Skip to main content
Search
Search
Quick Search anywhere
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Skip main navigationClose Drawer MenuOpen Drawer Menu
JACC Journals › JACC › Archives › Vol. 80 No. 22
Previous
Next

Transcatheter Edge-to-Edge Mitral Valve Repair in Patients With Severe Mitral Regurgitation and Cardiogenic ShockGET ACCESS

Original Investigation

J Am Coll Cardiol. 2022 Nov, 80 (22) 2072–2084
Topic(s):
Editorial Comment: Transcatheter Treatment of Mitral Regurgitation in Cardiogenic Shock: Promises and Pitfalls∗
Letters: Mitral Valve Transcatheter Edge-to-Edge Repair in Patients With Cardiogenic Shock and Severe Mitral Regurgitation
Sections

Central Illustration

Abstract

Background

Data on the efficacy of transcatheter edge-to-edge repair (TEER) in patients with cardiogenic shock (CS) are limited.

Objectives

This study investigated the characteristics and outcomes of consecutive patients with significant mitral regurgitation (MR) and CS who underwent TEER.

Methods

The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry was assessed from November 22, 2013, to December 31, 2021. CS was defined as the coding of: 1) CS; 2) inotrope use; or 3) mechanical circulatory support before TEER. Device success was defined as MR reduction of ≥1 grade and a final MR grade ≤2+. The primary outcome was the impact of device success on 1-year mortality or heart failure (HF) readmissions. Cox proportional hazards models were used to report the risk-adjusted association between device success and 1-year outcomes.

Results

A total of 3,797 patients met the inclusion criteria. Mean age was 73.0 ± 11.9 years, and 59.5% were male. Mean Society of Thoracic Surgery score (MV repair) was 14.9% ± 15.3%. MR etiology was degenerative (53.4%) and functional (27.5%). Device success was achieved in 3,249 (85.6%) patients given successful achievement of final MR grade ≤2+ (88.2%) and MR reduction ≥1 absolute grade (91.4%). At 1 year after TEER, device success was associated with significantly lower all-cause mortality (34.6% vs 55.5%; adjusted HR: 0.49; 95% CI: 0.41-0.59; P < 0.001) and a composite of mortality or HF admissions (29.6% vs 45.2%; adjusted HR: 0.51; 95% CI: 0.42-0.62; P < 0.001).

Conclusions

Successful MR reduction is achievable in most patients with CS and is associated with significantly lower mortality and HF hospitalization at 1 year. Randomized trials assessing TEER in CS are needed to establish this potential therapeutic approach.

References

  • 1. Mihatov N., Mosarla R.C., Kirtane A.J., et al. "Outcomes associated with peripheral artery disease in myocardial infarction with cardiogenic shock". J Am Coll Cardiol 2022;79:1223-1235.

    View ArticleGoogle Scholar

  • 2. Jung R.G., Simard T., Di Santo P., Hibbert B. "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.

    CrossrefMedlineGoogle Scholar

  • 3. Jung R.G., Simard T., Kovach C., et al. "Transcatheter mitral valve repair in cardiogenic shock and mitral regurgitation: a patient-level, multicenter analysis". J Am Coll Cardiol Intv 2021;14:1-11.

    View ArticleGoogle Scholar

  • 4. Mathew R., Di Santo P., Jung R.G., et al. "Milrinone as compared with dobutamine in the treatment of cardiogenic shock". N Engl J Med 2021;385:516-525.

    CrossrefMedlineGoogle Scholar

  • 5. Parlow S., Weng W., Di Santo P., et al. "Significant valvular dysfunction and outcomes in cardiogenic shock: insights from the randomized DOREMI Trial". Can J Cardiol 2022;38:1211-1219.

    CrossrefMedlineGoogle Scholar

  • 6. Thompson C.R., Buller C.E., Sleeper L.A., et al. "Cardiogenic shock due to acute severe mitral regurgitation complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we use emergently revascularize Occluded Coronaries in cardiogenic shocK?". J Am Coll Cardiol 2000;36:1104-1109.

    View ArticleGoogle Scholar

  • 7. Feldman T., Kar S., Elmariah S., et al. "Randomized comparison of percutaneous repair and surgery for mitral regurgitation: 5-year results of EVEREST II". J Am Coll Cardiol 2015;66:2844-2854.

    View ArticleGoogle Scholar

  • 8. Mack M., Carroll J.D., Thourani V., et al. "Transcatheter mitral valve therapy in the United States: a report from the STS-ACC TVT Registry". J Am Coll Cardiol 2021;78:2326-2353.

    View ArticleGoogle Scholar

  • 9. Stone G.W., Lindenfeld J., Abraham W.T., et al. "Transcatheter mitral-valve repair in patients with heart failure". N Engl J Med 2018;379:2307-2318.

    CrossrefMedlineGoogle Scholar

  • 10. Alkhouli M., Sulaiman S., Osman M., El Shaer A., Mayahni A.A., Kawsara A. "Trends in outcomes, cost, and readmissions of transcatheter edge to edge repair in the United States (2014-2018)". Catheter Cardiovasc Interv 2022;99:949-955.

    CrossrefMedlineGoogle Scholar

  • 11. Ben-Yehuda O., Shahim B., Chen S., et al. "Pulmonary hypertension in transcatheter mitral valve repair for secondary mitral regurgitation: the COAPT Trial". J Am Coll Cardiol 2020;76:2595-2606.

    View ArticleGoogle Scholar

  • 12. Beohar N., Ailawadi G., Kotinkaduwa L.N., et al. "Impact of baseline renal dysfunction on cardiac outcomes and end-stage renal disease in heart failure patients with mitral regurgitation: the COAPT trial". Eur Heart J 2022;43:1639-1648.

    CrossrefMedlineGoogle Scholar

  • 13. Hahn R.T., Asch F., Weissman N.J., et al. "Impact of tricuspid regurgitation on clinical outcomes: the COAPT Trial". J Am Coll Cardiol 2020;76:1305-1314.

    View ArticleGoogle Scholar

  • 14. Lerakis S., Kini A.S., Asch F.M., et al. "Outcomes of transcatheter mitral valve repair for secondary mitral regurgitation by severity of left ventricular dysfunction". EuroIntervention 2021;17:e335-e342.

    CrossrefMedlineGoogle Scholar

  • 15. Saxon J.T., Cohen D.J., Chhatriwalla A.K., et al. "Impact of COPD on outcomes after MitraClip for secondary mitral regurgitation: the COAPT Trial". J Am Coll Cardiol Intv 2020;13:2795-2803.

    View ArticleGoogle Scholar

  • 16. Alkhouli M., Alqahtani F., Bhatt D.L., Mathew V. "Outcomes and resource utilization for nonelective versus elective transcatheter mitral valve repair". Am J Cardiol 2019;123:1889-1891.

    CrossrefMedlineGoogle Scholar

  • 17. Haberman D., Estevez-Loureiro R., Benito-Gonzalez T., et al. "Conservative, surgical, and percutaneous treatment for mitral regurgitation shortly after acute myocardial infarction". Eur Heart J 2022;43:641-650.

    CrossrefMedlineGoogle Scholar

  • 18. Tang G.H.L., Estevez-Loureiro R., Yu Y., Prillinger J.B., Zaid S., Psotka M.A. "Survival following edge-to-edge transcatheter mitral valve repair in patients with cardiogenic shock: a nationwide analysis". J Am Heart Assoc 2021;10:e019882.

    CrossrefGoogle Scholar

  • 19. Alkhouli M., Zack C.J., Sarraf M., et al. "Successful percutaneous mitral paravalvular leak closure is associated with improved midterm survival". Circ Cardiovasc Interv 2017;10:

    CrossrefGoogle Scholar

  • 20. Lowenstern A., Lippmann S.J., Brennan J.M., et al. "Use of Medicare claims to identify adverse clinical outcomes after mitral valve repair". Circ Cardiovasc Interv 2019;12:e007451.

    CrossrefMedlineGoogle Scholar

  • 21. Stone G.W., Adams D.H., Abraham W.T., et al. "Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: part 2: endpoint definitions: a consensus document from the Mitral Valve Academic Research Consortium". J Am Coll Cardiol 2015;66:308-321.

    View ArticleGoogle Scholar

  • 22. Writing Committee Members. Otto C.M., Nishimura R.A., et al. "2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol 2021;77:450-500.

    View ArticleGoogle Scholar

  • 23. Thiele H., Ohman E.M., Desch S., Eitel I., de Waha S. "Management of cardiogenic shock". Eur Heart J 2015;36:1223-1230.

    CrossrefMedlineGoogle Scholar

  • 24. Adamo M., Curello S., Chiari E., et al. "Percutaneous edge-to-edge mitral valve repair for the treatment of acute mitral regurgitation complicating myocardial infarction: a single centre experience". Int J Cardiol 2017;234:53-57.

    CrossrefMedlineGoogle Scholar

  • 25. Falasconi G., Melillo F., Pannone L., et al. "Use of edge-to-edge percutaneous mitral valve repair for severe mitral regurgitation in cardiogenic shock: a multicenter observational experience (MITRA-SHOCK study)". Catheter Cardiovasc Interv 2021;98:E163-E170.

    CrossrefMedlineGoogle Scholar

  • 26. Flint K., Brieke A., Wiktor D., Carroll J. "Percutaneous edge-to-edge mitral valve repair may rescue select patients in cardiogenic shock: findings from a single center case series". Catheter Cardiovasc Interv 2019;94:E82-E87.

    CrossrefMedlineGoogle Scholar

  • 27. Martinez-Gomez E., McInerney A., Tirado-Conte G., et al. "Percutaneous mitral valve repair with MitraClip device in hemodynamically unstable patients: a systematic review". Catheter Cardiovasc Interv 2021;98:E617-E625.

    MedlineGoogle Scholar

  • 28. So C.Y., Kang G., Lee J.C., et al. "Transcatheter edge-to-edge repair for acute mitral regurgitation with cardiogenic shock secondary to mechanical complication". Cardiovasc Revasc Med 2022;S1553-8389(22)00645-5: https://doi.org/10.1016/j.carrev.2022.07.003.

    Google Scholar

  • 29. Godino C., Munafò A., Scotti A., et al. "MitraClip in secondary mitral regurgitation as a bridge to heart transplantation: 1-year outcomes from the International MitraBridge Registry". J Heart Lung Transplantation 2020;39:1353-1362.

    CrossrefMedlineGoogle Scholar

  • 30. Chhatriwalla A.K., Vemulapalli S., Holmes D.R., et al. "Institutional experience with transcatheter mitral valve repair and clinical outcomes: insights from the TVT Registry". J Am Coll Cardiol Intv 2019;12:1342-1352.

    View ArticleGoogle Scholar

  • 31. Lemor A., Basir M.B., Patel K., et al. "Multivessel versus culprit-vessel percutaneous coronary intervention in cardiogenic shock". J Am Coll Cardiol Intv 2020;13:1171-1178.

    View ArticleGoogle Scholar

  • 32. Masha L., Vemulapalli S., Manandhar P., et al. "Demographics, procedural characteristics, and clinical outcomes when cardiogenic shock precedes TAVR in the United States". J Am Coll Cardiol Intv 2020;13:1314-1325.

    View ArticleGoogle Scholar

  • 33. Omer M.A., Brilakis E.S., Kennedy K.F., et al. "Multivessel versus culprit-vessel percutaneous coronary intervention in patients with non-ST-segment elevation myocardial infarction and cardiogenic shock". J Am Coll Cardiol Intv 2021;14:1067-1078.

    View ArticleGoogle Scholar

  • 34. Piriou P.G., Manigold T., Letocart V., et al. "Outcomes of emergency transcatheter aortic valve replacement in patients with cardiogenic shock: a multicenter retrospective study". Catheter Cardiovasc Interv 2022;99:2117-2124.

    CrossrefMedlineGoogle Scholar

  • 35. Zeymer U., Hochadel M., Karcher A.K., et al. "Procedural success rates and mortality in elderly patients with percutaneous coronary intervention for cardiogenic shock". J Am Coll Cardiol Intv 2019;12:1853-1859.

    View ArticleGoogle Scholar

  • 36. Alkhouli M., Chaker Z., Cook C.C., Raybuck B. "Emergent transcatheter aortic valve replacement for the treatment of severe aortic stenosis patients presenting with cardiogenic shock or cardiac arrest; a case series". Structural Heart 2018;2:523-527.

    CrossrefGoogle Scholar

  • 37. Jentzer J.C., van Diepen S., Barsness G.W., et al. "Cardiogenic shock classification to predict mortality in the cardiac intensive care unit". J Am Coll Cardiol 2019;74:2117-2128.

    View ArticleGoogle Scholar

  • 38. Naidu S.S., Baran D.A., Jentzer J.C., et al. "SCAI SHOCK stage classification expert consensus update: a review and incorporation of validation studies: this statement was endorsed by the American College of Cardiology (ACC), American College of Emergency Physicians (ACEP), American Heart Association (AHA), European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC), International Society for Heart and Lung Transplantation (ISHLT), Society of Critical Care Medicine (SCCM), and Society of Thoracic Surgeons (STS) in December 2021". J Am Coll Cardiol 2022;79:933-946.

    View ArticleGoogle Scholar

  • 39. Parlow S., Di Santo P., Jung R.G., et al. "Transcatheter mitral valve repair for inotrope dependent cardiogenic shock—design and rationale of the CAPITAL MINOS Trial". Am Heart J 2022;254:81-87.

    CrossrefMedlineGoogle Scholar

  • 40. Leon M.B., Smith C.R., Mack M., et al. "Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery". N Engl J Med 2010;363:1597-1607.

    CrossrefMedlineGoogle Scholar

  • 41. Kawsara A., Sulaiman S., Mohamed M., et al. "Treatment effect of percutaneous coronary intervention in dialysis patients with ST-elevation myocardial infarction". Am J Kidney Dis 2022;79:832-840.

    CrossrefMedlineGoogle Scholar

  • 42. Sulaiman S., Kawsara A., Mohamed M.O., et al. "Treatment effect of percutaneous coronary intervention in men versus women with ST-segment-elevation myocardial infarction". J Am Heart Assoc 2021;10:e021638.

    CrossrefGoogle Scholar