Transcatheter Mitral Valve Repair in Cardiogenic Shock and Mitral Regurgitation
| Autor: | Rosa Cardenal-Piris, Felipe Fernández-Vázquez, Creighton W. Don, Francesca Valentini, Simon Parlow, Nicolina Conti, Mohamad A. Alkhouli, Alessandra Berardini, Dan Haberman, Amos Levi, Claudio Rapezzi, Marino Labinaz, Marta Bargagna, Luca Branca, Thierry G. Mesana, Benjamin Hibbert, Elena Biagini, Tomás Benito-González, Nicola Buzzatti, Risa Shorr, Richard G. Jung, Davide Schiavi, Sinisa Markovic, Marianna Adamo, José Francisco Díaz Fernández, Federico Pappalardo, Pietro Di Santo, Trevor Simard, Alessandra Sala, Christopher P. Kovach, Vincent Chan, Mony Shuvy, Claudia Marini, Paolo Denti, Mark Hynes, Rodrigo Estévez-Loureiro, Kelsey M. Flint, Ana J. Manovel, Maurizio Taramasso |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
education.field_of_study Mitral regurgitation business.industry Cardiogenic shock Hazard ratio Population 030204 cardiovascular system & hematology medicine.disease Confidence interval 3. Good health 03 medical and health sciences 0302 clinical medicine Interquartile range Internal medicine Heart failure medicine Cardiology Transcatheter mitral valve repair 030212 general & internal medicine 10. No inequality Cardiology and Cardiovascular Medicine business education |
| Zdroj: | JACC: Cardiovascular Interventions. 14:1-11 |
| ISSN: | 1936-8798 |
| Popis: | Objectives: The aim of this study was to evaluate the outcome of transcatheter mitral valve repair (TMVr) in patients with cardiogenic shock and significant mitral regurgitation (MR). Background: Patients in cardiogenic shock with severe MR have a poor prognosis in the setting of conventional medical therapy. Because of its favorable safety profile, TMVr is being increasingly used as an acute therapy in this population, though its efficacy remains unknown. Methods: A multicenter, collaborative, patient-level analysis was conducted. Patients with cardiogenic shock and moderate to severe (3+) or severe (4+) MR who were not surgical candidates were treated with TMVr. The primary outcome was in-hospital mortality. Secondary outcomes included 90-day mortality, heart failure (HF) hospitalization, and the combined event rate of 90-day mortality and HF hospitalization following dichotomization by TMVr device success. Results: Between January 2011 and February 2019, 141 patients across 14 institutions met the inclusion criteria. In-hospital mortality occurred in 22 patients (15.6%), at 90 days in 38 patients (29.5%), and at one year in 55 patients (42.6%). Median length of hospital stay following TMVr was 10 days (interquartile range: 6 to 20 days). HF hospitalization occurred in 26 patients (18.4%) at a median of 73 days (interquartile range: 26 to 546 days). When stratified by TMVr procedural results, successful TMVr reduced rates of in-hospital mortality (hazard ratio [HR]: 0.36; 95% confidence interval [CI]: 0.13 to 0.98; p = 0.04), 90-day mortality (HR: 0.36; 95% CI: 0.16 to 0.78; p = 0.01), and the composite of 90-day mortality and HF hospitalization (HR: 0.41; 95% CI: 0.19 to 0.90; p = 0.03). Conclusions: TMVr may improve short- and intermediate-term mortality in high-risk patients with cardiogenic shock and moderate to severe MR. Randomized studies are needed to definitively establish MR as a therapeutic target in patients with cardiogenic shock. |
| Databáze: | OpenAIRE |
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