Dimitriadis Kyriakos, Soulaidopoulos Stergios, Pyrpyris Nikolaos, Sagris Μarios, Aznaouridis Konstantinos, Beneki Eirini, Theofilis Panagiotis, Tsioufis Panagiotis, Tatakis Fotis, Fragkoulis Christos, Shuvy Mony, Chrysohoou Christina, Aggeli Konstantina, Tsioufis Konstantinos
First Cardiology Department, Hippokration General Hospital, School of Medicine National and Kapodistrian University of Athens Athens Greece.
Jesselson Integrated Heart Centre, Shaare Zedek Medical Center and Faculty of Medicine Hebrew University Jerusalem Israel.
J Am Heart Assoc. 2025 Mar 18;14(6):e034932. doi: 10.1161/JAHA.124.034932. Epub 2025 Mar 7.
Patients with severe mitral regurgitation and cardiogenic shock demonstrate a poor prognosis. Mitral transcatheter edge-to-edge repair could alter patient management.
We systematically reviewed PubMed/Medline, Scopus, and Cochrane Library until January 2023, including studies assessing transcatheter edge-to-edge repair in patients with severe mitral regurgitation and cardiogenic shock. Studies with <5 patients were excluded. The primary outcome was device success and all-cause death, while secondary outcomes included myocardial infarction, stroke, and heart failure hospitalization rates at 30-day and intermediate-term follow-up. A fixed-effects meta-analysis was used to estimate pooled rates. Risk of bias was assessed with the Newcastle-Ottawa Scale. A total of 24 studies and 5428 patients were included, with a mean age of 71.2±3.3 years and a high mean Society of Thoracic Surgery score (15.2±8.9). Device success was achieved in 86% (95% CI, 85%-87%) and mitral regurgitation ≤2+ in 89% (95% CI: 88%-90%). The 30-day all-cause mortality rate was 14% (95% CI, 13%-15%). Stroke, myocardial infarction, and heart failure hospitalization rates were 2% (95% CI, 1%-2%), 15% (95% CI, 13%-18%), and 9% (95% CI, 8%-10%), respectively. Patients with acute myocardial infarction had similar device success (81% [95% CI, 74%-87%]), a 30-day mortality rate of 20% (95% CI, 16%-25%), and intermediate-term mortality rate of 14% (95% CI, 9%-19%). In non-myocardial infarction populations, the 30-day mortality rate was 13% (95% CI, 13%-14%), and the intermediate-term mortality rate was 35% (95% CI, 34%-36%).
In patients with mitral regurgitation and cardiogenic shock, transcatheter edge-to-edge repair is associated with favorable 30-day and intermediate-term outcomes. Limitations, including the observational design of included studies and considerable heterogeneity, necessitate further research in this setting.
重度二尖瓣反流合并心源性休克的患者预后较差。二尖瓣经导管缘对缘修复术可能会改变患者的治疗策略。
我们系统检索了截至2023年1月的PubMed/Medline、Scopus和Cochrane图书馆，纳入评估重度二尖瓣反流合并心源性休克患者经导管缘对缘修复术的研究。排除患者数少于5例的研究。主要结局为手术成功和全因死亡，次要结局包括30天及中期随访时的心肌梗死、卒中及心力衰竭住院率。采用固定效应荟萃分析估计合并率。使用纽卡斯尔-渥太华量表评估偏倚风险。共纳入24项研究和5428例患者，平均年龄为71.2±3.3岁，胸外科医师协会评分较高（15.2±8.9）。手术成功率为86%（95%CI，85%-87%），二尖瓣反流≤2+的比例为89%（95%CI：88%-90%）。30天全因死亡率为14%（95%CI，13%-15%）。卒中、心肌梗死和心力衰竭住院率分别为2%（95%CI，1%-2%）、15%（95%CI，13%-18%）和9%（95%CI，8%-10%）。急性心肌梗死患者的手术成功率相似（81%[95%CI，74%-87%]），30天死亡率为20%（95%CI，16%-25%），中期死亡率为14%（95%CI，9%-19%）。在非心肌梗死人群中，30天死亡率为13%（95%CI，13%-14%），中期死亡率为35%（95%CI，34%-36%）。
对于二尖瓣反流合并心源性休克的患者，经导管缘对缘修复术具有良好的30天和中期结局。包括纳入研究的观察性设计和相当大的异质性在内的局限性，需要在该领域进一步开展研究。
