Severe Mitral Regurgitation and Cardiogenic Shock: Is Edge-to-Edge a Valid Strategy?

At present, cardiogenic shock continues to present high mortality despite the new treatments and ventricular assistance devices available in some centers.

Resultados alentadores en la válvula mitral percutánea en los pacientes complejos

In this group, the presence of severe mitral regurgitation (MR) is around 5% and, on many occasions, it cannot be treated with surgery because of hemodynamic conditions.

Edge-to-edge repair has been looked at by several studies with promising results.

This study looked at patients from the STS/ACC, a registry of patients with cardiogenic shock and severe MR undergoing edge-to-edge repair with MitraClip.

It included 3,797 patients. 3,249 (85.6%) were successfully implanted.

The populations were similar, mean age was 73, 60% were men, 80% were hypertensive, 2% had endocarditis, 37% prior MI, 35% prior PCI, and 64% atrial fibrillation.

MR was degenerative in 53,4% and STS was 15%.

At 30 days, procedural complications were quite low, with no differences, but mortality was higher in those presenting device failure (16.4% vs. 9.1% p<0.001), as well as lower hospital stay (14.3 vs. 12.2 days p<0.001).

At one-year followup, mortality was lower among the successfully implanted (34.6% vs 55.5%; P < 0.001), with a number needed to treat (NNT) of 4.8 patients. Likewise, the combination of mortality and hospitalization for cardiac failure was lower in this group (29.6% vs 45.2%; P <0.001; NNT 6.4).

Conclusion

Reducing mitral regurgitation was possible in most patients with cardiogenic shock and was associated with significantly lower mortality and hospitalization for cardiac failure. Further randomized studies on Edge- to-edge in patients with cardiogenic shock are needed to establish the potential of this treatment.