부산대학교 도서관

Introduction: Cardiogenic shock (CS) is associated with high mortality and morbidity. Severe mitral regurgitation (MR) in the setting of CS is associated with poor outcomes. Transcatheter Edge-to-Edge Repair (TEER) with the Mitraclip system is commonly used to treat MR, though its use in CS is less defined.Hypothesis: TEER with Mitraclip in patients with moderate to severe MR and CS improves cardiovascular outcomes compared to medical management alone.Methods: A single-center, retrospective study included adult patients with moderate to severe MR and CS between 2012 and 2021. Moderate to severe MR was defined by grades 3+ and 4+ MR. CS was defined as a sustained systolic blood pressure <90mmHg for at least 1 hour, use of inotropes, vasopressors, or mechanical circulatory support, and clinical and laboratory findings of end-organ damage. The primary outcome was major adverse cardiovascular events (MACE) defined as cardiovascular death, heart failure admission, stroke, and myocardial infarction at 30 days and 6 months. The secondary outcome was change in New York Heart Association (NYHA) classification.Results: There were 28 patients included in the medical management and 33 in the Mitraclip groups. Table 1 includes this study’s outcomes. There were no significant differences in patients with a MACE at 30 days (13 vs. 8, p=0.069), though there were significant differences at 6 months (12 vs. 7, p=0.002). There were no differences in cardiovascular death. Patients in the Mitraclip group had fewer heart failure admissions at 6 months (p=<0.001), though not at 30 days. At 30 days, more patients in the Mitraclip group improved to NYHA classes I/II compared to medical management alone (10 [35.7%] vs. 16 [50%], p=0.043). There were no differences in NYHA classes I/II at 6 months (7 [43.7%] vs. 13 [54.2%], p=0.63).Conclusions: TEER using the Mitraclip system improves mid-term cardiovascular outcomes in patients with CS compared to medical management alone.