Clinical outcomes of transcatheter edge-to-edge repair in patients with acute mitral regurgitation complicated by cardiogenic shock: a systematic review and meta-analysis

Authors

Ashraf Ahmed, Yale New Haven Health - Bridgeport Hospital Department of Internal Medicine, Bridgeport, CT 06610, United States.Follow
Rafael Contreras, Department of Internal medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut.Follow
Anoop Gurram, Department of Hospital Medicine, Cleveland Clinic, 33300 Cleveland Clinic Blvd, Avon, Ohio, ashua, NH, 44011, 03062, USA.
Parsa Saberian, Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
Rasha Kaddoura, Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
Kayla Boyea, Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, USAFollow
Yussif Issaka MD, Department of Internal Medicine, Yale New Haven HealthFollow
Mohammad Hashemi, Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
Daniyal Ameen, Division of Hospital Medicine, Department of Internal Medicine, Bridgeport Hospital, Yale New Heaven, Bridgeport, CT, USA.Follow
Sara Nobakht, Guilan University of Medical Sciences, Rasht, Iran.
Ehsan Amini-Salehi, Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
Nayak Sandeep, Department of Internal Medicine, Yale University School of Medicine, Bridgeport Hospital, Bridgeport, CT, USA.

Document Type

Article

Publication Title

BMC Cardiovascular Disorders

Abstract

Background: Acute mitral regurgitation (AMR) complicated by cardiogenic shock (CS) is a critical cardiovascular emergency associated with high morbidity and mortality. Surgical intervention is often not feasible due to the unstable clinical status of these patients. Transcatheter edge-to-edge repair (TEER) has emerged as a minimally invasive alternative, yet its safety and efficacy in this specific population remain uncertain. This study aimed to systematically evaluate and synthesize the evidence on the clinical outcomes of TEER in patients with AMR complicated by CS.

Methods: Databases including PubMed, Embase, and Web of Science were searched through March 4, 2025. Eligible studies included adult patients with AMR and CS undergoing TEER and reporting clinical outcomes. Data were synthesized using a random-effects model.

Results: The pooled in-hospital mortality rate following TEER was 17.8% (95% CI: 11.2-25.2%). One-month mortality was 7.9% (95% CI: 1.1-16.8%), six-month mortality was 21.0% (95% CI: 11.2-32.7%), and one-year mortality was 36.5% (95% CI: 34.9-38.2%). Among patients with degenerative MR, the one-year mortality was 7.9% (95% CI: 0.8-19.0%), while for functional MR it was 9.4% (95% CI: 1.3-21.5%). Postprocedural MR reduction to ≤ grade 2 was achieved in 86.2% of patients (95% CI: 70.7-97.3%). The intra-aortic balloon pump (IABP) application rate was 57.9% (95% CI: 24.2%-88.5%). Compared to usual care, TEER significantly reduced in-hospital mortality (OR = 0.64; 95% CI: 0.51-0.81; P < 0.01). However, no significant reduction was found in rehospitalization risk (OR = 0.65; 95% CI: 0.14-3.03; P = 0.59).

Conclusion: TEER appears to be a promising therapeutic option for patients with AMR complicated by CS. Compared to usual care, it is associated with significantly lower in-hospital mortality. However, high heterogeneity and low certainty of evidence highlight the need for further high-quality prospective studies to validate long-term outcomes and optimize patient selection.

First Page

380

DOI

10.1186/s12872-025-04844-z

Publication Date

5-2025

Recommended Citation

Ahmed A, Contreras R, Gurram A, Saberian P, Kaddoura R, Boyea K, Issaka Y, Hashemi SM, Ameen D, Nobakht S, Amini-Salehi E, Nayak SS. Clinical outcomes of transcatheter edge-to-edge repair in patients with acute mitral regurgitation complicated by cardiogenic shock: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2025 May 19;25(1):380. doi: 10.1186/s12872-025-04844-z.

e-ISSN

1471-2261