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Percutaneous edge‐to‐edge mitral valve repair may rescue select patients in cardiogenic shock: Findings from a single center case series
Author(s) -
Flint Kelsey,
Brieke Andreas,
Wiktor Dominik,
Carroll John
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28089
Subject(s) - medicine , cardiogenic shock , shock (circulatory) , inotrope , mitral regurgitation , cardiology , percutaneous , trauma center , heart failure , surgery , myocardial infarction , retrospective cohort study
Background Patients with severe mitral regurgitation (MR) and cardiogenic shock are typically too high risk for immediate surgery; however, percutaneous edge‐to‐edge mitral valve repair (pMVr) may be reasonable in select patients. Aim Describe characteristics and outcomes of patients who underwent pMVr with and without shock at a single center. Methods Chart review of all patients who underwent non‐investigational pMVr from November 2013 to October 2018. Shock was defined as dependence on an intravenous (IV) inotrope, IV afterload reduction, and/or temporary mechanical circulatory support immediately preceding pMVr. Results There were 135 patients. Mean age was 80 ± 12 years and 56 (41%) were female. Twelve (8.9%) had shock. All patients had 3+ or 4+ MR at baseline. Post‐procedure, all shock patients had 2+ or less MR. Two (17%) shock patients and 4 (3%) non‐shock patients died within 30 days of pMVr ( P = 0.03). Six (50%) shock patients had resolution of shock and discharged home (primary outcome). Five shock patients had acute MI, four of whom met the primary outcome. Four shock patients had chronic MR (>21 days), three of whom did not meet the primary outcome. Overall, follow‐up time for mortality was median (IQR) 198 (42–379) days. Shock patients who survived to 30 days post‐procedure had significantly shorter time from diagnosis of MR to pMVr compared to those who died (35 ± 68 vs. 374 ± 111 days; P = 0.0001). Conclusion Percutaneous edge‐to‐edge MVr may be reasonable in shock patients with acute MR and/or acute MI. This case series should guide larger studies designed to improve selection of shock patients for pMVr.