Acute Mitral Regurgitation Research Articles

Abstract 4148083: Mechanism of Acute Mitral Regurgitation in Patients with Acute Coronary Syndrome As A Predictor Of Mortality

Introduction: Mechanical complications after acute myocardial infarction (MI) have decreased in the context of readily available pPCI and other reperfusion therapies, however, many patients still cannot achieve adequate reperfusion status. Acute Mitral Regurgitation (AMR) is associated with worse clinical outcomes, and can be classified according to three main mechanisms; papillary muscle ischemia, papillary muscle rupture and left ventricular remodeling. Data regarding AMR an association between disease mechanism and mortality is lacking. Objective: To assess the association between AMR mechanism and mortality Methods: We performed a retrospective cohort study and included patients who visited the ED in a Mexican National Institute due to ACS who also presented AMR from February 2006 through to October 2023. A univariate Cox regression model was performed and adjusted by age and sex, and the only Killip-Kimball class (K-K) and Type of ACS at admission showed significance, which both persisted in individual adjusted multivariate analyses. A survival analysis with Kaplan-Meier curve was done. Results: We included 161 patients in the analysis. The frequency per AMR mechanism was 98 (60.4%) for ischemia of papillary muscle, 33 (20.3%) for papillary muscle rupture, and 30 (19.3%) for left ventricular remodeling. The multivariate Cox regression models were done by subgroup analysis, by each different type of AMR mechanism. Ischemia of Papillary Muscle showed a significantly increased risk for mortality when analyzed by K-K (HR 1.48, 95% CI 1.01-2.17, p=0.045), but showed a decreased risk by ACS type (HR 0.39, 95% CI 0.18-0.82, p=0.014). Papillary Muscle Rupture was associated with increased risk for mortality in the model with K-K (HR 1.8, 95% CI 0.95-3.38, p=0.067) but not by ACS type. Left Ventricular Remodelling was not significantly associated with an increased risk in any model. Conclusions: In patients presenting AMR and ACS, there was an increased risk of mortality in the subgroup of patients with ischemic mitral regurgitation.

Impella 5.5 as a bridge-to-surgery in acute ischemic mitral regurgitation post-percutaneous coronary intervention: a case report

BackgroundAcute ischemic mitral regurgitation (AIMR) is a significant complication of acute coronary syndrome that leads to severe and immediate hemodynamic deterioration and cardiogenic shock. Intra-aortic balloon pumps (IABP) are commonly used to support patients with AIMR as a bridge to surgery, though they may be insufficient in some cases.Case PresentationA 74-year-old male presented with two days of indigestion and evident hypoxia, and an electrocardiogram revealed inferior and lateral ST-elevation myocardial infarction. Angiography demonstrated severe two-vessel coronary disease with a 100% thrombotic occlusion of the second obtuse marginal artery (OM2, culprit lesion) and an 80% stenosis of the proximal left anterior descending artery (LAD). Despite stenting of OM2, the patient remained hypoxic and hypotensive, necessitating escalated support via an IABP. A follow-up echocardiogram revealed severe mitral regurgitation presumed to be AIMR secondary to a ruptured posteromedial papillary muscle with a flail anterior leaflet (A2). Despite aggressive supportive measures with the IABP, the patient’s hemodynamics continued to show cardiogenic shock and clinical status did not improve. However, the patient was required to abstain from surgery for a P2Y12 inhibitor therapy wash out period. Consequently, the IABP was upgraded to Impella 5.5 as bridge-to-surgery support on day 1 post-admission. Subsequently, the patient’s hemodynamics improved, and he underwent a combined mitral valve replacement and coronary artery bypass grafting surgery on day 7 post-admission without incident. The Impella was successfully explanted on day 25 post-admission. Delay in explant was due to hypotension and respiratory status despite normalizing hemodynamics and echocardiogram revealing recovered left ventricular ejection fraction. The patient developed bacterial pneumonia and acute respiratory distress syndrome and expired on day 27 post-admission.ConclusionAlthough IABP is standard for supporting AIMR patients as a bridge to surgery, it may not provide sufficient hemodynamic support. This case supports a growing body of evidence that alternative forms of hemodynamic support should be considered if the traditional therapeutic modalities for AIMR do not adequately support patients. Clinicians may consider upgrading IABP to Impella to provide increased hemodynamic support and maintain AIMR patient stability while awaiting cardiac surgery.

Acute Mitral Regurgitation Presenting as Unilateral Pulmonary Edema

Acute Mitral Regurgitation Presenting as Unilateral Pulmonary Edema

P40 A challenging case of new systemic lupus erythematosus

Abstract Introduction The diagnosis of systemic lupus erythematosus (SLE) and its distinction from systemic infection can be challenging. We present a case of new systemic lupus alongside endocarditis, which illustrates this problem. Case description A previously well, 35-year-old male tarmacer of mixed ethnicity, presented with a three months’ history of general malaise, arthralgia and weight loss of 20kg. Two weeks prior to admission he developed progressive confusion, headaches and imbalance. Clinical assessment revealed a pyrexial patient in delirium without focal neurological signs, a faint maculopapular facial rash, symmetrical synovitis, very few nailfold infarcts, a systolic and diastolic murmur and sterile haemato-proteinuria. No history of IV drug abuse. Investigations showed elevated ESR 61, CRP 217, WBC 11.70 and procalcitonin 7.0. He had AKI stage 2 (eGFR 35 with a urinary protein/creat ratio 162; homogenous ANA (1:1280) with positive dsDNA and crithidia-luciliae binding. C3 and C4 suppressed (0.59 and 0.13, respectively); One blood culture prior to broad spectrum antibiotics was negative. Assuming the possibility of Libman-Sacks endocarditis, the attending acute stroke physician initially also treated with pulsed IV steroids, as well as antibiotics. Due to the delirium, key diagnostic tests were technically difficult, although a transthoracic ECHO showed moderately severe aortic and mitral regurgitation that were not felt to be typical for infective endocarditis by the attending cardiologist. The ITU team offered sedation and controlled ventilation to enable all necessary investigations: trans-oesophageal ECHO showed vegetations of aortic and mitral valve leaflets with perforations of single leaflets, resulting in severe acute aortic and mitral regurgitation; a renal biopsy showed class 3 lupus nephritis and an MRI/A Brain showed widespread cerebral foci of restricted diffusion imaging. Consultation with the regional cardiothoracic centre advised urgent transfer for double metal valve replacement, performed on Day 8 post admission. Surgical inspection confirmed an aortic root abscess, and enrichment culture of the native valve subsequently grew Staph. aureus. In addition to IV antibiotics for infective endocarditis, he was continued on steroid taper and commenced on MMF for lupus nephritis. Discussion It can be difficult to differentiate between infective endocarditis and Libman-Sacks endocarditis, especially when there are no existing risk factors. In cases like these antibiotics and steroids can be started at the same time. In our case, we had a young gentleman with no prior medical history who had multiple compounding factors and barriers to fully investigate. Because of his agitation, he required sedation and that allowed the team to perform life saving investigations (renal biopsy and TOE). He ended up having a double metal valve replacement within 8 days post-admission. Multidisciplinary team involvement and close collaboration was of crucial importance in this case to ensure a safe patient outcome. Key learning points • This case illustrates the need to vigorously chase the possibility of concurrent infection in severe new SLE. Close collaboration between multiple specialities to achieve this is key, especially when a patient lacks agency due to their illness.

Transcatheter edge-to-edge repair for acute mitral valve regurgitation due to papillary muscle rupture in cardiogenic shock patient with acute myocardial infarction.

Transcatheter edge-to-edge repair for acute mitral valve regurgitation due to papillary muscle rupture in cardiogenic shock patient with acute myocardial infarction.

TCT-628 Transcatheter Edge-to-Edge Repair in Patients With Acute Mitral Regurgitation Complicated by Cardiogenic Shock

TCT-628 Transcatheter Edge-to-Edge Repair in Patients With Acute Mitral Regurgitation Complicated by Cardiogenic Shock

Late mitral leaflet tear after transcatheter edge-to-edge repair for acute ischemic mitral regurgitation: a case report

Abstract Background Acute mitral regurgitation due to papillary muscle rupture is a severe complication of acute myocardial infarction. Transcatheter edge-to-edge repair is emerging as an effective alternative to surgical treatment, with encouraging outcomes. Leaflet adverse events are rare and are associated with relapse of significant mitral regurgitation. Case summary A 54-year-old man arrived at our hospital with a late presentation of ST-elevation myocardial infarction. During primary percutaneous coronary intervention of the circumflex coronary artery, a partial papillary muscle rupture occurred with acute severe mitral regurgitation and cardiogenic shock. Due to the severe hemodynamic instability, the patient underwent an emergent transcatheter edge-to-edge repair with MitraClip device during Impella support with mitral regurgitation resolution and hemodynamic stabilization. At 2-month follow-up an interclip leaflet tear occurred with relapse of severe mitral regurgitation, requiring a mitral valve replacement surgery. Discussion Acute mitral regurgitation due to papillary muscle rupture is a serious complication of acute myocardial infarction. Management is based on hemodynamic stabilization and surgery. The transcatheter edge-to-edge repair is emerging as a therapeutic alternative in high-risk cases. Leaflet adverse events rarely occur during the transcatheter edge-to-edge repair procedure or before patient discharge. Our case is the first to report a late leaflet adverse event, occurring two months after the procedure and, interestingly, after an acute myocardial infarction conditioning an ischemic mitral regurgitation. This event may be the result of the progressive adverse remodeling of left ventricular inferolateral akinetic wall, with consequent increase of tethering forces on the posterior leaflet, tensioned in the opposite direction by the clip.

Edge-to-edge therapy in acute mitral regurgitation. Proposal for a management protocol of the Ischemic Heart Disease and Acute Cardiac Care, Interventional Cardiology, and Cardiovascular Imaging Associations of the Spanish Society of Cardiology

Edge-to-edge therapy in acute mitral regurgitation. Proposal for a management protocol of the Ischemic Heart Disease and Acute Cardiac Care, Interventional Cardiology, and Cardiovascular Imaging Associations of the Spanish Society of Cardiology

Edge-to-edge therapy in acute mitral regurgitation. Proposal for a management protocol of the Ischemic Heart Disease and Acute Cardiac Care, Interventional Cardiology, and Cardiovascular Imaging Associations of the Spanish Society of Cardiology

Edge-to-edge therapy in acute mitral regurgitation. Proposal for a management protocol of the Ischemic Heart Disease and Acute Cardiac Care, Interventional Cardiology, and Cardiovascular Imaging Associations of the Spanish Society of Cardiology

Preoperative extracorporeal mechanical circulatory support for patients with acute severe mitral valve regurgitation due to papillary muscle necrosis

Preoperative extracorporeal mechanical circulatory support for patients with acute severe mitral valve regurgitation due to papillary muscle necrosis

The use of veno-veno-arterial ECMO as a successful strategy in acute mitral regurgitation secondary to papillary muscle rupture causing cardiogenic shock and profound hypoxemia: a case report

Abstract Acute mitral regurgitation (MR) secondary to papillary muscle rupture is a rare mechanical complication of acute myocardial infarction occurring in 0.05–0.26% of all cases of myocardial infarction. The only treatment is emergency mitral valve surgery with high operative mortality reaching up to 39%. The use of extracorporeal membrane oxygenator (ECMO) as a stabilization strategy and a bridge to recovery may potentially improve the outcome of such cases. Here, we report a case of acute MR presenting with cardiogenic shock and severe hypoxia that required insertion of veno-veno-arterial ECMO initially and followed by emergency mitral valve replacement. This strategy proved useful with full recovery of the patient.

MITRACLIP TREATMENT FOR CARDIOGENIC SHOCK DUE TO ACUTE MITRAL REGURGITATION IN A PATIENT WITH POSTINFARCTION PAPILLARY MUSCLE RUPTURE

Abstract A 85–year–old woman presented to ED with worsening dyspnea for 24 hours; no other related symptom. Her medical history included hypertension, dyslipidemia, type 2 DM and surgical coronary revascularization 13 years before for multiple critical coronary artery disease (LIMA to LAD and sequential SVG to PDA and OM branch). The ECG promptly revealed a subacute infero–lateral STEMI. Transthoracic echocardiography (TTE) showed inferior and postero–lateral wall akinesia with severely reduced left ventricle ejection fraction (LVEF), mildly reduced right ventricle systolic function and severe mitral regurgitation (MR) due to posterior papillary muscle (PM) rupture (Fig.1). Clinical scenario was complicated by pulmonary edema and cardiogenic shock treated with diuretics and sodium nitroprusside infusion, non–invasive ventilation and IABP insertion. Urgent coronary angiography revealed a thrombotic occlusion of the venous graft for OM branch. Surgical correction was excluded due to hemodynamic instability. Graft occlusion was treated with manual thromboaspiration, balloon dilatations and abciximab infusion. After an initial stabilization, transesophageal echocardiography (TEE) was performed confirming severe MR resulting from rupture of one head of a bifid posterior PM (red arrows, Fig.1) and prolapse of the anterior leaflet combined with restrictive systolic movement of the posterior leaflet due to wall motion abnormalities. 3 days later a transcatheter mitral valve edge–to–edge repair (MTEER) was performed using a MitraClip device (1 XTR clip and 1 NTR clip, Fig.2). TEE with 3D and TrueVue vision confirmed the correct placement of clips (Fig.3), a mild–to–moderate residual MR, absence of significant transmitral gradient and a mildly reduced LVEF. No clinical events were reported during recovery; patient was discharged after 2 weeks. Conclusion MTEER is an established therapy for reducing degenerative and functional MR. Little data is available on its use in the setting of PM rupture. This rare complication of AMI carries a mortality rate of 80% during the first week without surgical correction but more than half of patients are excluded because of prohibitive operative risk. TEER may be an alternative for these patients. In this case report we described the utility of MTEER in the setting of cardiogenic shock secondary to acute ischemic MR with papillary muscle partial rupture. This procedure can be useful with acceptable safety and procedural success.

Acute mitral regurgitation complicating STEMI

Abstract Funding Acknowledgements None. Introduction Acute ischemic mitral regurgitation (aiMR) occurs in 17-40% of patients suffering an acute coronary syndrome. Although severe forms constitute less than 1% of the cases, this complication significantly increases mortality risk. While surgery has been traditionally considered the treatment of choice, heterogeneity in underlying mechanisms and lack of updated evidence questions optimal treatment. Purpose The aim of the present study was to describe baseline clinical characteristics, management and outcomes of a contemporary cohort of patients with aiMR. Methods A retrospective cohort including patients diagnosed with moderate to severe aiMR presenting from 2006 to 2019 at the National Institute of Cardiology "Ignacio Chavez" in Mexico City. Results A total of 10,434 patients presented to the study center with an ACS from 2006 to 2019, out of which 6,448 (61.8%) were diagnosed with STEMI and 3,986 (38.2%) with NSTEMI. Mechanical post-infarction complications occurred in 203 (1.9%). Among these, aiMR was observed in 132 patients (1.3%), categorized as moderate in 49 patients (37.2%) and severe in 83 patients (62.8%). 6 patients were excluded due to incomplete information. Acute ischemic mitral regurgitation was more frequent in patients with STEMI (79.4%) compared with NSTEMI (20.6%) and 88.9% were non-reperfused infarctions. 65.9% of patients were male and 57.1% had hypertension. In-hospital mortality was present in 40 patients (31.7%). Ischemia of the papillary muscle was the most commonly reported mechanism (38.1%), followed by alterations in the left ventricle's geometry (33.3%), mitral annular dilation (14.3%), papillary muscle rupture (7.1%) and chordae tendineae rupture (5.6%). The least frequently reported mechanism was pre existing non-ischemic mitral regurgitation (1.6%). There was no significant difference in mortality based on the mechanism responsible for aiMR. Patients with aiMR managed solely with medical therapy had a higher mortality rate (41.3%) compared to those undergoing mitral valve replacement (37%) (Figure 1). Timely reperfusion (thrombolysis/primary PCI) significantly reduced in-hospital mortality (85% survival) in contrast to those with a non-reperfused MI (66% survival). Conclusions Acute ischemic mitral regurgitation remains an entity with a high mortality rate. Early identification of underlying etiology, prompt reperfusion treatment and tailored surgery, if needed, are key to improve outcomes.

Abstract 2113: Transcatheter Aortic Valve Replacement (TAVR) Complication: Intraoperative Mitral Regurgitation.

Introduction: Transcatheter aortic valve replacement (TAVR) is the preferred treatment for aortic stenosis (AS) in patients with high surgical risk. This case report delves into a rare, significant intra-procedural mitral regurgitation (MR) of TAVR. Case Presentation: A 94-year-old female with severe AS and a STS score of 3.9% underwent TAVR. A recent 2D ECHO revealed severe AS. CT angiogram pre-TAVR exhibited scattered coronary artery calcifications, severe aortic valve calcification, and calcified atherosclerotic plaque. During the procedure, a 26mm CoreValve was deployed appropriately, with no perivalvular leak observed on angiography and transesophageal echocardiography (TEE). However, post-deployment, the patient experienced a sudden drop in blood pressure, and intra-procedural TEE revealed severe MR, not detected in previous studies. Treatment included pressors, non-invasive positive pressure ventilation, and diuretics, resulting in a favorable response. Subsequent TTE on the 4th day showed improvement in MR. A one-year follow-up TTE revealed only trace MR, confirming the normal functioning of the prosthetic valve. Discussion: Acute mitral regurgitation is an uncommon TAVR complication with potential morbidity and mortality. Various studies propose multiple mechanisms, and in this case, we attribute it to intraoperative global hypoperfusion causing transient MR. Hypoperfusion of the papillary muscle disrupted leaflet coaptation, leading to MR, as supported by its resolution with improved blood pressure. Studies have reported different mechanisms for acute MR, including papillary muscle rupture, leaflet perforation, guidewire impingement, and global hypoperfusion, with some indicating a higher incidence in CoreValve compared to other valve types. Conclusion: Given the rarity of acute MR during TAVR and the unclear pathophysiology, there are no established society guidelines for its management. With TAVR becoming routine, further clinical trials are crucial for optimizing treatment, including head-to-head comparisons of valves and procedural techniques, and developing comprehensive management strategies based on the specific mechanisms of this acute complication.

Safety and outcomes of surgical treatment of atrial fibrillation in emergency surgery cases.

Recent developments in surgical devices, including left atrial appendage closure, have enabled surgeons to perform aggressive operations for atrial fibrillation (AF). However, the outcomes of AF surgery in emergent cases have not been extensively studied. The present study aimed to investigate the effectiveness of AF surgery in emergency surgery cases associated with cardiovascular events. We enrolled 18 patients who underwent various types of AF surgery due to emergencies, including acute aortic dissection (n = 6), acute myocardial infarction (n = 5), bleeding due to perforation from radiofrequency catheter ablation (n = 4), acute mitral regurgitation (n = 2), and cardiac tumor (n = 1). Four and ten patients underwent the full maze procedure and pulmonary vein isolation, respectively. Ganglionated plexi ablation was also performed in three patients as part of a combined procedure. The left atrial appendage was solely closed in four patients. There was no surgical mortality or major adverse cardiac and cerebrovascular events in our patient series. The rates of freedom of recurrence of AF or atrial tachycardia at 1 and 3years were 92.9% and 82.5%, respectively. After a mean follow-up period of 46.7 ± 25.8months, no thromboembolism events were observed in the patients. Furthermore, no cardiovascular death was recorded. The surgical procedures for AF are safe and effective in cases requiring emergency surgery.

Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers After Transcatheter Aortic Valve Replacement: A Meta-Analysis

BackgroundPersistent left ventricular hypertrophy after transcatheter aortic valve replacement (TAVR) has been associated with poor outcomes. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), due to their favorable effects on ventricular remodeling, have been hypothesized to improve outcomes post-TAVR, yet there are no recommendations regarding their use. ObjectivesThis study aimed to compare the outcomes of patients receiving ACEIs/ARBs with those not receiving ACEIs/ARBs after TAVR. MethodsWe performed a literature search on PubMed and Cochrane Library until June 14, 2023, and included all studies comparing clinical outcomes between patients given ACEIs/ARBs and those not given ACEIs/ARBs after TAVR. All-cause mortality was the primary outcome. We used a random effects model with appropriate corrections to calculate relative risk (RR) and CIs, with all analyses carried out using R v4.0.3. ResultsWe included ten studies on the use of ACEIs/ARBs post-TAVR. Patients on ACEIs/ARBs had lower risk of all-cause mortality (RR: 0.74, 95% CI: 0.65-0.86, I2 = 62%, chi-square P < 0.01), cardiovascular mortality (RR: 0.70, 95% CI: 0.56-0.88, I2 = 0%, chi-square P = 0.54), and new-onset atrial fibrillation (RR: 0.71, 95% CI: 0.52-0.96, I2 = 0%, chi-square P = 0.59). Patients on ACEIs/ARBs had a similar risk of myocardial infarction, heart failure, stroke, new permanent pacemaker implantation, acute kidney injury, major bleeding, vascular complications, aortic regurgitation, and mitral regurgitation. ConclusionsWe found that patients receiving ACEIs/ARBs had a lower risk of all-cause mortality, cardiovascular mortality, and new-onset atrial fibrillation. Risk of other outcomes was similar to patients not receiving ACEIs/ARBs. Randomized clinical trials are needed to explore the benefits of ACEIs/ARBs post-TAVR, so that definitive guidelines can be developed.

(1199) - Double Bridge Approach for Treatment of Acute Mitral Regurgitation from Ruptured Chordae

(1199) - Double Bridge Approach for Treatment of Acute Mitral Regurgitation from Ruptured Chordae

Transcatheter edge-to-edge mitral valve repair in patients with acute decompensated heart failure due to severe mitral regurgitation.

Transcatheter edge-to-edge mitral valve repair (TEER) has been established as a therapy for severe symptomatic mitral regurgitation (MR) in stable patients, and it has recently emerged as a reasonable option for acutely ill patients. The aim of this study was to evaluate the safety and efficacy of TEER in hospitalized patients with acute decompensated heart failure (ADHF) and severe MR that was deemed to play a major role in their deterioration. We included 31 patients who underwent emergent TEER for MR ≥ 3+ from 2012 to 2022 at Sheba Medical Center. Outcomes included procedural safety, procedural success, all-cause mortality, heart failure readmission, and functional improvement. Outcomes were evaluated at 3 months and at 1 year. Data were obtained retrospectively by chart review. Implantation of a TEER device was achieved in 97% of patients, and reduction in MR severity of at least two grades and final MR ≤ 2+ at discharge was achieved in 74%. No intra-procedural mortality or life-threatening complications were noted. Mortality at 30 days was 23%. No excess mortality occurred beyond 6 months, with a total mortality of 41%. At 1 year all survivors had MR ≤ 2+, all were free of heart failure hospitalizations, and 88% were at New York Heart Association class ≤ II. Mitral valve TEER for patients with ADHF and significant MR is safe, feasible, and achieves substantial reduction in MR severity. Despite high early mortality, procedural success is associated with good long-term clinical outcomes for patients surviving longer than 6 months.

Transcatheter edge-to-edge repair in papillary muscle injury complicating acute myocardial infarction.

Acute mitral regurgitation (MR) in the setting of myocardial infarction (MI) may be the result of papillary muscle rupture (PMR). This condition is associated with high morbidity and mortality. We aim to evaluate the feasibility of transcatheter edge-to-edge mitral valve repair (TEER) in this acute setting. We analysed data from the International Registry of MitraClip in Acute Mitral Regurgitation following acute Myocardial Infarction (IREMMI) of 30 centres in Europe, North America, and the middle east. We included patients with post-MI PMR treated with TEER as a salvage procedure, and we evaluated immediate and 30-day outcomes. Twenty-three patients were included in this analysis (9 patients suffered complete papillary muscle rupture, 9 partial and 5 chordal rupture). The patients' mean age was 68±14years. Patients were at high surgical risk with median EuroSCORE II 27% (IQR 16, 28) and 20 out of 23 (87% were in cardiogenic shock). All patients were treated with vasopressors, and 17 out of 23 patients required mechanical support. TEER procedure was performed on the median 6days after the index MI date IQR (3, 11). Procedural success was achieved in 87% of patients. The grade of MR was significantly decreased after the procedure. MR reduction to 0 or 1+was achieved in 13 patients (57%), to 2+in 7 patients (30%), P<0.01. V-Wave was reduced from 49±8mmHg to 26±10mmHg post-procedure, P<0.01. Sixteen out of 23 patients (70%) were discharged from hospital and 5 of them required reintervention with surgical mitral valve replacement. No additional death at 1year was documented. TEER is a feasible therapy in critically ill patients with PMR due to a recent MI. TEER may have a role as salvage treatment or bridge to surgery in this population.

The Results of Urgent and Emergent Transcatheter Mitral Valve Repair (MitraClip®): A Comparison with Standard Elective Repair.

Mitral regurgitation (MR) is the most common valvular disease worldwide. MR has been managed surgically, with either a mitral valve replacement or repair. Percutaneous transcatheter mitral valve repair (TMVr) with MitraClip® insertion has gained wide popularity and success over medical and surgical therapy for MR. Some patients with acute MR or decompensated heart failure could benefit from urgent TMVr. This meta-analysis aims to compare clinical outcomes of urgent versus elective TMVr. We performed a study-level meta-analysis to compare the clinical outcomes of urgent versus elective TMVr using the MitraClip system. The primary endpoint outcome was all-cause mortality. Additional outcomes included procedural success, postoperative acute kidney injury (AKI), stroke, and length of in-hospital stay. Overall, 30-day mortality was significantly higher in the urgent group (odds ratio [OR]: 2.74; 95% confidence interval [CI] [2.17, 3.48]; P < 0.00001; I² =0%). However, subgroup analysis of matched cohorts showed no significant difference between both groups (OR: 1.80; 95% CI [0.94, 3.46]; P = 0.08; I² =0%). One-year mortality was similar between both groups (and: 1.67; 95% CI [0.96, 2.90]; P = 0.07; I² =0%). Procedural success was similar between both groups (89.4% vs. 89.8%; P = 0.43). Postoperative AKI was significantly higher in the urgent group (OR: 4.12; 95% CI [2.87, 5.91]; P < 0.00001; I² =0%). Urgent TMVr should be indicated in select populations as it is considered therapeutic with acceptable outcomes therein.