Functional outcomes of clip use in severe mitral regurgitation and shock (FOCUS-MR): Single-center registry.

Background: Severe mitral regurgitation (MR) is associated with significant morbidity and mortality, particularly in patients with shock. While surgical repair remains the standard of care in acute primary MR, many critically ill patients are ineligible due to advanced age or comorbidities. Transcatheter edge-to-edge mitral valve repair (TEER) with MitraClip has emerged as a promising alternative. Unlike prior registries, this study directly compares cardiogenic vs. mixed shock using invasive criteria, integrates SCAI staging, BOS-MA2 risk prediction, and valve phenotyping, and highlights the need for prospective studies to refine patient selection.

Objectives: To evaluate the feasibility, safety, and clinical outcomes of MitraClip implantation in patients with severe MR and cardiogenic or mixed shock.

Methods: This retrospective cohort study analyzed 47 patients with severe MR and cardiogenic (n = 32) or mixed shock (n = 15) treated with MitraClip between January 2017 and December 2023. Procedural success, defined as successful clip deployment, reduction of MR to ≤2, and absence of major device-related complications, was assessed alongside short- and long-term outcomes. Baseline characteristics, hemodynamic parameters, and outcomes were compared between shock subtypes.

Results: Procedural success was achieved in 100 % of cases. MR severity improved significantly from grade 4 to grade ≤ 2 (p < 0.001). In-hospital mortality was 8.5 %, and 1-year mortality was 25.5 %. Patients with mixed shock had higher in-hospital mortality (20 % vs. 3.1 %, p = 0.53) and lower 1-year readmission rates (21.4 % vs. 58.6 %, p = 0.02). Predictors of 1-year mortality included advanced age, elevated left atrial volume index, and prolonged vasopressor use.

Conclusions: MitraClip implantation is a feasible intervention for severe MR in patients with shock, demonstrating high procedural success and meaningful reductions in MR severity across both cardiogenic and mixed shock. These exploratory findings highlight the need for larger prospective studies to validate outcomes and refine patient selection.