Title : Bridge to Clip- Adjunctive Management of Acute Severe MR in the setting of Cardiogenic Shock
Abstract:
Acute severe mitral regurgitation (MR) can occur through different mechanisms with two primary categories being functional or degenerative. Acute severe MR complicates 5-12% of CS cases. Definitive treatment is surgical repair or replacement according to current valvular heart disease guidelines. In recent times, the MitraClip (MC) system has been proposed as an alternative to surgical therapies in high-prohibitive surgical risk patients. However, many patients with combined severe MR and cardiogenic shock (CS) require adjunctive therapies in an effort to stabilize the patient prior to proceeding with a complex intervention such as MitraClip. We present four cases of acute MR and CS with various etiologies that required the use of medical inotropes/pressors, intra-aortic balloon pump (IABP), Impella, or combination thereof that successfully allowed for stabilization of hemodynamics and bridging to completion of successful MitraClip that resulted in patient stabilization and cardiac recovery. Immediate improvement in severe MR and overall clinical status noted post-MC in all our cases suggest that use of MC can enhance acute cardiac functional status and has potential for treatment of cardiogenic shock due to acute severe MR in unstable patients despite appropriate therapies. Cardiogenic shock presages poor prognosis despite correction of acute severe MR. However, early mitral valve repair with MitraClip System in hemodynamically unstable patients can provide a minimally invasive and effective alternative with low post-procedural mortality rate.
What will audience learn from your presentation?
- Cardiogenic shock remains a clinical challenge that continues to have high mortality rates but early recognition and intervention is key.
- The MitraClip system is a safe, effective, and minimally invasive alternative to surgical intervention for functional severe mitral regurgitation. However, the outcome is dependent on various factors including patient’s baseline health and functional status as well as presentation with shock.
- Using current standard therapies for cardiogenic shock stabilization to bridge to MitraClip with successful MR reduction can lead to favorable patient outcomes.
- This requires a multidisciplinary Heart Team approach with flexibility in choosing adjunctive therapies of cardiogenic shock based on the variability in each case presentation.
- Feasibility at smaller community center.
