Percutaneous Mitral Valve Repair With MitraClip in Inoperable Patients With Severe Mitral Regurgitation Complicated by Cardiogenic Shock.

BACKGROUND

Severe mitral regurgitation (MR) complicated by cardiogenic shock has high operative mortality. Percutaneous leaflet repair with MitraClip (Abbott Vascular) is a less invasive alternative to surgery. The effectiveness and safety of this approach is unknown.

METHODS

We retrospectively analyzed procedural characteristics of shock patients with severe MR treated with MitraClip in a tertiary, high-volume program (Abbott Northwestern Hospital, Minneapolis, Minnesota) during 2010-2019. The primary outcome of the study was 30-day survival free of significant MR (grade ≤2). One-year mortality was a secondary outcome.

RESULTS

Among 322 patients who underwent MitraClip implantation during the study period, 11 inoperable patients with severe MR and cardiogenic shock were included in this analysis. Mean patient age was 74 ± 11 years and 54% were male. The mechanism of MR was degenerative in 7 patients (63.6%) and functional in 4 patients (36.4%), including 1 post myocardial infarction, 1 with chronic ischemic heart disease, and 2 with end-stage non-ischemic cardiomyopathy. Hemodynamic support with intra-aortic balloon pump was used in 5 patients (45%). The A2-P2 scallop was the more common location for MitraClip insertion, and 27% of patients had >1 clip implanted. Median fluoroscopy time was 18.5 minutes (interquartile range [IQR], 10-22 minutes) and mean postprocedure gradient was 4.5 mm Hg (IQR, 3-5 mm Hg). At 30 days, eight patients (72.7%) were alive with MR grade ≤2. At 1 year, mortality was 66%, and was driven mainly by non-cardiac causes.

CONCLUSIONS

Among inoperable patients with severe MR and cardiogenic shock, percutaneous leaflet repair with MitraClip is associated with acceptable short-term effectiveness.