PDF(Pubmed)
Abstract：
Background: Patients with cardiogenic shock (CS) and mitral regurgitation (MI) have a prohibitive risk that contraindicates surgical treatment. Although the feasibility of transcatheter edge-to-edge therapy (TEER) has been demonstrated in this setting, the benefit of the combined use of TEER with mechanical circulatory support devices (MCS) has not been studied. The aim of this study was to evaluate the clinical outcomes of TEER in patients with MCS. Methods: The MITRA-ASSIST study is a retrospective multicentre Spanish registry that included patients with MR and CS who underwent TEER in combination with MCS. The primary endpoint was death from any cause at 12 months. The secondary endpoint was a composite of death from any cause or hospitalisation for heart failure at 12 months. Results: A total of twenty-four patients in nine high-volume Spanish centres (66.2 (51-82) years, 70.8% female, EuroSCORE II 20.4 ± 17.8) were included. Acute ST-elevation myocardial infarction was the main CS aetiology (56%), and the most implanted MCS was the intra-aortic balloon pump (82.6%), followed by ECMO (8.7%), IMPELLACP® (4.3%), or a combination of both (4.3%). Procedural success was 95.8%, with 87.5% in-hospital survival. At 12-month follow-up, 25.0% of patients died, and 33.3% had a composite event of death from any cause or hospitalisation for heart failure. Conclusions: TEER in patients with concomitant CS and MR who require MCS appears to be a promising therapeutic alternative with a high device procedural success rate and acceptable mortality and heart failure readmission rates at follow-up.
摘要：
背景：心源性休克（CS）和二尖瓣返流（MI）患者具有禁忌症的手术治疗风险。尽管在这种情况下已证明了经导管边缘到边缘治疗（TEER）的可行性，TEER与机械循环支持装置(MCS)联合使用的益处尚未得到研究.这项研究的目的是评估TEER在MCS患者中的临床结果。方法：MITRA-ASSIST研究是一项回顾性的多中心西班牙注册研究，其中包括接受TEER联合MCS治疗的MR和CS患者。主要终点是12个月时的任何原因死亡。次要终点是12个月时任何原因死亡或因心力衰竭住院的复合终点。结果：共有24名患者在9个高容量西班牙中心（66.2（51-82）年，70.8%女性,包括EuroSCOREII20.4±17.8）。急性ST段抬高型心肌梗死是CS的主要病因（56%），植入最多的MCS是主动脉内球囊反搏（82.6％），其次是ECMO(8.7%)，IMPELLACP®（4.3%），或两者的组合（4.3％）。手术成功率为95.8%，住院生存率为87.5%。在12个月的随访中，25.0%的患者死亡,33.3%的患者发生了全因死亡或因心力衰竭住院的复合事件.结论：对于合并CS和MR的患者，需要MCS的TEER似乎是一种有希望的治疗选择，具有较高的设备手术成功率以及可接受的死亡率和心力衰竭再入院率。
