Percutaneous Edge To Edge Mitral Repair As Salvage Temporizing Procedure In Acute Severe Mitral Regurgitation
Malak Elbatarny, Zvi Peled, Eric Cohen, Andrew Czarnecki, Gideon Cohen.
University of Toronto, Toronto, ON, Canada.
Introduction Patients with acute mitral regurgitation (MR) present in critical condition and surgical mortality is high. Percutaneous edge to edge mitral valve repair carries relatively low procedural risk and represents a possible temporizing approach until definitive repair can be performed under elective conditions. Objectives We examined perioperative as well as mid-term follow up outcomes of edge to edge percutaneous mitral valve repair in adults with acute severe MR precipitating cardiogenic shock. Method Patients with acute severe MR in cardiogenic shock were collected into our prospective percutaneous edge to edge repair database from 2013 to 2019. After excluding 2 patients who were deemed to be presenting subacutely, the final cohort consisted of 8 patients. Additional demographic and procedural details were obtained from chart review. Continuous variables are presented as means ± standard deviation; binary variables are indicated by proportions. Primary outcomes were survival to discharge and hospital length of stay. Other outcomes were: survival at latest follow up and completion of the second stage surgical intervention. Result The cohort had mean age 66±12 and 7 males (86%). All presented with acute MR in NYHA IV and critical condition (Table 1). Mean EUROSCORE II was 25±16. Among those presenting with MI, mean time since MI was 7±7 days. Mean preprocedural ejection fraction (EF) was 54±15%. Technical success was achieved in all 8 (100%) patients using a mean of 2±1 clips and mean postprocedural MR was reduced to 2±1. There was 1 late clip failure, that required re-clipping, followed by acute surgical intervention. Postprocedure EF was 54±16%. Three patients (43%) had concomitant PCI. Six patients (86%) survived to discharge; the one who was taken to surgery acutely, remained admitted at the time of follow up. Mean follow up was 22±24 months. Five patients (71%) underwent elective definitive surgical repair with mitral valve replacement and survived. One patient did not undergo elective surgical revision due to lack of symptoms and stable MR; he remains stable. Conclusions We demonstrate that percutaneous mitral repair may be a reasonable salvage strategy to stabilize acute MR patients in cardiogenic shock. This strategy can facilitate staged definitive surgical repair at lower risk in the elective setting.
| Variable | Mean±SD or N(%) |
| Age | 66±12 |
| Male | 7(88) |
| Euroscore II | 25±16 |
| Papillary MuscleRupture | 6(75) |
| STEMI | 4(50) |
| NSTEMI | 3(38) |
| IABP | 6(75) |
| Inotropes/Vasopressors | 5(63) |
| Ventilated | 7(88) |
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