Percutaneous mitral valve repair with MitraClip device in hemodynamically unstable patients: A systematic review.

Autor: Martinez-Gomez E; Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., McInerney A; Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Tirado-Conte G; Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., de Agustin JA; Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Jimenez-Quevedo P; Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Escudero A; Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Pozo Osinalde E; Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Viana-Tejedor A; Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Goirigolzarri J; Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Marroquin L; Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Vivas D; Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Ferrera C; Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Noriega F; Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Restrepo-Cordoba MA; Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Gonzalo N; Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Escaned J; Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Fernández-Ortiz A; Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Amat-Santos I; Cardiology Department, CIBERCV, Hospital Clínico Universitario, Valladolid, Spain., Estevez-Loureiro R; Interventional Cardiology Unit, University Hospital Alvaro Cunqueiro, Vigo, Spain., Macaya C; Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Nombela-Franco L; Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.
Jazyk: angličtina
Zdroj: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2021 Oct; Vol. 98 (4), pp. E617-E625. Date of Electronic Publication: 2021 Apr 15.
DOI: 10.1002/ccd.29703
Abstrakt: Background: Very few data exist on percutaneous mitral valve repair (PMVr) in unstable patients with concomitant moderate-severe mitral regurgitation (MR). The purpose of this systematic review was to evaluate baseline characteristics, management and clinical outcomes of critically ill patients undergoing PMVr with MitraClip.
Methods: We conducted a systematic review of the published data on MitraClip from its first use in 2003 to December 2020. Studies referring to critically ill patients in cardiogenic shock or acute refractory pulmonary edema were included. A total of 40 publications including 254 patients with significant MR (Grade 4 in 91%) were included.
Results: Mean age was 70 ± 12 years with mean Euroscore II and STS of 21 ± 13 and 20.5 ± 16, respectively. Clinical presentation was with cardiogenic shock and acute myocardial infarction in 72.8 and 60.0% of patients, respectively. Device success was achieved in 238 (93.7%) patients with a significant reduction in MR (Grade ≤ 2 in 91.8%, p < .001). The median weaning time from the procedure, to discontinuation of mechanical circulatory or respiratory support, was 2 days (IQR 1-4), with an in-hospital mortality and non-fatal complication rate of 12.6 and 9.1%, respectively. Kaplan-Meier curves estimated an overall mortality rate of 39.1% at 12-month follow-up, with persistent reduction in MR severity for survivors (Grade ≤ 2 in 81.3%) and one case of mitral valve reintervention.
Conclusions: Percutaneous mitral valve repair with MitraClip device is a technically feasible and potentially viable management option in high-risk patients with cardiogenic shock or refractory pulmonary edema and concomitant moderate-severe MR. Prospective trials are required to confirm these findings, and definitively determine the value of MitraClip in hemodynamically unstable patients.
(© 2021 Wiley Periodicals LLC.)
Databáze: MEDLINE
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