Transcatheter edge-to-edge repair (TEER) can reduce mitral regurgitation (MR) in patients who present with severe MR and cardiogenic shock (CS), according to a new analysis published in the Journal of the American College of Cardiology.[1]
“TEER has emerged as an effective treatment for high-risk patients with severe symptomatic MR,” wrote first author Trevor Simard, MD, an interventional cardiologist with Mayo Clinic in Rochester, Minnesota, and colleagues. “The clinical benefit of TEER has been documented with various MR etiologies and across a wide range of high-risk populations, including patients with chronic renal insufficiency, severe ventricular dysfunction, pulmonary hypertension, tricuspid regurgitation, and obstructive lung disease. However, data on the outcomes of patients with CS undergoing TEER are restricted to smaller cohorts of patients.”
Simard et al. aimed to gain a better understanding of TEER’s impact on CS patients by using the STS/ACC TVT Registry, a collaboration between the Society of Thoracic Surgeons and American College of Cardiology. Overall, the group examined data from nearly 4,000 TEER patients with CS who received care from November 2013 to December 2021. CS was defined as a patient who presented with CS or required inotrope use or mechanical circulatory support before the procedure. The mean patient age was 73 years old, and 59.5% were male.
Device success was seen in 85.6% of patients, which broke down to 87.2% among patients with functional MR, 83.7% among patients with degenerative MR and 88.6% among patients with mixed MR.
Researchers examined echocardiographic data from each patient, noting that patients in the device failure group had a higher baseline left ventricular ejection fraction (LVEF) and lower prevalence of moderate-severe MR or severe MR.
Device success was associated with “significantly lower in-hospital and 30-day mortality” as well as shorter lengths of stay. Most complication rates were similar between the device success and device failure groups, though single leaflet device attachment was more likely for the device failure group. The group also found that device success was consistently associated with lower mortality and heart failure hospitalization rates after one year.
“The current study documents that in patients with CS, TEER can achieve successful MR reduction in more than 85% of patients and that successful MR reduction in this extreme-risk population is associated with a greater one-year survival and lower HF hospitalization or death rates,” the authors wrote. “Accordingly, owing to the prevalence and potential impact, the current data supports the rationale of randomized studies to prospectively establish efficacy of this therapy in this patient cohort.”
TEER is the procedure previously known as transcatheter mitral valve repair. CMS officially changed the procedure’s name in early 2021.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.