International Society For Minimally Invasive Cardiothoracic Surgery

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Transcatheter Mitral Valve Repair System Implantation In Patients With Acute Severe Mitral Valve Regurgitation And Cardiogenic Shock
Cinthia Orlov1, Oleg Orlov1, Vishal Shah1, Scott Goldman1, Eric Gnall1, Katie Hawthorne1, William Gray1, Roberto Rodriguez1, Sandra Abramson1, Konstadinos Plestis2.
1Lankenau Medical Center, Wynnewood, PA, USA, 2Lankenau Medical Center, Philadelphia, PA, USA.

Objectives: Patients with acute mitral valve regurgitation (MR) presenting with cardiogenic shock have a high risk of mortality. Preoperative stabilization may improve overall patient survival. The purpose of this study is to evaluate the application of the transcatheter mitral valve repair system in patients with acute severe MR and cardiogenic shock. Methods: From 2014 to 2018, 6 patients underwent MitraClip placement for acute MR and cardiogenic shock. The median age was 83 years (range 73-89). Five patients (83%) were female. Three patients (50%) had a prior myocardial infarction. Five patients (83%) had severe and 1 patient (17%) had moderate MR prior to MitraClip implantation. Three patients (50%) had ejection fraction below 40% (median 42%, range 28%-65%). Results: Four patients required preoperative left ventricular assist device placement to support their left ventricular function. Transcatheter mitral valve repair system was implanted at a median 6.5 days (range 0-17 days) from admission. Post-procedure, 4 patients (66%) had mild MR and 2 (44%) patients had moderate MR. The median duration of ventilatory support was 3.3 days (0-35.8 days). Thirty-day mortality was 33% (2 patients). One patient had mitral valve replacement 6 months after MitraClip implantation for severe recurrent MR. Conclusion: The transcatheter mitral valve repair system may decrease mortality in critically ill patients presenting with acute mitral regurgitation and cardiogenic shock and avoids emergency surgery owing to successful acute stabilization.

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