Transcatheter edge-to-edge mitral valve repair for mitral regurgitation in patients with cardiogenic shock: A systematic review and meta-analysis

Background: There is currently little evidence for transcatheter edge-to-edge mitral valve repair (TEER) for mitral regurgitation (MR) in patients with cardiogenic shock (CS). Therefore, this study investigated the characteristics and outcomes of CS patients who underwent TEER for MR. Methods: PubMed, EMBASE were searched in July 2023. Case series and observational studies reporting clinical characteristics and outcomes in CS patients with MR who underwent TEER were included. We performed a one-group meta-analysis using a random effects model. Results: A total of 4060 patients from 7 case series and 5 observational studies were included. The mean age was 68.2 (95% confidence interval [CI]: 64.1–72.2) years, and 41.4% of patients (95% CI: 39.1%–43.7%) were female. Pre-TEER, severe MR was present in 85.3% (95% CI: 76.1%–91.3%) of patients. Mean left ventricular ejection fraction was 36.7% (95% CI: 29.2%–44.2%), and 54.6% (95% CI: 36.9%–71.2%) of patients received mechanical circulatory support. The severity of MR post-TEER was less than 2+ in 88% (95% CI: 87%–89%) of patients. In-hospital mortality was 11% (95% CI: 10%–13%), whereas 30-day and 1-year mortality rates were 15% (95% CI: 13%–16%), and 36% (95% CI: 21%–54%), respectively. Conclusions: This systematic review and meta-analysis assessed the clinical characteristics and outcomes of TEER in CS patients with MR. TEER for MR in patients with CS has been successful in reducing MR in most of the patients, but with a high mortality rate. Randomized controlled trials of TEER for MR and CS are needed.