1Universitätsklinikum Tübingen Innere Medizin III, Kardiologie und Angiologie Tübingen, Deutschland; 2Universitätsklinikum Tübingen Innere Medizin III, Kardiologie und Kreislauferkrankungen Tübingen, Deutschland
Transcatheter edge-to-edge repair (TEER) has proven to be an effective treatment option for patients experiencing cardiogenic shock with concomitant high-grade mitral valve regurgitation. However, hemodynamic changes following mitral repair have not been thoroughly investigated. Afterload mismatch, leading to the deterioration of hemodynamics subsequent to mitral regurgitation correction, could potentially occur and adversely impact prognosis. Therefore, our objective was to analyze hemodynamic changes during TEER in patients with cardiogenic shock.
Methods:
We conducted a consecutive study of patients undergoing TEER for mitral valve repair in the setting of cardiogenic shock at our hospital. Echocardiographic and hemodynamic parameters before and after clip placement were systematically analyzed. Changes in left atrial pressure, pulmonary pressure, and cardiac index were the focus of our investigation.
Results:
A total of 24 patients underwent TEER in the context of cardiogenic shock. All patients were successfully treated with at least of one grade reduction in mitral regurgitation and no patient had high grade regurgitation after the procedure. The mean left atrial pressure decreased significantly from 23 mmHg to 15 mmHg (p < 0.01), and the v-wave decreased from 37 mmHg to 20 mmHg (p < 0.01) following the procedure. The cardiac index increased from 2.0 to 2.7 l/min/m² (P = 0.04) after TEER device deployment. The mean pulmonary pressure showed no significant change (decreasing from 38 mmHg to 34 mmHg after TEER, p = 0.34, Figure 1). We did not observe any worsening of the ejection fraction after the procedure. Nine patients (37.5%) died during their hospital stay.
Conclusion:
Our study demonstrates that TEER leads to favorable hemodynamic changes after device placement in patients with cardiogenic shock. We observed a significant reduction in left atrial pressure, v-wave, and an elevation in cardiac index. Importantly, we did not observe any deterioration in left ventricular function following the procedure. This supports the concept of hemodynamic stabilization with TEER in patients with cardiogenic shock and high-grade mitral regurgitation.
Figure 1
Hemodynamic changes during TEER in patients with cardiogenic shock