Percutaneous edge-to-edge mitral valve repair may rescue select patients in cardiogenic shock: Findings from a single center case series

Abstract

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.

Keywords: MitraClip; cardiogenic shock; edge-to-edge mitral valve repair; mitral regurgitation.