One Year outcomes for URGENT MitraClip placement in patients with Cardiogenic Shock: Single Center Experience
Roberto Rodriguez, Marco K. Rodriguez, Eric Gnall, Paul Coady, Kate Hawthorne, Sandra Abramson, William Gray, Scott Goldman.
Lankenau Medical Center, Wynnewood, PA, USA.
From 2014-20, 323 patients underwent MitraClip placement in high-risk surgical patients with +3/+4 mitral regurgitation. A retrospective review of patients in cardiogenic shock or acute on chronic intractable CHF: 26 patients were identified. All clips placed urgently. Patients underwent general anesthesia with right common femoral vein and trans-septal approach. Pre-procedure mechanical support was required in 50% (13/26). IABP in 10 patients and 3 impellas. The average EF was 50%±18 with 42.3% having an EF<45%. All patients were initially evaluated for surgical intervention. The STS risk score was 14.1%±9.4 for repair and 16.7%±7.8 for replacement.
In-hospital and 1-year mortality was 8.0% and 36%. MitraClip deployment was successful 96.5% (25/26). There were no surgical conversions during deployment. 3 patients returned for MVR, 2 returned for second MitraClip placement. Patients characteristics included, males (38.5%), female (61.5%), age 76±13, BMI 27.9±6.7, creatinine, 2.05±1.6 mg/dL, NYHA Class IV (100%), BNP 1331.6±1009.1 pg/mL. 3+/ 4+ MR was present in 26.9% and 73.1% respectively. DMR was present in 84.6% and FMR in 15.4%. Post clip MR: 8% trace, 64% mild, 16% moderate, 12% severe. Average gradient was 3.9±1.5 mmHg with average area of 4.2±0.5 cm^2. Median hospital stay 13±11.1 days.
Urgent MitraClip for hemodynamic instability can be effectively performed for most patients. Reasonable morbidity and mortality can be achieved in patients with cardiogenic shock and MR despite comorbidities. MitraClip can be used as a bridge to surgical intervention or as a destination therapy.
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