CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada.
Curr Opin Crit Care. 2022 Aug 1;28(4):426-433. doi: 10.1097/MCC.0000000000000952.
Cardiogenic shock with significant mitral regurgitation portends a poor prognosis with limited therapeutic options. Herein, we review the available evidence regarding the patient characteristics, management, impact of transcatheter edge-to-edge repair (TEER) on hemodynamics, and clinical outcomes of patients with cardiogenic shock and mitral regurgitation.
Several observational studies and systematic reviews have demonstrated the feasibility and safety of TEER in cardiogenic shock complicated by degenerative or functional mitral regurgitation. Surgical interventions for mitral regurgitation remain limited owing to the risk profile of patients in cardiogenic shock. TEER has been studied in both degenerative and functional mitral regurgitation and remains feasible in the critically ill population. Moreover, TEER is associated with reduction in mitral regurgitation and improvement in-hospital and long-term mortality.
TEER remains a promising therapeutic option in cardiogenic shock complicated by significant mitral regurgitation, but additional research is required to identify patient and procedural characteristics, hemodynamic parameters, and the optimal time for intervention. Moreover, future randomized controlled trials are in progress to evaluate the potential benefit of TEER against medical management in cardiogenic shock and mitral regurgitation.
伴有严重二尖瓣反流的心源性休克预后不良，治疗选择有限。本文回顾了有关心源性休克伴二尖瓣反流患者的特征、治疗、经导管缘对缘修复（TEER）对血流动力学的影响以及临床结局的现有证据。
几项观察性研究和系统评价表明，TEER 在心源性休克合并退行性或功能性二尖瓣反流中具有可行性和安全性。由于心源性休克患者的风险状况，二尖瓣反流的手术干预仍然有限。TEER 已在退行性和功能性二尖瓣反流中进行研究，并在危重症患者中具有可行性。此外，TEER 与二尖瓣反流减少以及住院和长期死亡率降低相关。
TEER 仍然是伴严重二尖瓣反流的心源性休克有前途的治疗选择，但需要进一步研究以确定患者和手术特征、血流动力学参数以及干预的最佳时机。此外，正在进行未来的随机对照试验，以评估 TEER 在心源性休克和二尖瓣反流中的治疗效果是否优于药物治疗。
