Edge-to-Edge Treatment in Cardiogenic Shock

Cardiogenic shock (CS) is characterized by severe ventricular dysfunction, most often of ischemic origin. It is frequently associated with severe mitral regurgitation (MR), either due to primary mitral valve disease from ruptured chordae tendineae or papillary muscles, or—less commonly—from mixed causes.

While surgery is the treatment of choice in CS patients, that is not a feasible alternative in certain scenarios due to high associated risk. In such cases, edge-to-edge repair becomes a valid therapeutic strategy.

Researchers conducted an analysis on 30 patients with CS (19 with Impella support and the remainder with intra-aortic balloon pump, IABP), all with degenerative or functional moderate or severe mitral regurgitation, who were not surgical candidates and were treated with edge-to-edge therapy using MitraClip.

The average age was 74 years; 19 subjects were men, and the STS predicted mortality for valve repair was 13.8%. The patients’ medical history included diabetes in 6 patients, hypertension in 22, chronic obstructive pulmonary disease (COPD) in 6 (5 requiring oxygen permanently), prior percutaneous coronary intervention (PCI) in 11, myocardial revascularization surgery (MRS) in 4, atrial fibrillation in 15, pacemaker implantation in 11, stroke in 3, and peripheral vascular disease in 3. The mean creatinine level was 1.6 mg/dL.

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The average ejection fraction was 40%. The left ventricular end-diastolic diameter was 55 mm, and the end-systolic diameter was 43 mm. Six patients had moderate or severe aortic regurgitation, 2 had moderate or severe aortic stenosis, and 18 had moderate or severe tricuspid regurgitation.

The average time from admission to edge-to-edge treatment was 2.1 days.

The procedure was successful in 25 patients; in 2 cases, severe MR persisted after the procedure, and in 3 cases, the procedure could not be completed. The final transmitral gradient was ≤5 mmHg.

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Hospital survival, 30-day survival, and 6-month survival rates were 86.6%, 80%, and 73.3%, respectively. At 30 days, the distribution of MR grades was: MR 1+ in 62% of subjects, 2+ in 19%, 3+ in 15%, and 4+ in 4% of patients.

Conclusion

In patients with cardiogenic shock complicated by mitral regurgitation, edge-to-edge treatment with mandatory ventricular support proved to be a safe strategy and was associated with favorable clinical outcomes.

Original Title: Mitral Transcatheter Edge-to-Edge Repair and Mandatory Mechanical Circulatory Support in Patients With Structural Shock. 

Reference: David G. Rizik, el al. Journal of the Society for Cardiovascular Angiography & Interventions 4 (2025) 10262 6 https://doi.org/10.1016/j.jscai.2025.102626.