Transcatheter Mitral Valve Repair in Cardiogenic Shock and Mitral Regurgitation: A Patient-Level, Multicenter Analysis.
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Jung Richard G, Simard Trevor, Kovach Christopher, Flint Kelsey, Don Creighton, Di Santo Pietro, Adamo Marianna, Branca Luca, Valentini Francesca, Benito-González Tomás, Fernández-Vázquez Felipe, Estévez-Loureiro Rodrigo, Berardini Alessandra, Conti Nicolina, Rapezzi Claudio, Biagini Elena, Parlow Simon, Shorr Risa, Levi Amos, Manovel Ana, Cardenal-Piris Rosa, Diaz Fernandez Jose, Shuvy Mony, Haberman Dan, Sala Alessandra, Alkhouli Mohamad A, Marini Claudia, Bargagna Marta, Schiavi Davide, Denti Paolo, Markovic Sinisa, Buzzatti Nicola, Chan Vincent, Hynes Mark, Mesana Thierry, Labinaz Marino, Pappalardo Federico, Taramasso Maurizio, Hibbert Benjamin
Аннотация
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.