STS/ACC TVT Registry Analysis Evaluates the Use of Edge-to-Edge Transcatheter Repair in Cases of Severe Mitral Regurgitation and Cardiogenic Shock

News — BOSTON – September 17, 2022 – An analysis of the Society of Thoracic Surgeons/American College of Cardiology (STS/ACC) TVT Registry found that most patients with severe mitral regurgitation (MR) and cardiogenic shock (CS) who underwent edge-to-edge repair edge by transcatheter mitral valve (TEER) in the United States achieved successful reduction of MR, and this successful repair was associated with lower heart failure (HF) mortality and hospitalizations one year after the procedure compared to a unsuccessful repair.

The results were reported today at TCT 2022, 34e annual scientific symposium of the Cardiovascular Research Foundation (CRF). TCT is the world’s premier educational meeting specializing in interventional cardiovascular medicine.

TEER is an increasingly adopted treatment option for high-risk patients with severe symptomatic MR in the United States. A high-risk group that may benefit from TEER but has been understudied are patients with CS in addition to severe MR. CS has a consistently high mortality and few interventions have improved its prognosis. In addition, moderate to severe MR is present in up to one in five patients admitted for caesarean section and increases the risk of mortality by 60%.

The researchers used data from the STS/ACC TVT registry from November 22, 2013 to December 31, 2021. A total of 3,797 patients undergoing TEER in the United States met at least one of the pre-specified inclusion criteria for cesarean section due to the presence of cardiogenic shock, use of inotropes or mechanical circulatory support before TEER. Of this group, 3249 (85.6%) patients achieved device success defined as ≥ 1 grade MR reduction and ≤ moderate (2+) final MR.

The primary endpoint was the impact of device success on clinical outcomes – specifically, one-year mortality and HF admissions. One year after the intervention, device success was associated with significantly lower all-cause mortality (34.6% versus 55.5%, adjusted HR 0.49, 95% CI 0.41-0.59 , p

“This analysis examined the characteristics and outcomes of TEER in patients with cardiogenic shock,” said Mohamad A. Alkhouli, MD, president of research and innovation, division of interventional cardiology, Mayo Clinic and professor of Medicine, Mayo Clinic College of Medicine. “Our results show not only that TEER in cesarean section patients can achieve successful MR reduction most of the time, but also that the success of the device in this high-risk population is associated with a better rate of survival at one year as well as unless heart failure hospitalizations Randomized trials of the role of TEER in patients with cardiogenic shock are needed to make it a potential treatment option.

This research was supported by the National Cardiovascular Data Registry (NCDR) of the American College of Cardiology Foundation and the National Database of the Society of Thoracic Surgeons.

Dr. Alkhouli reported the following disclosures: grants/research support from Boston Scientific and Philips in addition to consulting fees from Abbott, Biosense Webster, Boston Scientific and Philips.

About CRF and TCT

The Cardiovascular Research Foundation (CRF) is one of the world’s leading nonprofit organizations specializing in innovation, research and education in interventional cardiology. The CRF is dedicated to helping physicians improve survival and quality of life for people with heart and vascular disease. For more than 30 years, CRF has helped accelerate medical breakthroughs and educate physicians on the latest treatments for heart disease. CRF Centers of Excellence include CRF Skirball Center for Innovation, CRF Clinical Trials Center, CRF Center for Education, CRF Digital, TCTMD and Structural heart: the Journal of the Heart team.

Transcatheter Cardiovascular Therapeutics (TCT) is CRF’s annual scientific symposium and premier educational meeting specializing in interventional cardiovascular medicine. Now in his 34’se year, TCT showcases major breakthroughs in medical research and brings together leading researchers and clinicians from around the world to present and discuss the latest evidence-based research in the field.

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