Transcatheter edge-to-edge mitral valve repair in patients with acute decompensated heart failure due to severe mitral regurgitation
Abstract
Background: Transcatheter edge-to-edge mitral valve repair (TEER) has been established as a therapy for severe symptomatic mitral regurgitation (MR) in stable patients, and it has recently emerged as a reasonable option for acutely ill patients. The aim of this study was to evaluate the safety and efficacy of TEER in hospitalized patients with acute decompensated heart failure (ADHF) and severe MR that was deemed to play a major role in their deterioration.
Methods: We included 31 patients who underwent emergent TEER for MR ≥ 3+ from 2012 to 2022 at Sheba Medical Center. Outcomes included procedural safety, procedural success, all-cause mortality, heart failure readmission, and functional improvement. Outcomes were evaluated at 3 months and at 1 year. Data were obtained retrospectively by chart review.
Results: Implantation of a TEER device was achieved in 97% of patients, and reduction in MR severity of at least two grades and final MR ≤ 2+ at discharge was achieved in 74%. No intra-procedural mortality or life-threatening complications were noted. Mortality at 30 days was 23%. No excess mortality occurred beyond 6 months, with a total mortality of 41%. At 1 year all survivors had MR ≤ 2+, all were free of heart failure hospitalizations, and 88% were at New York Heart Association class ≤ II.
Conclusions: Mitral valve TEER for patients with ADHF and significant MR is safe, feasible, and achieves substantial reduction in MR severity. Despite high early mortality, procedural success is associated with good long-term clinical outcomes for patients surviving longer than 6 months.
Keywords: mitral valvemitral regurgitationacute decompensated heart failuretrans-catheter edge-to-edge repairtranscatheter edge-to-edge mitral valve repair
References
- Alla F, Zannad F, Filippatos G. Epidemiology of acute heart failure syndromes. Heart Failure Rev. 2007; 12(2): 91–95.
- Braunwald E. The war against heart failure: the Lancet lecture. Lancet. 2015; 385(9970): 812–824.
- Shah KS, Xu H, Matsouaka RA, et al. Heart failure with preserved, borderline, and reduced ejection fraction: 5-year outcomes. J Am Coll Cardiol. 2017; 70(20): 2476–2486.
- Magnussen C, Niiranen TJ, Ojeda FM, et al. Sex-specific epidemiology of heart failure risk and mortality in Europe: results from the biomarcare consortium. JACC Heart Fail. 2019; 7(3): 204–213.
- Arora S, Sivaraj K, Hendrickson M, et al. Prevalence and prognostic significance of mitral regurgitation in acute decompensated heart failure: the ARIC study. JACC Heart Fail. 2021; 9(3): 179–189.
- Whitlow PL, Feldman T, Pedersen WR, et al. EVEREST II Investigators. Acute and 12-month results with catheter-based mitral valve leaflet repair: the EVEREST II (Endovascular Valve Edge-to-Edge Repair) High Risk Study. J Am Coll Cardiol. 2012; 59(2): 130–139.
- Maisano F, Franzen O, Baldus S, et al. Percutaneous mitral valve interventions in the real world. J Am Coll Cardiol. 2013; 62(12): 1052–1061.
- Glower DD, Kar S, Trento A, et al. Percutaneous mitral valve repair for mitral regurgitation in high-risk patients: results of the EVEREST II study. J Am Coll Cardiol. 2014; 64(2): 172–181.
- Puls M, Lubos E, Boekstegers P, et al. One-year outcomes and predictors of mortality after MitraClip therapy in contemporary clinical practice: results from the German transcatheter mitral valve interventions registry. Eur Heart J. 2015; 37(8): 703–712.
- Stone GW, Lindenfeld J, Abraham WT, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med. 2018; 379(24): 2307–2318.
- Flint K, Brieke A, Wiktor D, et al. Percutaneous edge-to-edge mitral valve repair may rescue select patients in cardiogenic shock: findings from a single center case series. Catheter Cardiovasc Interv. 2019; 94(2): E82–E87.
- Haberman D, Taramasso M, Czarnecki A, et al. Salvage MitraClip in severe secondary mitral regurgitation complicating acute myocardial infarction: data from a multicentre international study. Eur J Heart Fail. 2019; 21(9): 1161–1164.
- Cheng R, Dawkins S, Hamilton MA, et al. Percutaneous mitral repair for patients in cardiogenic shock requiring inotropes and temporary mechanical circulatory support. JACC Cardiovasc Interv. 2019; 12(23): 2440–2441.
- Kovach CP, Bell S, Kataruka A, et al. Outcomes of urgent/emergent transcatheter mitral valve repair (MitraClip): a single center experience. Catheter Cardiovasc Interv. 2021; 97(3): E402–E410.
- Haberman D, Estévez-Loureiro R, Benito-Gonzalez T, et al. Safety and feasibility of MitraClip implantation in patients with acute mitral regurgitation after recent myocardial infarction and severe left ventricle dysfunction. J Clin Med. 2021; 10(9): 1819.
- Estévez-Loureiro R, Shuvy M, Taramasso M, et al. Use of MitraClip for mitral valve repair in patients with acute mitral regurgitation following acute myocardial infarction: Effect of cardiogenic shock on outcomes (IREMMI Registry). Catheter Cardiovasc Interv. 2021; 97(6): 1259–1267.
- Feldman T, Foster E, Glower DD, et al. Percutaneous repair or surgery for mitral regurgitation. N Engl J Med. 2011; 364(15): 1395–1406.
- Obadia JF, Messika-Zeitoun D, Leurent G, et al. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med. 2018; 379(24): 2297–2306.
- Geis NA, Puls M, Lubos E, et al. Safety and efficacy of MitraClip™ therapy in patients with severely impaired left ventricular ejection fraction: results from the German transcatheter mitral valve interventions (TRAMI) registry. Eur J Heart Fail. 2018; 20(3): 598–608.
- Lorusso R, Gelsomino S, De Cicco G, et al. Mitral valve surgery in emergency for severe acute regurgitation: analysis of postoperative results from a multicentre study. Eur J Cardiothorac Surg. 2008; 33(4): 573–582.
