Transcatheter Edge-to-Edge Repair for Acute Mitral Regurgitation With Cardiogenic Shock Secondary to Mechanical Complication

• Published in: Cardiovascular revascularization medicine 2022-12, Vol.45, p.44-50
• Main Authors: So, Chak-yu, Kang, Guson, Lee, James C., Frisoli, Tiberio M., O'Neill, Brian, Wang, Dee Dee, Eng, Marvin H., O'Neill, William, Villablanca, Pedro A.
• Format: Article
• Language: English
• Subjects: Cardiogenic shock; Humans; Mitral regurgitation; Myocardial infarction; Shock, Cardiogenic - diagnosis; Shock, Cardiogenic - etiology; Shock, Cardiogenic - therapy; Transcatheter edge to edge repair
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2022.07.003

Acute MR due to mechanical mitral valve (MV) complications frequently results in cardiogenic shock and requires emergency surgical intervention. There was limited evidence for alternative treatment like MitraClip for patients at prohibitive surgical risk. We aimed to study the technical features and outcomes of emergency transcatheter edge-to-edge repair (TEER) using the MitraClip system for patients with cardiogenic shock (CS) secondary to acute mitral regurgitation (MR) and mechanical MV complication. We performed institutional review and systemic literature review to identify all TEER for CS patients due to acute mitral regurgitation and mechanical MV complication. Clinical endpoints included device success rate assessed at the end of procedure, ability to wean off MCS, all-cause and cardiovascular mortality at 30-day. Eight patients were identified from institutional review. Detail anatomical analysis found that patients with mechanical MV complications related to myocardial infarction had a lower transseptal height achieved during MitraClip (3.6 ± 0.1 cm vs 4.3 ± 0.3 cm, p = 0.03) than those not related. Pooled analysis for cases from institutional review (n = 8) and systemic literature review (n = 16) was performed. The device success rate was 68.8 %. Seventy-five percent (n = 18) cases required mechanical circulatory support (MCS), and 94.4 % were able to wean off MCS. At 30-day, the cardiovascular mortality was 4.5 % and the all-cause mortality was 9.1 %. In CS patients due to acute MR and mechanical MV complications, TEER with/without MCS was feasible with a reasonable device success rate. •Results from this study suggest that transcatheter edge-to-edge repair, specifically MitraClip, is a feasible treatment alternative for inoperable patients with cardiogenic shock due to acute mitral regurgitation and mechanical mitral valve complications.•MitraClip could be used as a bridge to definitive mitral valve surgery and in some isolated cases as destination therapy.