Edge-to-Edge Repair in Cardiogenic Shock

The edge-to-edge approach with MitraClip has been established as a valid strategy for patients who experience severe symptomatic mitral regurgitation (MI) with high risk for surgery, currently with a IIa indication.

La insuficiencia renal post tratamiento borde a borde tricuspídeo impacta en el pronóstico

MI complicated by cardiogenic shock, which results in a high risk for conventional valve surgery, is a particularly complex scenario. In such a case, edge-to-edge repair emerges as an alternative, despite the current lack of exhaustive analyses or randomized studies, with only a handful of publications available.

Researchers conducted a meta-analysis that included 12 studies (7 case series and 5 observational studies) involving 460 patients.

The primary endpoint (PEP) assessed was mortality at one year.

Mean patient age was 68 years; 40% of patients were women. In general, 70% of patients had hypertension, 35% had diabetes, 43% had impaired renal function, 20% had chronic obstructive pulmonary disease (COPD), 11% had a prior stroke, 61% experienced coronary artery disease, and 49% had undergone a prior PCI. Additionally, 21% had undergone previous myocardial revascularization surgery. Ejection fraction was 36%.

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About 74% of patients received inotropics, and a ventricular assist device was used as follows: 28% of patients received an intra-aortic balloon pump (IABP), 29% received an Impella device, and 13% of patients had extracorporeal membrane oxygenation (ECMO).

The most frequent cause of MI was functional (54%), followed by 26% of ischemic origin and 40% resulting from acute myocardial infarction (AMI).

The STS risk index was 17.7%.

The PEP at one year was 36% (95% confidence interval [CI]: 21%–54%), and the presence of MI <2+ was 88% (95% CI: 87%–89%).

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Mortality at 30 days was 11% (95% CI: 10%–13%) and 15% at 15 days (95% CI: 13%–16%), with an average hospital stay of 13.9 days (95% CI: 7.08–20.7).


This study is a systematic review and meta-analysis of the clinical features and evolution of edge-to-edge repair in cardiogenic shock in patients with mitral regurgitation. The edge-to-edge approach in mitral regurgitation with cardiogenic shock has been shown to be successful in reducing mitral regurgitation in most patients, although it is associated with a high mortality rate. Randomized controlled studies on edge-to-edge treatment of mitral regurgitation in cardiogenic shock are absolutely imperative.

Dr. Carlos Fava - Consejo Editorial SOLACI

Dr. Carlos Fava.
Mmember of the Editorial Board of SOLACI.org.

Original Title: Transcatheter edge‐to‐edge mitral valve repair for mitral regurgitation in patients with cardiogenic shock: A systematic review and meta‐analysis.

Reference: Tetsuya Saito, et al. Catheter Cardiovasc Interv. 2024;103:340–347.

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