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Meta-Analysis
. 2025 Mar 18;14(6):e034932.
doi: 10.1161/JAHA.124.034932. Epub 2025 Mar 7.

Transcatheter Edge-to-Edge Repair for Severe Mitral Regurgitation in Patients With Cardiogenic Shock: A Systematic Review and Meta-Analysis

Kyriakos Dimitriadis  1 , Stergios Soulaidopoulos  1 , Nikolaos Pyrpyris  1 , Μarios Sagris  1 , Konstantinos Aznaouridis  1 , Eirini Beneki  1 , Panagiotis Theofilis  1 , Panagiotis Tsioufis  1 , Fotis Tatakis  1 , Christos Fragkoulis  1 , Mony Shuvy  2 , Christina Chrysohoou  1 , Konstantina Aggeli  1 , Konstantinos Tsioufis  1
Affiliations
Meta-Analysis

Transcatheter Edge-to-Edge Repair for Severe Mitral Regurgitation in Patients With Cardiogenic Shock: A Systematic Review and Meta-Analysis

Kyriakos Dimitriadis et al. J Am Heart Assoc. .

Abstract

Background: Patients with severe mitral regurgitation and cardiogenic shock demonstrate a poor prognosis. Mitral transcatheter edge-to-edge repair could alter patient management.

Methods and results: We systematically reviewed PubMed/Medline, Scopus, and Cochrane Library until January 2023, including studies assessing transcatheter edge-to-edge repair in patients with severe mitral regurgitation and cardiogenic shock. Studies with <5 patients were excluded. The primary outcome was device success and all-cause death, while secondary outcomes included myocardial infarction, stroke, and heart failure hospitalization rates at 30-day and intermediate-term follow-up. A fixed-effects meta-analysis was used to estimate pooled rates. Risk of bias was assessed with the Newcastle-Ottawa Scale. A total of 24 studies and 5428 patients were included, with a mean age of 71.2±3.3 years and a high mean Society of Thoracic Surgery score (15.2±8.9). Device success was achieved in 86% (95% CI, 85%-87%) and mitral regurgitation ≤2+ in 89% (95% CI: 88%-90%). The 30-day all-cause mortality rate was 14% (95% CI, 13%-15%). Stroke, myocardial infarction, and heart failure hospitalization rates were 2% (95% CI, 1%-2%), 15% (95% CI, 13%-18%), and 9% (95% CI, 8%-10%), respectively. Patients with acute myocardial infarction had similar device success (81% [95% CI, 74%-87%]), a 30-day mortality rate of 20% (95% CI, 16%-25%), and intermediate-term mortality rate of 14% (95% CI, 9%-19%). In non-myocardial infarction populations, the 30-day mortality rate was 13% (95% CI, 13%-14%), and the intermediate-term mortality rate was 35% (95% CI, 34%-36%).

Conclusions: In patients with mitral regurgitation and cardiogenic shock, transcatheter edge-to-edge repair is associated with favorable 30-day and intermediate-term outcomes. Limitations, including the observational design of included studies and considerable heterogeneity, necessitate further research in this setting.

Keywords: MitraClip; TEER; cardiogenic shock; mitral regurgitation; myocardial infarction; transcatheter edge‐to‐edge repair.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses diagram of the included studies.
Figure 2
Figure 2. Postprocedural device success.
Figure 3
Figure 3. In‐hospital/30‐day postprocedural all‐cause death.
Figure 4
Figure 4. Intermediate‐term postprocedural all‐cause death.
See this image and copyright information in PMC

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