Salvage MitraClip in severe secondary mitral regurgitation complicating acute myocardial infarction: data from a multicentre international study

Haberman, Dan; Taramasso, Maurizio; Czarnecki, Andrew; Kerner, Arthur; Chrissoheris, Michael; Spargias, Konstantinos; Poles, Lion; Agmon, Yoram; Salvatore, Silvia; Beeri, Rоnen; Lotan, Chaim; Shuvy, Mony

doi:10.1002/ejhf.1565

Cited by 31 publications

(45 citation statements)

References 8 publications

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“…The impact of MitraClip in an acute setting was initially only evaluated in case reports and a small case series [31][32][33][34]. The two largest case series were previously published by our group [13,14]. Our findings confirm that MitraClip is a safe and effective procedure in acute settings for a selected high-risk group, both with LVEF < 35% and LVEF ≥ 35%, and that in most of the patients the effectiveness of mitral intervention was sustainable in long term follow up.…”

Section: Discussionsupporting

confidence: 67%

Safety and Feasibility of MitraClip Implantation in Patients with Acute Mitral Regurgitation after Recent Myocardial Infarction and Severe Left Ventricle Dysfunction

Haberman

Estévez‐Loureiro

Benito‐González

et al. 2021

JCM

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Patients with severe mitral regurgitation (MR) after myocardial infarction (MI) have an increased risk of mortality. Transcatheter mitral valve repair may therefore be a suitable therapy. However, data on clinical outcomes of patients in an acute setting are scarce, especially those with reduced left ventricle (LV) dysfunction. We conducted a multinational, collaborative data analysis from 21 centers for patients who were, within 90 days of acute MI, treated with MitraClip due to severe MR. The cohort was divided according to median left ventricle ejection fraction (LVEF)—35%. Included in the study were 105 patients. The mean age was 71 ± 10 years. Patients in the LVEF < 35% group were younger but with comparable Euroscore II, multivessel coronary artery disease, prior MI and coronary artery bypass graft surgery. Procedure time was comparable and acute success rate was high in both groups (94% vs. 90%, p = 0.728). MR grade was significantly reduced in both groups along with an immediate reduction in left atrial V-wave, pulmonary artery pressure and improvement in New York Heart Association (NYHA) class. In-hospital and 1-year mortality rates were not significantly different between the two groups (11% vs. 7%, p = 0.51 and 19% vs. 12%, p = 0.49) and neither was the 3-month re-hospitalization rate. In conclusion, MitraClip intervention in patients with acute severe functional mitral regurgitation (FMR) due to a recent MI in an acute setting is safe and feasible. Even patients with severe LV dysfunction may benefit from transcatheter mitral valve intervention and should not be excluded.

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Section: Discussionsupporting

confidence: 67%

Safety and Feasibility of MitraClip Implantation in Patients with Acute Mitral Regurgitation after Recent Myocardial Infarction and Severe Left Ventricle Dysfunction

Haberman

Estévez‐Loureiro

Benito‐González

et al. 2021

JCM

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“…The 30‐day mortality and periprocedural complication rates of our cohort exceeded those of elective TMVr in high‐risk nonsurgical candidates reported in randomized trials 12,13 . Several recent observational studies have evaluated outcomes of high‐risk TMVr in the setting of refractory ADHF or CS with 30‐day mortality ranging from 5 to 42% 18‐21 . Compared to these studies our cohort was similar in age, comorbidities, baseline LV function, and severity of MR, but included more patients with primary MR and relatively few patients with secondary MR in the context of acute myocardial infarction.…”

Section: Discussionmentioning

confidence: 92%

“…With increasing provider and institutional experience with TMVr, there is interest in evaluating the role of urgent and emergent TMVr to treat CS or refractory ADHF complicated by severe MR given the lack of effective treatment options 14,15 . However, data regarding outcomes among this critically ill population are limited 16‐21 …”

Section: Introductionmentioning

confidence: 99%

Outcomes of urgent/emergent transcatheter mitral valve repair (MitraClip): A single center experience

Kovach

Bell

Kataruka

et al. 2020

Cathet Cardio Intervent

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Objectives To describe the outcomes of urgent/emergent transcatheter edge‐to‐edge mitral valve repair (TMVr) and compare the clinical, echocardiographic, and procedural characteristics of survivors and nonsurvivors. Background TMVr is a treatment strategy for select patients with severe primary or secondary mitral regurgitation. However, knowledge regarding outcomes for urgent/emergent TMVr is limited. Methods All urgent or emergent TMVr procedures using MitraClip performed at the University of Washington Medical Center between January 2018 and March 2019 were identified and clinical, echocardiographic, hemodynamic, procedural, and outcomes data were obtained by chart review. Outcomes included all‐cause mortality, hospital mortality, procedural success, periprocedural complications, and hospital readmission. Results Of the 20 patients who underwent urgent/emergent TMVr, eight were treated for cardiogenic shock (CS), four for acute decompensated heart failure (ADHF) with hypoxemic respiratory failure requiring mechanical ventilation, and eight for ADHF with failure of inpatient medical therapy. Mechanical circulatory support (MCS) was used in six patients; preceding TMVr in three patients and immediately post‐TMVr in three patients. Overall, 30‐day mortality and hospital readmission rates were 21 and 13%, respectively. Over a median 153 days (IQR 20–491) of follow‐up, 10 patients (50%) died. Preprocedure CS, new or ongoing MCS post‐TMVr, refractory respiratory failure post‐TMVr, and acute kidney injury post‐TMVr were associated with mortality. Conclusions In a single‐center retrospective analysis, urgent/emergent TMVr in high‐risk patients with ADHF or CS was associated with high short‐term mortality and periprocedural complications. Prospective studies are warranted to inform patient selection and periprocedural management for urgent/emergent TMVr.

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“…Real-world experience on percutaneous edge-to-edge repair of acute MR is uniquely derived from case reports and small-size registries, listed and synthetized in Table 2 [19,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] .…”

Section: Real-world Evidences Of Mitraclip Procedures In Acute Mrmentioning

confidence: 99%

“…One to three clips were deployed with an almost complete procedural success, due to significant reduction of MR, huge reduction of left atrial pressures and increase of cardiac output. Haberman et al [42] reported one case of posterior leaflet tear during a second clip implantation, followed by urgent MV surgery and lastly by patient death. Early outcomes were promising, with high survival rates, sustained reduction of MR grade and improved functional class.…”

Section: Real-world Evidences Of Mitraclip Procedures In Acute Mrmentioning

confidence: 99%

Percutaneous mitral valve repair in acute mitral regurgitation: case report and review of the literature

Cannata¹,

Sanz‐Sánchez²,

Chiarito³

et al. 2020

Mini-invasive Surg

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Acute mitral regurgitation is a heterogeneous and life-threatening pathology, with severe hemodynamic consequences and extremely adverse outcomes. Traditionally, the definitive treatment is prompt surgical intervention after hemodynamic stabilization. Nowadays, however, percutaneous repair of mitral valve with MitraClip device has emerged as a safe and effective therapeutic option. Evidences in this field are still scarce. Hereby, we report the case of an 82-year-old woman with lateral ST-elevation myocardial infarction determining severe acute mitral regurgitation (MR) with an asymmetric leaflet tethering mechanism. Due to prohibitive operative risk and unstable hemodynamic status, the patient underwent a successful urgent MitraClip procedure with optimal reduction of MR and immediate hemodynamic improvement. Moreover, we provide a review of the available literature regarding the echocardiographic assessment of acute MR, results of published cases and possible management of this complex pathology.

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Salvage MitraClip in severe secondary mitral regurgitation complicating acute myocardial infarction: data from a multicentre international study

Cited by 31 publications

References 8 publications

Safety and Feasibility of MitraClip Implantation in Patients with Acute Mitral Regurgitation after Recent Myocardial Infarction and Severe Left Ventricle Dysfunction

Safety and Feasibility of MitraClip Implantation in Patients with Acute Mitral Regurgitation after Recent Myocardial Infarction and Severe Left Ventricle Dysfunction

Outcomes of urgent/emergent transcatheter mitral valve repair (MitraClip): A single center experience

Percutaneous mitral valve repair in acute mitral regurgitation: case report and review of the literature

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