Mitral Transcatheter Edge-to-Edge Repair and Mandatory Mechanical Circulatory Support in Patients With Structural Shock

Background

Mitral regurgitation (MR) may be a cause or contributor to cardiogenic shock (CS). The roles of mitral transcatheter edge-to-edge repair (M-TEER) and mechanical circulatory support (MCS) have not been fully delineated. This prospective registry of patients with significant MR and CS was designed to determine procedural success and survival with M-TEER performed with mandatory MCS.

Methods

Over an 8-year period ending August 2024, this single hospital system prospective analysis identified consecutive patients with CS with significant MR. The primary outcome was achieving pre-defined procedural objectives: In aggregate, an absolute >2 Grade MR reduction, normalization of pulmonary venous flow pattern and final mean transvalvular gradient <5 mmHg and 6-month mortality.

Results

The cohort included n = 30 patients with acute hemodynamic deterioration (mean age 74.1 + 13.7 years, 63.3% male). Mean Society of Thoracic Surgery score (MV repair) was 13.6% + 14.7%. Clinical profiles included: Chronic progressive shock/Acute shock on chronic CHF (50%), Ruptured mitral valve chordae with leaflet incompetence and intact LVEF (23.3%), Mixed etiology defined as reduced EF and ruptured chordae (13.3%) and Acute myocardial infarction (AMI) induced papillary muscle rupture (13.3%). M-TEER with mandatory MCS was performed in all 30 patients. Procedural objectives were achieved in 25 patients (83.3%). Survival to hospital discharge was 86.6% and at 3-months 80.0%. Overall, 6-month survival was 73.3%.

Conclusions

In CS complicated by significant MR, M-TEER with mandatory MCS can be performed with excellent procedural success and is associated with favorable clinical outcomes.