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.
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%.
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).
Conclusion
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.
Mmember of the Editorial Board of SOLACI.org.
Reference: Tetsuya Saito, et al. Catheter Cardiovasc Interv. 2024;103:340–347.
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