Transcatheter Edge-to-Edge Repair for Severe Mitral Regurgitation in Patients With Cardiogenic Shock: A Systematic Review and Meta-Analysis

BACKGROUND: Patients with severe mitral regurgitation and cardiogenic shock demonstrate a poor prognosis. Mitral transcatheter edge-to-edge repair could alter patient management. METHODS AND RESULTS: We systematically reviewed PubMed/Medline, Scopus, and Cochrane Library until January 2023, including studies assessing transcatheter edge-to-edge repair in patients with severe mitral regurgitation and cardiogenic shock. Studies with <5 patients were excluded. The primary outcome was device success and all-cause death, while secondary outcomes included myocardial infarction, stroke, and heart failure hospitalization rates at 30-day and intermediate-term follow-up. A fixed-effects meta-analysis was used to estimate pooled rates. Risk of bias was assessed with the Newcastle– Ottawa Scale. A total of 24 studies and 5428 patients were included, with a mean age of 71.2±3.3 years and a high mean Society of Thoracic Surgery score (15.2±8.9). Device success was achieved in 86% (95% CI, 85%–87%) and mitral regurgitation ≤2+ in 89% (95% CI: 88%–90%). The 30-day all-cause mortality rate was 14% (95% CI, 13%–15%). Stroke, myocardial infarction, and heart failure hospitalization rates were 2% (95% CI, 1%–2%), 15% (95% CI, 13%–18%), and 9% (95% CI, 8%– 10%), respectively. Patients with acute myocardial infarction had similar device success (81% [95% CI, 74%–87%]), a 30-day mortality rate of 20% (95% CI, 16%–25%), and intermediate-term mortality rate of 14% (95% CI, 9%–19%). In non–myocardial infarction populations, the 30-day mortality rate was 13% (95% CI, 13%–14%), and the intermediate-term mortality rate was 35% (95% CI, 34%–36%). CONCLUSIONS: In patients with mitral regurgitation and cardiogenic shock, transcatheter edge-to-edge repair is associated with favorable 30-day and intermediate-term outcomes. Limitations, including the observational design of included studies and considerable heterogeneity, necessitate further research in this setting.