Five-year Outcomes of Transcatheter Edge-to-Edge Repair in Patients with Mitral Regurgitation and Cardiogenic Shock
Notice bibliographique
Résumé
Objective: To analyze five-year clinical and echocardiographic outcomes in patients presenting with acute cardiogenic shock (CS) who underwent transcatheter edge-to-edge repair (TEER) for moderate or severe mitral valve regurgitation (MR). Methods: All consecutive patients who underwent TEER for MR were identified from our institutional medical records between 2015 and 2022. Patients presenting with CS undergoing TEER were included in the primary analysis. MR was diagnosed based on patient's echocardiographic findings and CS was diagnosed according to the definition in the TVT registry and/or presence of inotrope use prior to procedure and/or mechanical circulatory support prior to procedure. Kaplan-Meier survival curves were constructed to analyze outcomes. Primary outcome was five-year incidence of all-cause death. Secondary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE) and readmission for heart failure (HF). Results: A total of 35 patients were included in the study. Mean age was 81±10.4 years and 16 patients (45.7%) were male. Mean STS-score was 10.2±7.1. Nine (25.7%) patients had prior myocardial infarction (MI), 22 (62.8%) had previous atrial fibrillation, while 9 (25.7%) patients were hospitalized for HF within the past year. MR etiology was degenerative (71.4%), functional (22.9%), and mixed (5.7%). Prior to presentation with CS, NYHA classification included 2 (5,7%) patients in class I, 6 (17.1%) in class II, 13 (37.1%) in class III, and 14 (40%) in class IV. Pre-procedural mean LVEF was 56.4 ± 13%. Procedural characteristics included mean procedural time (from access to guide removal) of 2.0 ± 0.6 hours, > 1 implanted device in 14 (40.0%) patients, 1 patient had a single leaflet attachment. There was no procedural device embolism, device thrombosis, conversion to sternotomy, life threatening bleeding, stroke, MI, or death. Mean postoperative length of stay was 5.1 ± 4.4 days. During their hospital stay, a transient ischemic attack event occurred in 1 patient; however, no MI, stroke, or death were observed in any patient. During the follow-up, 13 (37.1%) patients were readmitted for HF, 1 patient needed mitral valve replacement and 1 patient needed new TEER. At 5 years, only 4 (11.4%) patients were alive. Conclusion: Despite excellent procedural and early outcomes for patients with significant MR and CS undergoing TEER, poor survival was observed after 5 years, which may be related to advanced age of this cohort.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».