Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado.
Rocky Mountain Regional VA Medical Center, Medicine Services, Cardiology, Aurora, Colorado.
Catheter Cardiovasc Interv. 2019 Aug 1;94(2):E82-E87. doi: 10.1002/ccd.28089. Epub 2019 Jan 24.
Patients with severe mitral regurgitation (MR) and cardiogenic shock are typically too high risk for immediate surgery; however, percutaneous edge-to-edge mitral valve repair (pMVr) may be reasonable in select patients.
Describe characteristics and outcomes of patients who underwent pMVr with and without shock at a single center.
Chart review of all patients who underwent non-investigational pMVr from November 2013 to October 2018. Shock was defined as dependence on an intravenous (IV) inotrope, IV afterload reduction, and/or temporary mechanical circulatory support immediately preceding pMVr.
There were 135 patients. Mean age was 80 ± 12 years and 56 (41%) were female. Twelve (8.9%) had shock. All patients had 3+ or 4+ MR at baseline. Post-procedure, all shock patients had 2+ or less MR. Two (17%) shock patients and 4 (3%) non-shock patients died within 30 days of pMVr (P = 0.03). Six (50%) shock patients had resolution of shock and discharged home (primary outcome). Five shock patients had acute MI, four of whom met the primary outcome. Four shock patients had chronic MR (>21 days), three of whom did not meet the primary outcome. Overall, follow-up time for mortality was median (IQR) 198 (42-379) days. Shock patients who survived to 30 days post-procedure had significantly shorter time from diagnosis of MR to pMVr compared to those who died (35 ± 68 vs. 374 ± 111 days; P = 0.0001).
Percutaneous edge-to-edge MVr may be reasonable in shock patients with acute MR and/or acute MI. This case series should guide larger studies designed to improve selection of shock patients for pMVr.
患有严重二尖瓣反流（MR）和心源性休克的患者通常手术风险过高；然而，在某些患者中，经皮缘对缘二尖瓣修复术（pMVr）可能是合理的。
描述在一家中心接受 pMVr 治疗的有和无休克患者的特征和结局。
对 2013 年 11 月至 2018 年 10 月期间接受非介入性 pMVr 的所有患者进行病历回顾。休克定义为在 pMVr 前立即依赖静脉（IV）正性肌力药、IV 后负荷降低和/或临时机械循环支持。
共有 135 名患者，平均年龄为 80±12 岁，56 名（41%）为女性。12 名（8.9%）有休克。所有患者在基线时均有 3+或 4+MR。术后，所有休克患者的 MR 均为 2+或以下。2 名（17%）休克患者和 4 名（3%）非休克患者在 pMVr 后 30 天内死亡（P=0.03）。6 名（50%）休克患者休克缓解并出院（主要结局）。5 名休克患者发生急性心肌梗死，其中 4 名符合主要结局。4 名休克患者有慢性 MR（>21 天），其中 3 名不符合主要结局。总体而言，死亡率的随访时间中位数（IQR）为 198（42-379）天。存活至 pMVr 后 30 天的休克患者从 MR 诊断到 pMVr 的时间明显短于死亡患者（35±68 与 374±111 天；P=0.0001）。
对于急性 MR 和/或急性 MI 的休克患者，经皮缘对缘 MVr 可能是合理的。本病例系列应指导旨在改善对休克患者进行 pMVr 选择的更大研究。
