Kelsey Flint1,2, Andreas Brieke1,3, Dominik Wiktor1,4, John Carroll1,4. 1. Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado. 2. Rocky Mountain Regional VA Medical Center, Medicine Services, Cardiology, Aurora, Colorado. 3. University of Colorado School of Medicine, Division of Cardiology, Section of Advanced Heart Failure, Transplantation and Mechanical Circulatory Support, Aurora, Colorado. 4. University of Colorado School of Medicine, Division of Cardiology, Section of Interventional Cardiology, Aurora, Colorado.
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.
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 shockpatients had 2+ or less MR. Two (17%) shockpatients and 4 (3%) non-shockpatientsdied within 30 days of pMVr (P = 0.03). Six (50%) shockpatients had resolution of shock and discharged home (primary outcome). Five shockpatients had acute MI, four of whom met the primary outcome. Four shockpatients 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. Shockpatients 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 shockpatients with acute MR and/or acute MI. This case series should guide larger studies designed to improve selection of shockpatients for pMVr.