Key result
Emergent MitraClip achieved mild mitral regurgitation in 87.5% of patients with cardiogenic shock compared to 95.2% in elective patients (P=0.514), though long-term survival was poorer (P=0.008).
Why the study?
Emergent surgical intervention carries extremely high risk in patients with severe MR and cardiogenic shock, and the feasibility and efficacy of emergent MitraClip in critical conditions remained unclear.
Is emergent transcatheter edge-to-edge mitral valve repair feasible and effective for patients with severe mitral regurgitation and cardiogenic shock compared to elective procedures?
Cohort (n=50)
Is emergent transcatheter edge-to-edge mitral valve repair feasible and effective for patients with severe mitral regurgitation and cardiogenic shock compared to elective procedures?
Absolute Event Rate: 87.5% vs 95.2%
p-value: p=0.514
Emergent transcatheter edge-to-edge mitral valve repair is a feasible alternative to rescue patients with severe mitral regurgitation and cardiogenic shock, achieving high procedural success rates despite expectedly lower long-term survival.
BACKGROUND: The transcatheter edge-to-edge mitral valve repair using MitraClip has been a safe and effective treatment for severe mitral regurgitation (MR). In patients with severe MR and cardiogenic shock under hemodynamic supporting devices, emergent surgical mitral valve interventions carry extremely high risk for peri-operative morbidities and mortalities. The feasibility and efficacy of emergent MitraClip to rescue patients in critical conditions remains elucidate. METHODS: Patients with severe MR and high or prohibitive surgical risks were referred for MitraClip procedures. Emergent MitraClip were conducted in patients with unstable hemodynamics and under mechanical or inotropic support. The hemodynamic measures, transthoracic echocardiography, transesophageal echocardiography, and blood tests were performed before MitraClip procedures. Procedural success was defined as having mild mitral regurgitation immediately after MitraClip, and patients were free from in-hospital mortality. Clinical and echocardiographic outcomes were followed by telephones and clinics. RESULTS: Among 50 consecutive patients (74.7 ± 11.2 years, 74% male), 8 emergent MitraClip procedures were conducted to rescue patients with cardiogenic shock. Extracorporeal membrane oxygenations were used in 2 patients and intra-aortic balloon pump were applied in 4 patients (50%). Compare to those who underwent elective procedures, patients underwent emergent MitraClip had higher surgical risk profile (EuroSCORE II 34.8% vs 5.1% and STS score 19.7% vs 5.1%), poorer renal function and higher right atrial pressure. There was no peri-procedural death, myocardial infarction, stroke or any adverse events requiring emergent cardiac surgery in both groups. Mild mitral regurgitation was achieved in 87.5% patients from the emergent group and 95.2% patients in the elective group (P = 0.514). The Kaplan-Meier analysis showed patients who underwent emergent procedures have poorer long-term survival rate as compare to those who received elective procedures. (P value = 0.008). CONCLUSION: When open-heart surgery is not feasible, trans-catheter mitral valve repair is an alternative way to rescue patients in cardiogenic shock status.
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Lee et al. (2020) conducted a cohort in Severe mitral regurgitation and high or prohibitive surgical risks (n=50). Emergent MitraClip vs. Elective MitraClip was evaluated on Mild mitral regurgitation immediately after MitraClip (p=0.514). Emergent MitraClip achieved mild mitral regurgitation in 87.5% of patients with cardiogenic shock compared to 95.2% in elective patients (P=0.514), though long-term survival was poorer (P=0.008).
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