TY - JOUR
T1 - Transcatheter Mitral Valve Repair in Cardiogenic Shock and Mitral Regurgitation
T2 - A Patient-Level, Multicenter Analysis
AU - Jung, Richard G.
AU - Simard, Trevor
AU - Kovach, Christopher
AU - Flint, Kelsey
AU - Don, Creighton
AU - Di Santo, Pietro
AU - Adamo, Marianna
AU - Branca, Luca
AU - Valentini, Francesca
AU - Benito-González, Tomás
AU - Fernández-Vázquez, Felipe
AU - Estévez-Loureiro, Rodrigo
AU - Berardini, Alessandra
AU - Conti, Nicolina
AU - Rapezzi, Claudio
AU - Biagini, Elena
AU - Parlow, Simon
AU - Shorr, Risa
AU - Levi, Amos
AU - Manovel, Ana
AU - Cardenal-Piris, Rosa
AU - Diaz Fernandez, Jose
AU - Shuvy, Mony
AU - Haberman, Dan
AU - Sala, Alessandra
AU - Alkhouli, Mohamad A.
AU - Marini, Claudia
AU - Bargagna, Marta
AU - Schiavi, Davide
AU - Denti, Paolo
AU - Markovic, Sinisa
AU - Buzzatti, Nicola
AU - Chan, Vincent
AU - Hynes, Mark
AU - Mesana, Thierry
AU - Labinaz, Marino
AU - Pappalardo, Federico
AU - Taramasso, Maurizio
AU - Hibbert, Benjamin
N1 - Publisher Copyright:
© 2021 The Authors
PY - 2021/1/11
Y1 - 2021/1/11
N2 - 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.
AB - 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.
KW - cardiogenic shock
KW - mitral regurgitation
KW - transcatheter mitral valve repair
UR - http://www.scopus.com/inward/record.url?scp=85095446296&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2020.08.037
DO - 10.1016/j.jcin.2020.08.037
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C2 - 33069653
AN - SCOPUS:85095446296
SN - 1936-8798
VL - 14
SP - 1
EP - 11
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 1
ER -