经导管缘对缘修复术治疗急性二尖瓣反流合并心源性休克患者的临床结局：一项系统评价和荟萃分析
Clinical outcomes of transcatheter edge-to-edge repair in patients with acute mitral regurgitation complicated by cardiogenic shock: a systematic review and meta-analysis.
作者信息
Ahmed Ashraf, Contreras Rafael, Gurram Anoop, Saberian Parsa, Kaddoura Rasha, Boyea Kayla, Issaka Yussif, Hashemi Seyyed Mohammad, Ameen Daniyal, Nobakht Sara, Amini-Salehi Ehsan, Nayak Sandeep Samethadka
机构信息
Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, USA.
Department of Hospital Medicine, Cleveland Clinic, 33300 Cleveland Clinic Blvd, Avon, OH, 44011, USA.
出版信息
BMC Cardiovasc Disord. 2025 May 19;25(1):380. doi: 10.1186/s12872-025-04844-z.
BACKGROUND
Acute mitral regurgitation (AMR) complicated by cardiogenic shock (CS) is a critical cardiovascular emergency associated with high morbidity and mortality. Surgical intervention is often not feasible due to the unstable clinical status of these patients. Transcatheter edge-to-edge repair (TEER) has emerged as a minimally invasive alternative, yet its safety and efficacy in this specific population remain uncertain. This study aimed to systematically evaluate and synthesize the evidence on the clinical outcomes of TEER in patients with AMR complicated by CS.
METHODS
Databases including PubMed, Embase, and Web of Science were searched through March 4, 2025. Eligible studies included adult patients with AMR and CS undergoing TEER and reporting clinical outcomes. Data were synthesized using a random-effects model.
RESULTS
The pooled in-hospital mortality rate following TEER was 17.8% (95% CI: 11.2-25.2%). One-month mortality was 7.9% (95% CI: 1.1-16.8%), six-month mortality was 21.0% (95% CI: 11.2-32.7%), and one-year mortality was 36.5% (95% CI: 34.9-38.2%). Among patients with degenerative MR, the one-year mortality was 7.9% (95% CI: 0.8-19.0%), while for functional MR it was 9.4% (95% CI: 1.3-21.5%). Postprocedural MR reduction to ≤ grade 2 was achieved in 86.2% of patients (95% CI: 70.7-97.3%). The intra-aortic balloon pump (IABP) application rate was 57.9% (95% CI: 24.2%-88.5%). Compared to usual care, TEER significantly reduced in-hospital mortality (OR = 0.64; 95% CI: 0.51-0.81; P < 0.01). However, no significant reduction was found in rehospitalization risk (OR = 0.65; 95% CI: 0.14-3.03; P = 0.59).
CONCLUSION
TEER appears to be a promising therapeutic option for patients with AMR complicated by CS. Compared to usual care, it is associated with significantly lower in-hospital mortality. However, high heterogeneity and low certainty of evidence highlight the need for further high-quality prospective studies to validate long-term outcomes and optimize patient selection.
CLINICAL TRIAL NUMBER
Not applicable.
背景
急性二尖瓣反流（AMR）合并心源性休克（CS）是一种严重的心血管急症，发病率和死亡率都很高。由于这些患者临床状态不稳定，手术干预往往不可行。经导管缘对缘修复术（TEER）已成为一种微创替代方案，但其在这一特定人群中的安全性和有效性仍不确定。本研究旨在系统评价和综合关于TEER治疗AMR合并CS患者临床结局的证据。
方法
检索了包括PubMed、Embase和Web of Science在内的数据库，检索截至2025年3月4日的文献。符合条件的研究包括接受TEER并报告临床结局的成年AMR合并CS患者。使用随机效应模型对数据进行综合分析。
结果
TEER术后住院死亡率的合并率为17.8%（95%置信区间：11.2 - 25.2%）。1个月死亡率为7.9%（95%置信区间：1.1 - 16.8%），6个月死亡率为21.0%（95%置信区间：11.2 - 32.7%），1年死亡率为36.5%（95%置信区间：34.9 - 38.2%）。在退行性二尖瓣反流患者中，1年死亡率为7.9%（95%置信区间：0.8 - 19.0%），而功能性二尖瓣反流患者为9.4%（95%置信区间：1.3 - 21.5%）。86.2%的患者术后二尖瓣反流程度降至≤2级（95%置信区间：70.7 - 97.3%）。主动脉内球囊泵（IABP）的应用率为57.9%（95%置信区间：24.2% - 88.5%）。与常规治疗相比，TEER显著降低了住院死亡率（比值比[OR]=0.64；95%置信区间：0.51 - 0.81；P<0.01）。然而，再住院风险没有显著降低（OR = 0.65；95%置信区间：0.14 - 3.03；P = 0.59）。
结论
TEER似乎是治疗AMR合并CS患者的一种有前景的治疗选择。与常规治疗相比，它与显著更低的住院死亡率相关。然而，高度的异质性和证据的低确定性凸显了需要进一步开展高质量的前瞻性研究来验证长期结局并优化患者选择。
临床试验编号
不适用。
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