Cardiogenic shock patients with severe mitral regurgitation (MR) are among the most critically ill receiving care at the University of Ottawa Heart Institute (UOHI). With mortality rates soaring near 60%, surgical intervention is not typically an option for patients in this cohort.
A multidisciplinary team of cardiologists, surgeons, anesthesiologists and trainees at the UOHI are hopeful the results of an international, multicentre, patient-level analysis published today in JACC Cardiovascular Interventions will provide some hope where little existed before.
Principal Investigator Dr. Benjamin Hibbert, an interventional cardiologist and director of the Vascular Biology and Experimental Medicine Laboratory at the UOHI, and Lead Authors Dr. Richard Jung and Cardiac Surgeon and Mitral Valve Expert Dr. Vincent Chan sought to evaluate whether transcatheter mitral valve repair (TMVr), already an established therapy for functional mitral regurgitation, might also represent a salvage therapy for patients with this condition and severe cardiogenic shock. The results suggest that by targeting the source of the regurgitation and implanting a device called a MitraClip, a “pincer clip” that prevents the backflow of blood in the heart, doctors can increase the chances of survival in severe shock patients.
“Our analysis reveals TMVr is associated with a significant reduction in in-hospital mortality, 90-day mortality, and heart failure hospitalization,” said Dr. Benjamin Hibbert. “We believe these results lay the foundation for a multicentre randomized controlled trial to further evaluate these findings.”
Dr. Richard Jung said: “We wanted to show whether TMVr represents a ‘last ditch’ effort for treating patients with significant mitral valve regurgitation and cardiogenic shock. Our findings suggest there is a viable therapeutic salvage strategy available for treating a sub-set of patients who are typically deemed too sick for surgery. Our analysis offers hope for the sickest of the sick, who may now have a fighting chance to get out of the hospital and return home to their loved ones.”
“Patients in cardiogenic shock with severe valvular disease represent a uniquely high-risk cohort with poor outcomes and limited therapies,” said Dr. Thierry Mesana, president and chief executive of the Heart Institute and a world-renowned mitral valve surgeon. “TMVr using the MitraClip system appears to be a viable therapeutic salvage strategy, demonstrating procedural safety and efficacy in mitral regurgitation reduction in patients with significant MR and cardiogenic shock.” Mesana co-founded the UOHI’s MitraClip Program with Interventional Cardiologist Dr. Marino Labinaz in 2012.
The study authors note a randomized study is needed to definitively establish mitral regurgitation as a therapeutic target in cardiogenic shock.
The paper, “Transcatheter mitral valve repair in cardiogenic shock and mitral regurgitation: A patient-level, multicenter analysis” is available online.
To conduct an interview with the study authors (Drs. Richard Jung, Trevor Simard, Pietro Di Santo, Simon Parlow, Amos Levi, Vincent Chan, Mark Hynes, Thierry Mesana, Marino Labinaz, and Benjamin Hibbert), please contact the media liaison named below.
Leigh B. Morris
University of Ottawa Heart Institute