Jung Richard G, Simard Trevor, Kovach Christopher, Flint Kelsey, Don Creighton, Di Santo Pietro, Adamo Marianna, Branca Luca, Valentini Francesca, Benito-González Tomás, Fernández-Vázquez Felipe, Estévez-Loureiro Rodrigo, Berardini Alessandra, Conti Nicolina, Rapezzi Claudio, Biagini Elena, Parlow Simon, Shorr Risa, Levi Amos, Manovel Ana, Cardenal-Piris Rosa, Diaz Fernandez Jose, Shuvy Mony, Haberman Dan, Sala Alessandra, Alkhouli Mohamad A, Marini Claudia, Bargagna Marta, Schiavi Davide, Denti Paolo, Markovic Sinisa, Buzzatti Nicola, Chan Vincent, Hynes Mark, Mesana Thierry, Labinaz Marino, Pappalardo Federico, Taramasso Maurizio, Hibbert Benjamin
CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada.
CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
JACC Cardiovasc Interv. 2021 Jan 11;14(1):1-11. doi: 10.1016/j.jcin.2020.08.037. Epub 2020 Oct 14.
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).
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.
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.
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).
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.
本研究旨在评估经导管二尖瓣修复术（TMVr）治疗心源性休克合并严重二尖瓣反流（MR）患者的疗效。
在传统药物治疗背景下，心源性休克合并严重MR的患者预后较差。由于TMVr具有良好的安全性，它正越来越多地被用作该人群的急性治疗方法，但其疗效仍不明确。
进行了一项多中心、协作的患者水平分析。对不适合手术的心源性休克合并中重度（3+）或重度（4+）MR的患者进行TMVr治疗。主要结局是住院死亡率。次要结局包括90天死亡率、心力衰竭（HF）住院率，以及根据TMVr手术成功与否进行二分法划分后的90天死亡率和HF住院率的联合事件发生率。
2011年1月至2019年2月期间，14家机构的141例患者符合纳入标准。22例患者（15.6%）发生住院死亡，38例患者（29.5%）在90天时死亡，55例患者（42.6%）在1年时死亡。TMVr术后住院时间中位数为10天（四分位间距：6至20天）。26例患者（18.4%）发生HF住院，中位数为73天（四分位间距：26至546天）。根据TMVr手术结果分层时，成功的TMVr降低了住院死亡率（风险比[HR]： 0.36；95%置信区间[CI]：0.13至0.98；p = 0.04）、90天死亡率（HR：0.36；95% CI：0.16至0.78；p = 0.01）以及90天死亡率和HF住院率的复合事件发生率（HR：0.41；95% CI：0.19至0.90；p = 0.03）。
TMVr可能改善心源性休克合并中重度MR的高危患者的短期和中期死亡率。需要进行随机研究以明确将MR确立为心源性休克患者的治疗靶点。
