TCT-24 Transcatheter Mitral Valve Repair With MitraClip Versus Surgical Repair for Acute Severe Mitral Regurgitation With Cardiogenic Shock: A Comparative Analysis of Patient Demographics and Clinical Outcomes

Document Type

Abstract

Publication Date

10-28-2025

Abstract

Background: Acute severe mitral regurgitation (MR) in the setting of cardiogenic shock presents a high-risk clinical scenario with limited time for intervention. This study compares outcomes between transcatheter edge-to-edge mitral valve repair (TEER) using the MitraClip device versus surgical mitral valve repair or replacement (SMVR) in patients presenting with acute severe MR and cardiogenic shock. Methods: A retrospective cohort analysis of 310 patients presenting with acute severe MR and cardiogenic shock across multiple centers from 2017–2023. Patients were treated either with MitraClip (n=158) or surgical repair/replacement (n=152). Baseline characteristics, procedural details, and in-hospital and 30-day outcomes were analyzed. Results: A total of 310 patients with acute severe MR complicated by cardiogenic shock were included in the analysis. Of these, 158 patients underwent transcatheter mitral TEER, and 152 underwent SMVR. Procedural success was achieved in 92.4% of patients in the M-TEER group compared with 97.3% in the SMVR group (p = 0.04). In-hospital mortality was significantly lower among patients treated with M-TEER (19.6%) compared to those who underwent SMVR (28.9%, p = 0.04). M-TEER also experienced shorter intensive care unit (ICU) stays (5.2 ± 2.8 days vs. 7.9 ± 3.6 days, p < 0.001) and were less likely to require mechanical ventilation for more than 48 hours (16.4% vs. 34.8%, p < 0.001). The incidence of acute kidney injury was also significantly lower in the M-TEER group (14.6% vs. 26.3%, p = 0.01). At 30 days, mortality remained significantly lower in the MitraClip group (24.1%) compared to the surgical repair group (33.6%, p = 0.03). Among survivors, successful MR reduction to ≤2+ at discharge was observed in 88.0% of patients treated with MitraClip versus 91.4% of those who underwent surgery (p = 0.32). Conclusion: In high-risk patients presenting with acute severe MR and cardiogenic shock, MitraClip offers a less invasive alternative to surgery with comparable procedural success and improved short-term outcomes. Patient selection remains paramount, and multidisciplinary Heart Team evaluation is essential. Categories: STRUCTURAL: Valvular Disease and Intervention: Mitral

Publication Title

Journal of the American College of Cardiology

Volume

86

Issue

17 Supplement

First Page

B16

Last Page

B16

Comments

Transcatheter Cardiovascular Therapeutics held 2025-10-25 to 2025-10-28 in San Francisco, CA

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