Impact of mitral valve transcatheter edge-to-edge repair on haemodynamic parameters in cardiogenic shock

IF 3.7 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

ESC Heart Failure Pub Date : 2025-04-14 DOI:10.1002/ehf2.15306

Michal Droppa, Dominik Rath, Philippa Jaeger, Ioannis Toskas, Monika Zdanyte, Andreas Goldschmied, Jürgen Schreieck, Meinrad Gawaz, Tobias Geisler

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Abstract

Background

Transcatheter edge-to-edge repair (TEER) has been shown to be an effective treatment option for patients experiencing cardiogenic shock (CS) with concomitant high-grade mitral valve regurgitation. However, haemodynamic changes following M-TEER have not been thoroughly investigated. Afterload mismatch, leading to the deterioration of haemodynamics subsequent to mitral regurgitation correction, could potentially occur and adversely impact prognosis. Our objective was to analyse the effect of TEER on haemodynamic and echocardiographic parameters in patients with CS.

Methods and results

We conducted a retrospective study of patients undergoing TEER for mitral valve regurgitation in the setting of CS. Haemodynamic and echocardiographic parameters before and after TEER were systematically analysed. A total of 25 patients underwent TEER in the context of CS. All patients were successfully treated with at least of one grade reduction in mitral regurgitation. The median left atrial mean pressure decreased from 23 mmHg (IQR 17–30) to 16 mmHg (IQR 11–20, P < 0.01), and the V-wave decreased from 36 mmHg (IQR 27–44) to 21 mmHg (IQR 14–25, P < 0.01) following the procedure. The stroke volume index and cardiac index increased from 25 mL/m² (IQR 18–29) to 34 mL/m² (IQR 25–44, P < 0.01) and from 1.90 L/min/m² (IQR 1.41–2.30) to 2.50 L/min/m² (IQR 1.99–2.86, P < 0.01), respectively. We did not observe any worsening of the ejection fraction after the procedure. Ten patients (40%) died during their hospital stay.

Conclusions

Our study demonstrates that TEER leads to favourable haemodynamic changes in patients with CS. We observed a significant reduction in left atrial pressure, V-wave, and an elevation in cardiac index. Importantly, we did not observe any deterioration in left ventricular function following the procedure. This supports the concept of haemodynamic stabilization with TEER in patients with CS and high-grade mitral regurgitation.

Abstract Image

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经导管二尖瓣边缘修复对心源性休克血流动力学参数的影响。

背景：经导管边缘到边缘修复（TEER）已被证明是心源性休克（CS）合并高级别二尖瓣反流患者的有效治疗选择。然而，M-TEER后的血流动力学变化尚未得到彻底调查。后负荷错配，导致二尖瓣返流矫正后血流动力学恶化，可能会发生并对预后产生不利影响。我们的目的是分析TEER对CS患者血流动力学和超声心动图参数的影响。方法和结果：我们进行了一项回顾性研究，患者接受TEER治疗二尖瓣反流在CS设置。系统分析TEER前后血流动力学及超声心动图参数。在CS背景下，共有25例患者接受了TEER。所有患者均成功治疗，二尖瓣返流至少降低一级。左房平均中位压由23 mmHg （IQR 17-30）降至16 mmHg (IQR 11-20, p2 （IQR 18-29）降至34 mL/m2 (IQR 25-44, p2 （IQR 1.41-2.30）降至2.50 L/min/m2 （IQR 1.99-2.86， P）。结论：我们的研究表明TEER可导致CS患者有利的血流动力学改变。我们观察到左房压、v波显著降低，心脏指数升高。重要的是，我们没有观察到手术后左心室功能的任何恶化。这支持了在CS和高级别二尖瓣反流患者中使用TEER稳定血流动力学的概念。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine

CiteScore

7.00

自引率

7.90%

发文量

461

审稿时长

12 weeks

期刊介绍： ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.