RT Journal Article
T1 Transcatheter Mitral Valve Repair in Cardiogenic Shock and Mitral Regurgitation A Patient-Level, Multicenter Analysis
A1 Jung, Richard G.
A1 Simard, Trevor
A1 Kovach, Christopher
A1 Flint, Kelsey
A1 Don, Creighton
A1 Di Santo, Pietro
A1 Adamo, Marianna
A1 Branca, Luca
A1 Valentini, Francesca
A1 Benito-Gonzalez, Tomas
A1 Fernandez-Vazquez, Felipe
A1 Estevez-Loureiro, Rodrigo
A1 Berardini, Alessandra
A1 Conti, Nicolina
A1 Rapezzi, Claudio
A1 Biagini, Elena
A1 Parlow, Simon
A1 Shorr, Risa
A1 Levi, Amos
A1 Manovel, Ana
A1 Cardenal-Piris, Rosa
A1 Fernandez, Jose Diaz
A1 Shuvy, Mony
A1 Haberman, Dan
A1 Sala, Alessandra
A1 Alkhouli, Mohamad A.
A1 Marini, Claudia
A1 Bargagna, Marta
A1 Schiavi, Davide
A1 Denti, Paolo
A1 Markovic, Sinisa
A1 Buzzatti, Nicola
A1 Chan, Vincent
A1 Hynes, Mark
A1 Mesana, Thierry
A1 Labinaz, Marino
A1 Pappalardo, Federico
A1 Taramasso, Maurizio
A1 Hibbert, Benjamin
K1 cardiogenic shock
K1 mitral regurgitation
K1 transcatheter mitral valve repair
K1 Acute myocardial-infarction
K1 Early revascularization
K1 Percutaneous repair
K1 Management
K1 Surgery
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. (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
PB Elsevier science inc
SN 1936-8798
YR 2021
FD 2021-01-04
LK https://hdl.handle.net/10668/26537
UL https://hdl.handle.net/10668/26537
LA en
DS RISalud
RD Apr 5, 2025