%. Thirty-day and 6-month survival rates were 78.4 and 45.2% respectively. Univariate Cox Regression Model analysis showed that procedural success was a predictor of both 30-day (HR = 0.12, 95% CI 0.03-0.55, p < .01) and 6-month survival (HR = 0.22, 95% CI 0.06-0.84, p = .027). CONCLUSIONS: Edge-to-edge PMVR in patients with CS and concomitant severe MR was associated with good procedural safety and success with acceptable short and mid-term survival rates. It could be considered a bailout option in this setting of patients.
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Falasconi et al. (2021) conducted an observational in Cardiogenic shock and severe mitral regurgitation (n=31). Edge-to-edge percutaneous mitral valve repair (MitraClip) was evaluated on 30-day mortality (HR 0.12, 95% CI 0.03-0.55, p=<.01). Procedural success of edge-to-edge percutaneous mitral valve repair in patients with cardiogenic shock and severe mitral regurgitation predicted 30-day survival (HR 0.12; 95% CI 0.03-0.55; p<0.01).