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Yokoyama H, Kokawa T, Shigekiyo S, Seno A, Izumi T, Ogura R, Mahara K, Hosokawa S. Outcomes of mitral valve transcatheter edge-to-edge repair for patients with hemodynamic instability: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00149-0. [PMID: 38584083 DOI: 10.1016/j.carrev.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND The outcomes after mitral valve transcatheter edge-to-edge repair (M-TEER) for the patients with severe mitral regurgitation (MR) in hemodynamically unstable conditions, such as cardiogenic shock, still remain unclear. We aimed to integrate previous publications regarding M-TEER indicated for life-threatening conditions and indirectly particularly compared the short-term outcomes thereof, with that of other treatments. METHODS We systematically searched the PubMed, Cochrane, and MEDLINE databases for studies from inception to June 2023, regarding M-TEER in patients with hemodynamic instability and severe MR. The primary outcomes analyzed included the in-hospital and 30-day mortality rates, and peri-procedural complications. RESULTS Of the initial 820 publications, we conducted a meta-analysis of a total of 25 studies. The relative risk of moderate-to-severe or severe MR was 0.13 (95 % confidence interval [CI]: 0.10-0.18, I2 = 45.2 %). The pooled in-hospital and 30-day mortality rates were 11.8 % (95 % CI: 8.7-15.9, I2 = 96.4 %) and 14.1 % (95 % CI: 10.9-18.3, I2 = 35.5 %), respectively. The 30-day mortality rate was statistically significantly correlated with the residual moderate-to-severe or severe MR, as per the meta-regression analysis (coefficient β = 3.48 [95 % CI: 0.99-5.97], p = 0.006). Regarding peri-procedural complications, the pooled rates of a stroke or transient ischemic attack, life-threatening or major bleeding, acute kidney injury, and peri-procedural mitral valve surgery were 2.3 % (95 % CI: 1.9-2.6), 7.6 % (95 % CI: 6.8-8.5), 32.9 % (95 % CI: 31.6-34.3), and 1.0 % (95 % CI: 0.8-1.3), respectively. CONCLUSIONS This meta-analysis demonstrates that the relatively higher rates of procedural complications were observed, nevertheless, M-TEER can potentially provide favorable short-term outcomes even in hemodynamically unstable patients. PROSPERO REGISTRATION NUMBER CRD42023468946.
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Affiliation(s)
| | | | | | - Akiho Seno
- Tokushima Red Cross Hospital, Tokushima, Japan
| | | | - Riyo Ogura
- Tokushima Red Cross Hospital, Tokushima, Japan
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van-Roessel AM, Asmarats L, Li CHP, Millán X, Fernández-Peregrina E, Menduiña I, Sanchez-Ceña J, Arzamendi D. Mitral transcatheter edge-to-edge repair: patient selection, current devices, and clinical outcomes. Expert Rev Med Devices 2024; 21:187-196. [PMID: 38155555 DOI: 10.1080/17434440.2023.2298713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION Over the last two decades, mitral transcatheter edge-to-edge repair (M-TEER) has become a safe and effective therapy for severe mitral regurgitation in patients deemed at high surgical risk. AREAS COVERED This review aims to encompass the most relevant and updated evidence in the field of M-TEER from its inception, focusing on clinical and anatomical features for proper patient and device selection. EXPERT OPINION Growing operator experience and device iterations have resulted in improved clinical outcomes and an expansion of the therapy to patients with complex anatomies and clinical scenarios. Future investigations are warranted to determine the best management options and the most suitable device for every patient with MR.
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Affiliation(s)
- Albert Massó van-Roessel
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Lluis Asmarats
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Chi Hion Pedro Li
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Xavier Millán
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | | | | | - Juan Sanchez-Ceña
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Dabit Arzamendi
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
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Fraccaro C, Karam N, Möllmann H, Bleiziffer S, Bonaros N, Teles RC, Carrilho Ferreira P, Chieffo A, Czerny M, Donal E, Dudek D, Dumonteil N, Esposito G, Fournier S, Hassager C, Kim WK, Krychtiuk KA, Mehilli J, Pręgowski J, Stefanini GG, Ternacle J, Thiele H, Thielmann M, Vincent F, von Bardeleben RS, Tarantini G. Transcatheter interventions for left-sided valvular heart disease complicated by cardiogenic shock: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the Association for Acute Cardiovascular Care (ACVC) and the ESC Working Group on Cardiovascular Surgery. EUROINTERVENTION 2023; 19:634-651. [PMID: 37624587 PMCID: PMC10587846 DOI: 10.4244/eij-d-23-00473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Abstract
Valvular heart disease (VHD) is one of the most frequent causes of heart failure (HF) and is associated with poor prognosis, particularly among patients with conservative management. The development and improvement of catheter-based VHD interventions have broadened the indications for transcatheter valve interventions from inoperable/high-risk patients to younger/lower-risk patients. Cardiogenic shock (CS) associated with severe VHD is a clinical condition with a very high risk of mortality for which surgical treatment is often deemed a prohibitive risk. Transcatheter valve interventions might be a promising alternative in this setting given that they are less invasive. However, supportive scientific evidence is scarce and often limited to small case series. Current guidelines on VHD do not contain specific recommendations on how to manage patients with both VHD and CS. The purpose of this clinical consensus statement, developed by a group of international experts invited by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Scientific Documents and Initiatives Committee, is to perform a review of the available scientific evidence on the management of CS associated with left-sided VHD and to provide a rationale and practical approach for the application of transcatheter valve interventions in this specific clinical setting.
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Affiliation(s)
- Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Nicole Karam
- Heart Valves Unit, Georges Pompidou European Hospital, Université Paris Cité, INSERM, Paris, France
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | | | - Nikolaos Bonaros
- Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Rui Campante Teles
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental (HSC), Carnaxide, Portugal and Comprehensive Health Research Center (CHRC), Nova Medical School, Lisbon, Portugal
| | - Pedro Carrilho Ferreira
- Cardiology Department, Santa Maria University Hospital, CHULN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Centre, Freiburg University, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Erwan Donal
- Service de Cardiologie, CCP CHU de Rennes, University of Rennes, INSERM, LTSI-UMR 1099, Rennes, France
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Giovanni Esposito
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Stephane Fournier
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland and University of Lausanne, Lausanne, Switzerland
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Won-Keun Kim
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Konstantin A Krychtiuk
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Julinda Mehilli
- Department of Cardiology, German Centre for Cardiovascular Research (DZHK), Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, Munich, Germany
- Medizinische Klinik I, Landshut-Achdorf Hospital, Landshut, Germany
| | - Jerzy Pręgowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | - Giulio G Stefanini
- Department of Biomedical Sciences Humanitas University, Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS Rozzano, Milan, Italy
| | - Julien Ternacle
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC, Canada and Université Laval, Quebec, QC, Canada
- Haut-Leveque Cardiology Hospital, Bordeaux University, Pessac, France
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, Leipzig, Germany and University of Leipzig, Leipzig, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Flavien Vincent
- Service de Cardiologie, Centre Hospitalier Universitaire de Lille, Lille, France
| | | | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Dryden A, Hynes M, Hibbert B. Anaesthesia for transcatheter mitral valve repair. BJA Educ 2023; 23:189-195. [PMID: 37124172 PMCID: PMC10140472 DOI: 10.1016/j.bjae.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/17/2023] [Indexed: 05/02/2023] Open
Affiliation(s)
- A. Dryden
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - M. Hynes
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - B. Hibbert
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Longitudinal Outcomes Following Surgical Repair of Primary Mitral Regurgitation. J Cardiovasc Dev Dis 2023; 10:jcdd10030095. [PMID: 36975860 PMCID: PMC10051838 DOI: 10.3390/jcdd10030095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Degenerative mitral valve (MV) disease is the most common cause of organic mitral regurgitation (MR) in developed countries. Surgical mitral valve repair is the gold standard treatment for primary MR. Surgical mitral valve repair is associated with excellent outcomes in terms of survival and freedom from recurrent MR. As well, innovations in surgical repair techniques, including thoracoscopically and robotically assisted approaches, further reduce morbidity. Emerging catheter-based therapies may also provide advantages in select patient groups. Although the outcomes following surgical mitral valve repair are well described in the literature, longitudinal follow-up is heterogenous. Indeed, longitudinal follow-up and long-term data are vital to better advise treatment and counsel patients.
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Kaddoura R, Al-Hijji M. Transcatheter Mitral Valve Repair in Acute and Critical Cardiac Conditions. Heart Views 2023; 24:29-40. [PMID: 37124432 PMCID: PMC10144416 DOI: 10.4103/heartviews.heartviews_73_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 01/22/2023] [Indexed: 02/24/2023] Open
Abstract
Acute mitral valve regurgitation (MR) is an emergency condition that requires an early diagnosis of the etiology and rapid management. Surgical intervention is the first-line treatment for acute severe MR. However, many patients are denied surgical intervention due to the acute risk of surgery. Transcatheter mitral valve repair (TMVr) is a less invasive technique and becoming a potential alternative to surgery in inoperable patients but is underrepresented in the literature. This review aims to discuss the published data on the use of TMVr in unstable MR patients presenting with acute or critical cardiac conditions.
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Affiliation(s)
- Rasha Kaddoura
- Department of Pharmacy, Heart Hospital Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Al-Hijji
- Department of Adult Cardiology, Heart Hospital Hamad Medical Corporation, Doha, Qatar
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7
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So CY, Kang G, Lee JC, Frisoli TM, O'Neill B, Wang DD, Eng MH, O'Neill W, Villablanca PA. Transcatheter Edge-to-Edge Repair for Acute Mitral Regurgitation With Cardiogenic Shock Secondary to Mechanical Complication. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 45:44-50. [PMID: 35882600 DOI: 10.1016/j.carrev.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Acute MR due to mechanical mitral valve (MV) complications frequently results in cardiogenic shock and requires emergency surgical intervention. There was limited evidence for alternative treatment like MitraClip for patients at prohibitive surgical risk. We aimed to study the technical features and outcomes of emergency transcatheter edge-to-edge repair (TEER) using the MitraClip system for patients with cardiogenic shock (CS) secondary to acute mitral regurgitation (MR) and mechanical MV complication. MATERIAL AND METHODS We performed institutional review and systemic literature review to identify all TEER for CS patients due to acute mitral regurgitation and mechanical MV complication. Clinical endpoints included device success rate assessed at the end of procedure, ability to wean off MCS, all-cause and cardiovascular mortality at 30-day. RESULTS Eight patients were identified from institutional review. Detail anatomical analysis found that patients with mechanical MV complications related to myocardial infarction had a lower transseptal height achieved during MitraClip (3.6 ± 0.1 cm vs 4.3 ± 0.3 cm, p = 0.03) than those not related. Pooled analysis for cases from institutional review (n = 8) and systemic literature review (n = 16) was performed. The device success rate was 68.8 %. Seventy-five percent (n = 18) cases required mechanical circulatory support (MCS), and 94.4 % were able to wean off MCS. At 30-day, the cardiovascular mortality was 4.5 % and the all-cause mortality was 9.1 %. CONCLUSIONS In CS patients due to acute MR and mechanical MV complications, TEER with/without MCS was feasible with a reasonable device success rate.
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Affiliation(s)
- Chak-Yu So
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI, USA; Divison of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, SAR, China.
| | - Guson Kang
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI, USA
| | - James C Lee
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI, USA
| | - Tiberio M Frisoli
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI, USA
| | - Brian O'Neill
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI, USA
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI, USA
| | - Marvin H Eng
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI, USA
| | - William O'Neill
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI, USA
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8
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Transcatheter edge-to-edge repair in patients with mitral regurgitation and cardiogenic shock: a new therapeutic target. Curr Opin Crit Care 2022; 28:426-433. [PMID: 35856980 DOI: 10.1097/mcc.0000000000000952] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Cardiogenic shock with significant mitral regurgitation portends a poor prognosis with limited therapeutic options. Herein, we review the available evidence regarding the patient characteristics, management, impact of transcatheter edge-to-edge repair (TEER) on hemodynamics, and clinical outcomes of patients with cardiogenic shock and mitral regurgitation. RECENT FINDINGS Several observational studies and systematic reviews have demonstrated the feasibility and safety of TEER in cardiogenic shock complicated by degenerative or functional mitral regurgitation. Surgical interventions for mitral regurgitation remain limited owing to the risk profile of patients in cardiogenic shock. TEER has been studied in both degenerative and functional mitral regurgitation and remains feasible in the critically ill population. Moreover, TEER is associated with reduction in mitral regurgitation and improvement in-hospital and long-term mortality. SUMMARY TEER remains a promising therapeutic option in cardiogenic shock complicated by significant mitral regurgitation, but additional research is required to identify patient and procedural characteristics, hemodynamic parameters, and the optimal time for intervention. Moreover, future randomized controlled trials are in progress to evaluate the potential benefit of TEER against medical management in cardiogenic shock and mitral regurgitation.
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9
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Messika-Zeitoun D, Hibbert B, Chan V. 'Primary' percutaneous mitral valve repair in patients with acute myocardial infarction: is it ready for primetime? Eur Heart J 2021; 43:651-653. [PMID: 34472599 DOI: 10.1093/eurheartj/ehab540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Benjamin Hibbert
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Vince Chan
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada
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10
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Martinez-Gomez E, McInerney A, Tirado-Conte G, de Agustin JA, Jimenez-Quevedo P, Escudero A, Pozo Osinalde E, Viana-Tejedor A, Goirigolzarri J, Marroquin L, Vivas D, Ferrera C, Noriega F, Restrepo-Cordoba MA, Gonzalo N, Escaned J, Fernández-Ortiz A, Amat-Santos I, Estevez-Loureiro R, Macaya C, Nombela-Franco L. Percutaneous mitral valve repair with MitraClip device in hemodynamically unstable patients: A systematic review. Catheter Cardiovasc Interv 2021; 98:E617-E625. [PMID: 33856097 DOI: 10.1002/ccd.29703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/27/2021] [Accepted: 03/14/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Very few data exist on percutaneous mitral valve repair (PMVr) in unstable patients with concomitant moderate-severe mitral regurgitation (MR). The purpose of this systematic review was to evaluate baseline characteristics, management and clinical outcomes of critically ill patients undergoing PMVr with MitraClip. METHODS We conducted a systematic review of the published data on MitraClip from its first use in 2003 to December 2020. Studies referring to critically ill patients in cardiogenic shock or acute refractory pulmonary edema were included. A total of 40 publications including 254 patients with significant MR (Grade 4 in 91%) were included. RESULTS Mean age was 70 ± 12 years with mean Euroscore II and STS of 21 ± 13 and 20.5 ± 16, respectively. Clinical presentation was with cardiogenic shock and acute myocardial infarction in 72.8 and 60.0% of patients, respectively. Device success was achieved in 238 (93.7%) patients with a significant reduction in MR (Grade ≤ 2 in 91.8%, p < .001). The median weaning time from the procedure, to discontinuation of mechanical circulatory or respiratory support, was 2 days (IQR 1-4), with an in-hospital mortality and non-fatal complication rate of 12.6 and 9.1%, respectively. Kaplan-Meier curves estimated an overall mortality rate of 39.1% at 12-month follow-up, with persistent reduction in MR severity for survivors (Grade ≤ 2 in 81.3%) and one case of mitral valve reintervention. CONCLUSIONS Percutaneous mitral valve repair with MitraClip device is a technically feasible and potentially viable management option in high-risk patients with cardiogenic shock or refractory pulmonary edema and concomitant moderate-severe MR. Prospective trials are required to confirm these findings, and definitively determine the value of MitraClip in hemodynamically unstable patients.
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Affiliation(s)
- Eduardo Martinez-Gomez
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Angela McInerney
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Gabriela Tirado-Conte
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Jose Alberto de Agustin
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Pilar Jimenez-Quevedo
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Andrés Escudero
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Eduardo Pozo Osinalde
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Ana Viana-Tejedor
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Josebe Goirigolzarri
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Luis Marroquin
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - David Vivas
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Carlos Ferrera
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Francisco Noriega
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | - Nieves Gonzalo
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Javier Escaned
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Ignacio Amat-Santos
- Cardiology Department, CIBERCV, Hospital Clínico Universitario, Valladolid, Spain
| | | | - Carlos Macaya
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Luis Nombela-Franco
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
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11
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Tang GHL, Estevez-Loureiro R, Yu Y, Prillinger JB, Zaid S, Psotka MA. Survival Following Edge-to-Edge Transcatheter Mitral Valve Repair in Patients With Cardiogenic Shock: A Nationwide Analysis. J Am Heart Assoc 2021; 10:e019882. [PMID: 33821669 PMCID: PMC8174169 DOI: 10.1161/jaha.120.019882] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Edge‐to‐edge transcatheter mitral valve repair as salvage therapy in high surgical risk patients with severe mitral regurgitation presenting with cardiogenic shock (CS) has been described in small case series, but large clinical results have not been reported. This study aimed to evaluate outcomes of transcatheter mitral valve repair with MitraClip in patients with mitral regurgitation and CS using a large national database. Methods and Results From January 2014 to March 2019, we identified hospitalizations for CS in patients with mitral valve disease using data from Centers for Medicare and Medicaid Services. Those with a prior surgical or percutaneous mitral valve intervention were excluded. We compared survival between patients who underwent MitraClip during the index hospitalization and those who did not using propensity‐matched analysis. The analysis included 38 166 patients (mean age, 71±11 years, 41.6% women) of whom 622 (1.6%) underwent MitraClip. MitraClip was increasingly used during CS hospitalizations over the study period (P<0.001). After matching, patients receiving MitraClip had significantly lower in‐hospital mortality (odds ratio, 0.6; 95% CI, 0.47–0.77; P<0.001) and 1‐year mortality (hazard ratio, 0.76; 95% CI, 0.65–0.88; P<0.001) compared with those without MitraClip. The survival benefit associated with MitraClip was consistent across subgroups of interest, with the exception of patients requiring acute mechanical circulatory support or hemodialysis at index. Conclusions In patients with mitral regurgitation presenting with CS, use of MitraClip is increasing and associated with greater in‐hospital and 1‐year survival. Further studies are warranted to optimize patient selection and procedure timing for those receiving MitraClip as a treatment option in CS.
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Affiliation(s)
- Gilbert H L Tang
- Department of Cardiovascular Surgery Mount Sinai Hospital New York NY
| | | | | | | | - Syed Zaid
- Division of Cardiology Westchester Medical Center Valhalla NY
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Abstract
Despite advances in cardiovascular care, managing cardiogenic shock caused by structural heart disease is challenging. Patients with cardiogenic shock are critically ill upon presentation and require early disease recognition and rapid escalation of care. Temporary mechanical circulatory support provides a higher level of care than current medical therapies such as vasopressors and inotropes. This review article focuses on the role of hemodynamic monitoring, mechanical circulatory support, and device selection in patients who present with cardiogenic shock due to structural heart disease. Early initiation of appropriate mechanical circulatory support may reduce morbidity and mortality.
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13
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Estévez-Loureiro R, Shuvy M, Taramasso M, Benito-Gonzalez T, Denti P, Arzamendi D, Adamo M, Freixa X, Villablanca P, Krivoshei L, Fam N, Spargias K, Czarnecki A, Haberman D, Agmon Y, Sudarsky D, Pascual I, Ninios V, Scianna S, Moaraf I, Schiavi D, Chrissoheris M, Beeri R, Kerner A, Fernández-Peregrina E, Di Pasquale M, Regueiro A, Poles L, Iñiguez-Romo A, Fernández-Vázquez F, Maisano F. Use of MitraClip for mitral valve repair in patients with acute mitral regurgitation following acute myocardial infarction: Effect of cardiogenic shock on outcomes (IREMMI Registry). Catheter Cardiovasc Interv 2021; 97:1259-1267. [PMID: 33600072 DOI: 10.1002/ccd.29552] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To assess outcomes in patients with acute mitral regurgitation (MR) following acute myocardial infarction (AMI) who received percutaneous mitral valve repair (PMVR) with the MitraClip device and to compare outcomes of patients who developed cardiogenic shock (CS) to those who did not (non-CS). BACKGROUND Acute MR after AMI may lead to CS and is associated with high mortality. METHODS This registry analyzed patients with MR after AMI who were treated with MitraClip at 18 centers within eight countries between January 2016 and February 2020. Patients were stratified into CS and non-CS groups. Primary outcomes were mortality and rehospitalization due to heart failure. Secondary outcomes were acute procedural success, functional improvement, and MR reduction. Multivariable Cox regression analysis evaluated association of CS with clinical outcomes. RESULTS Among 93 patients analyzed (age 70.3 ± 10.2 years), 50 patients (53.8%) experienced CS before PMVR. Mortality at 30 days (10% CS vs. 2.3% non-CS; p = .212) did not differ between groups. After median follow-up of 7 months (IQR 2.5-17 months), the combined event mortality/re-hospitalization was similar (28% CS vs. 25.6% non-CS; p = .793). Likewise, immediate procedural success (90% CS vs. 93% non-CS; p = .793) and need for reintervention (CS 6% vs. non-CS 2.3%, p = .621) or re-admission due to HF (CS 13% vs. NCS 23%, p = .253) at 3 months did not differ. CS was not independently associated with the combined end-point (hazard ratio 1.1; 95% CI, 0.3-4.6; p = .889). CONCLUSIONS Patients found to have significant MR during their index hospitalization for AMI had similar clinical outcomes with PMVR whether they presented in or out of cardiogenic shock, provided initial hemodynamic stabilization was first achieved before PMVR.
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Affiliation(s)
| | - Mony Shuvy
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Tomas Benito-Gonzalez
- Interventional Cardiology Unit, Complejo Asistencial Universitario de Leon, Leon, Spain
| | - Paolo Denti
- Department of Cardiovascular Surgery, San Raffaele University Hospital, Milan, Italy
| | - Dabit Arzamendi
- Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu, Barcelona, Spain
| | - Marianna Adamo
- Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | - Xavier Freixa
- Interventional Cardiology Unit, Hospital Clinic, Barcelona, Spain
| | - Pedro Villablanca
- Interventional Cardiology, Structural Heart Disease Interventions, Endovascular Interventions, The Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lian Krivoshei
- Department of Cardiology, Kantonsspital Baden, Baden, Switzerland
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Andrew Czarnecki
- Division of Cardiology, Sunnybrook Heath Sciences Centre, University of Toronto, Shulich Heart Centre, Tronto, Ontario, Canada
| | - Dan Haberman
- Heart Center, Kaplan Medical Center, Affiliated to the Hebrew University, Jerusalem, Israel
| | - Yoram Agmon
- Department of Cardiology, Rambam Medical Center, and B. Rappaport Faculty of Medicine, Technion Medical School, Haifa, Israel
| | - Doron Sudarsky
- Cardiovascular Institute, Padeh Medical Center, Tiberias, Israel
| | - Isaac Pascual
- Interventional Cardiology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Vlasis Ninios
- Department of Cardiology, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Salvatore Scianna
- Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland
| | - Igal Moaraf
- Department of Cardiology, Kantonsspital Baden, Baden, Switzerland
| | - Davide Schiavi
- Department of Cardiovascular Surgery, San Raffaele University Hospital, Milan, Italy
| | | | - Ronen Beeri
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Arthur Kerner
- Department of Cardiology, Rambam Medical Center, and B. Rappaport Faculty of Medicine, Technion Medical School, Haifa, Israel
| | | | - Mattia Di Pasquale
- Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | - Ander Regueiro
- Interventional Cardiology Unit, Hospital Clinic, Barcelona, Spain
| | - Lion Poles
- Heart Center, Kaplan Medical Center, Affiliated to the Hebrew University, Jerusalem, Israel
| | | | | | - Francesco Maisano
- Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland
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Jung RG, Simard T, Kovach C, Flint K, Don C, Di Santo P, Adamo M, Branca L, Valentini F, Benito-González T, Fernández-Vázquez F, Estévez-Loureiro R, Berardini A, Conti N, Rapezzi C, Biagini E, Parlow S, Shorr R, Levi A, Manovel A, Cardenal-Piris R, Diaz Fernandez J, Shuvy M, Haberman D, Sala A, Alkhouli MA, Marini C, Bargagna M, Schiavi D, Denti P, Markovic S, Buzzatti N, Chan V, Hynes M, Mesana T, Labinaz M, Pappalardo F, Taramasso M, Hibbert B. Transcatheter Mitral Valve Repair in Cardiogenic Shock and Mitral Regurgitation: A Patient-Level, Multicenter Analysis. JACC Cardiovasc Interv 2020; 14:1-11. [PMID: 33069653 DOI: 10.1016/j.jcin.2020.08.037] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/12/2020] [Accepted: 08/25/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the outcome of transcatheter mitral valve repair (TMVr) in patients with cardiogenic shock and significant mitral regurgitation (MR). BACKGROUND Patients in cardiogenic shock with severe MR have a poor prognosis in the setting of conventional medical therapy. Because of its favorable safety profile, TMVr is being increasingly used as an acute therapy in this population, though its efficacy remains unknown. METHODS A multicenter, collaborative, patient-level analysis was conducted. Patients with cardiogenic shock and moderate to severe (3+) or severe (4+) MR who were not surgical candidates were treated with TMVr. The primary outcome was in-hospital mortality. Secondary outcomes included 90-day mortality, heart failure (HF) hospitalization, and the combined event rate of 90-day mortality and HF hospitalization following dichotomization by TMVr device success. RESULTS Between January 2011 and February 2019, 141 patients across 14 institutions met the inclusion criteria. In-hospital mortality occurred in 22 patients (15.6%), at 90 days in 38 patients (29.5%), and at one year in 55 patients (42.6%). Median length of hospital stay following TMVr was 10 days (interquartile range: 6 to 20 days). HF hospitalization occurred in 26 patients (18.4%) at a median of 73 days (interquartile range: 26 to 546 days). When stratified by TMVr procedural results, successful TMVr reduced rates of in-hospital mortality (hazard ratio [HR]: 0.36; 95% confidence interval [CI]: 0.13 to 0.98; p = 0.04), 90-day mortality (HR: 0.36; 95% CI: 0.16 to 0.78; p = 0.01), and the composite of 90-day mortality and HF hospitalization (HR: 0.41; 95% CI: 0.19 to 0.90; p = 0.03). CONCLUSIONS TMVr may improve short- and intermediate-term mortality in high-risk patients with cardiogenic shock and moderate to severe MR. Randomized studies are needed to definitively establish MR as a therapeutic target in patients with cardiogenic shock.
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Affiliation(s)
- Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Trevor Simard
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Christopher Kovach
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado; Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Kelsey Flint
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado; Rocky Mountain Regional VA Medical Center, Medicine Services, Cardiology, Aurora, Colorado, USA
| | - Creighton Don
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marianna Adamo
- Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | - Luca Branca
- Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | - Francesca Valentini
- Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | | | | | | | - Alessandra Berardini
- Cardiology Unit, Cardio-Thoracic-Vascular Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Nicolina Conti
- Cardiology Unit, Cardio-Thoracic-Vascular Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Claudio Rapezzi
- Cardiological Center, Universitario di Ferrara, University of Ferrara, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Elena Biagini
- Cardiology Unit, Cardio-Thoracic-Vascular Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Simon Parlow
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Risa Shorr
- University of Ottawa Health Sciences Library, Ottawa, Ontario, Canada
| | - Amos Levi
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ana Manovel
- Juan Ramon Jimenez University Hospital, Huelva, Spain
| | | | | | - Mony Shuvy
- Cardiovascular Research Centre, Heart Institute, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Dan Haberman
- Heart Center, Kaplan Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alessandra Sala
- Department of Cardiovascular Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
| | - Mohamad A Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Claudia Marini
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Marta Bargagna
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | | | - Paolo Denti
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Sinisa Markovic
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | - Nicola Buzzatti
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Vincent Chan
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mark Hynes
- Department of Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario
| | - Thierry Mesana
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marino Labinaz
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Maurizio Taramasso
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy; University Heart Center Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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