Data from this analysis also confirm that “successful MRI reduction is possible with TEER in most patients with cardiogenic shock,” said Mohamad A. Alkhouli, MD, interventional cardiologist and professor of medicine at the Mayo Clinic, Rochester, Minnesota. . In those with device success, achieved in 85.6% of patients, all-cause mortality was approximately 21% lower (34.6% vs. 55.5%). Pi < 0.001) at 1 year than in those not successfully repaired, according to Drs. Alchoulis, who presented the findings at the annual Transcatheter Cardiovascular Therapeutics meeting in Boston. This translated into a reduction in the hazard ratio for death of almost 50% (HR, 0.52; 95% confidence interval, 0.43-0.63). A similar relative benefit was found for the composite endpoint of mortality and heart failure admissions at 1 year. Whether unadjusted (HR, 0.54; 95% CI, 0.45-0.66) or adjusted (HR, 0.51; 95% CI, 0.42-0.62), risk reductions with successful MR, defined as ≥1 grade improvement and a final MR grade ≤2+, showed a reduction in major adverse outcomes by approximately half.
STS/ACC TCT Registry Data Survey
Derived from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry, 3,797 patients with cardiogenic shock underwent MR repair between November 2013 and December 2021. Outcomes at 1 year were evaluable in 2,773 of these patients. To be included, all had to meet at least one of the definitions of cardiogenic shock, such as the use of inotropes or mechanical circulatory support. At baseline, 94.5% had an MRI severity of at least 3+ and most of them were 4+. Thirty days after treatment, 88.8% had an MR severity of 2+ or less, the majority of whom had a severity of 1+. These data address an important question that has not been well studied before, according to Dr. Alhoulis. In MR patients, cardiogenic shock is associated with a high risk of death, but there is little evidence that valve repair does not worsen, let alone modify, this risk. These data support the value of the intervention, which was performed in nearly all patients with the MitraClipä (Abbott), the only available device for most of the registry’s requested period. However, Dr. Alkhouli cautioned that his data are best viewed as “hypothesis building.” “We need a randomized trial,” he said at the meeting, sponsored by the Cardiovascular Research Foundation. He pointed out that this is a complex population for which many variables may skew the results when the data are analyzed retrospectively. After all, those MR patients with cardiogenic shock in the database screened for TEER may well have been relatively healthy and not represent an unselected population with both MR and cardiogenic shock. The question may be best answered by the CAPITAL MINOS multicenter Canadian trial, which has just begun. As described in an article in the American Heart Journal, it plans to enroll approximately 150 MRI patients with cardiogenic shock randomized to TEER or medical therapy. The results are expected in about 1 year, according to Dr. Alhouli. However, as far as the present analysis is concerned, Dr. an acute coronary syndrome (ACS), consistently supported a benefit from the intervention. Also, cardiogenic shock did not appear to be a factor in device failure, according to Dr.
>90% in NYHA Class III or IV Heart Failure
In this study, the mean age was 73 years. More than 90% were in class III or IV heart failure in the 2 weeks before TEER. More than half had established coronary artery disease. Other cardiovascular comorbidities, including atrial fibrillation or flutter (65%), previous MI (39%), and previous stroke or transient ischemic attack (>10%) were well represented. When those with device success were compared with those with device failure, the risk profile was comparable. Society of Thoracic Surgeons (STS) predicted mortality for mitral valve repair between these two groups was 14.8% versus 15% (Pi = 0.97), respectively. However, those with device failure had a lower baseline left ventricular ejection fraction (40.7% vs. 42.9%). Pi = 0.009) and a higher prevalence of moderate to severe or severe MRI (96.1% vs. 84.9%). Pi < 0.001). Growing experience with TEER means that benefit has now been demonstrated in many complex MRI groups, such as those with severe ventricular dysfunction, renal failure, and obstructive pulmonary disease. This was a rationale for examining the impact or rehabilitation of MRI in patients with cardiogenic shock. It’s a pressing question, according to Dr. Alhoulis. He cited studies suggesting that up to 20% of patients hospitalized for cardiogenic shock have at least moderate to severe MR. In contrast, cardiogenic shock is not an uncommon finding in MRI patients. While Dr. Alkhouli acknowledged that the many variables affecting outcome in MRI and cardiogenic shock patients would make a randomized trial “challenging,” many experts echoed that concern and even expressed some skepticism about the possibility of an unbiased trial.
Data confirm that magnetic resonance repair is safe during electrocution
“These data show that MRI repair is safe in patients with cardiogenic shock,” said Anita W. Asgar, MD, an interventional cardiologist affiliated with the Montreal Heart Institute, Canada. He noted that there was a 5- to 6-day delay among patients with cardiogenic shock before undergoing MRI repair in this analysis, possibly reflecting the elimination of very high-risk patients. Similarly, he suggested that many interventionists are likely to consider multiple variables before proceeding. As a result, MRI repair may not be amenable to randomization in a cardiogenic shock population, since this decision is not routinely made outside of a multivariate setting. “I’m not sure a clinical trial is ethical,” she said. He would expect that clinicians enrolling patients would only do so on a selective basis. Alexandra J. Lansky, MD, Director of the Yale Heart and Vascular Research Program, Yale University, New Haven, Connecticut, also emphasized the difficulty of controlling for variables such as duration of cardiogenic shock that influence decision making. However, he called the data “very important” as it provides at least some objective data for deciding whether to intervene in a group of “challenging” patients who are not uncommonly treated in clinical practice. Dr. Alkhouli reports financial relationships with Abbott Vascular, Boston Scientific, Johnson & Johnson, and Phillips. Dr. Asgar reports financial relationships with Abbott Vascular, Edwards Lifesciences, WL Gore & Associates, and Medtronic. Dr. Lasky reports no potential conflicts of interest.
