Transcatheter mitral valve repair for inotrope dependent cardiogenic shock – Design and rationale of the CAPITAL MINOS trial

Parlow, Simon; Santo, Pietro Di; Jung, Richard G.; Fam, Neil; Czarnecki, Andrew; Horlick, Eric; Abdel‐Razek, Omar; Chan, Vincent; Hynes, Mark; Nicholson, Donna; Dryden, Adam; Fernando, Shannon M.; Wells, George; Bernick, Jordan; Labinaz, Marino; Mathew, Rebecca; Simard, Trevor; Hibbert, Benjamin

doi:10.1016/j.ahj.2022.08.008

Cited by 16 publications

(5 citation statements)

References 29 publications

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“…The capital minos study [12] is an ongoing trial aiming to determine whether TEER improves outcomes in patients with CS and MR in comparison with medical therapy alone and will be an important step in optimizing treatment for this high-risk patient population.…”

Section: Discussionmentioning

confidence: 99%

Five-year Outcomes of Transcatheter Edge-to-Edge Repair in Patients with Mitral Regurgitation and Cardiogenic Shock

Dokollari,

Ramlawi

et al. 2023

IJS

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Objective: To analyze five-year clinical and echocardiographic outcomes in patients presenting with acute cardiogenic shock (CS) who underwent transcatheter edge-to-edge repair (TEER) for moderate or severe mitral valve regurgitation (MR). Methods: All consecutive patients who underwent TEER for MR were identified from our institutional medical records between 2015 and 2022. Patients presenting with CS undergoing TEER were included in the primary analysis. MR was diagnosed based on patient's echocardiographic findings and CS was diagnosed according to the definition in the TVT registry and/or presence of inotrope use prior to procedure and/or mechanical circulatory support prior to procedure. Kaplan-Meier survival curves were constructed to analyze outcomes. Primary outcome was five-year incidence of all-cause death. Secondary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE) and readmission for heart failure (HF). Results: A total of 35 patients were included in the study. Mean age was 81±10.4 years and 16 patients (45.7%) were male. Mean STS-score was 10.2±7.1. Nine (25.7%) patients had prior myocardial infarction (MI), 22 (62.8%) had previous atrial fibrillation, while 9 (25.7%) patients were hospitalized for HF within the past year. MR etiology was degenerative (71.4%), functional (22.9%), and mixed (5.7%). Prior to presentation with CS, NYHA classification included 2 (5,7%) patients in class I, 6 (17.1%) in class II, 13 (37.1%) in class III, and 14 (40%) in class IV. Pre-procedural mean LVEF was 56.4 ± 13%. Procedural characteristics included mean procedural time (from access to guide removal) of 2.0 ± 0.6 hours, > 1 implanted device in 14 (40.0%) patients, 1 patient had a single leaflet attachment. There was no procedural device embolism, device thrombosis, conversion to sternotomy, life threatening bleeding, stroke, MI, or death. Mean postoperative length of stay was 5.1 ± 4.4 days. During their hospital stay, a transient ischemic attack event occurred in 1 patient; however, no MI, stroke, or death were observed in any patient. During the follow-up, 13 (37.1%) patients were readmitted for HF, 1 patient needed mitral valve replacement and 1 patient needed new TEER. At 5 years, only 4 (11.4%) patients were alive. Conclusion: Despite excellent procedural and early outcomes for patients with significant MR and CS undergoing TEER, poor survival was observed after 5 years, which may be related to advanced age of this cohort.

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Section: Discussionmentioning

confidence: 99%

Five-year Outcomes of Transcatheter Edge-to-Edge Repair in Patients with Mitral Regurgitation and Cardiogenic Shock

Dokollari,

Ramlawi

et al. 2023

IJS

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“…Finally, the observational nature of these trials may introduce a selection bias, as patients that were more probable to survive may have been offered the intervention. Such limitations have to be addressed, and, therefore, the results of the first RCT in this context, i.e., CAPITAL MINOS, are largely awaited [ 67 ].…”

Section: Urgent Transcatheter Interventions For Mitral Pathologiesmentioning

confidence: 99%

Transcatheter Structural Heart Interventions in the Acute Setting: An Emerging Indication

Pyrpyris,

Dimitriadis,

Theofilis

et al. 2024

JCM

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Structural heart disease is increasingly prevalent in the general population, especially in patients of increased age. Recent advances in transcatheter structural heart interventions have gained a significant following and are now considered a mainstay option for managing stable valvular disease. However, the concept of transcatheter interventions has also been tested in acute settings by several investigators, especially in cases where valvular disease comes as a result of acute ischemia or in the context of acute decompensated heart failure. Tested interventions include both the mitral and aortic valve, mostly evaluating mitral transcatheter edge-to-edge repair and transcatheter aortic valve implantation, respectively. This review is going to focus on the use of acute structural heart interventions in the emergent setting, and it will delineate the available data and provide a meaningful discussion on the optimal patient phenotype and future directions of the field.

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“…36,37 Moreover, if mitral valve surgery is needed at a later time due to failure of the MitraClip, this would preclude these patients. 37 The CAPITAL MINOS randomized clinical trial is investigating TEER in medical therapy in patients with cardiogenic shock and MR. 38…”

Section: Role Of Teer In Asmrmentioning

confidence: 99%

10 Commandments of TEER in Patients With Secondary Mitral Regurgitation

Gedela

2023

Innovations�(Phila)

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Transcatheter mitral valve repair for inotrope dependent cardiogenic shock – Design and rationale of the CAPITAL MINOS trial

Cited by 16 publications

References 29 publications

Five-year Outcomes of Transcatheter Edge-to-Edge Repair in Patients with Mitral Regurgitation and Cardiogenic Shock

Five-year Outcomes of Transcatheter Edge-to-Edge Repair in Patients with Mitral Regurgitation and Cardiogenic Shock

Transcatheter Structural Heart Interventions in the Acute Setting: An Emerging Indication

10 Commandments of TEER in Patients With Secondary Mitral Regurgitation

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