• Sridhar R Musuku, Mohammed Mustafa, Mythili Pulavarthi, Isha Doshi, Yikun Zhang, Skylar Luu, Ali Naqvi, Imran Sunesara, Tanya Richvalsky, Dmitriy Yukhvid, Divya Cherukupalli, Augustine DeLago, Mikhail Torosoff, and Alexander D Shapeton.
• Albany Medical College, Albany, NY. Electronic address: musukus@mail.amc.edu.
• J. Cardiothorac. Vasc. Anesth. 2022 May 1; 36 (5): 1268-1275.

ObjectiveThe study authors sought to compare outcomes in patients with severe mitral valve regurgitation (MR) undergoing urgent, as compared to elective, mitral valve repair employing MitraClip. They hypothesized that, compared to elective cases, MitraClip procedures performed for urgent indications would be associated with increased intraoperative and postoperative complications but have similar long-term outcomes.DesignA retrospective chart review with 3:1 propensity score matching of elective-to-urgent cases.SettingA single, large-volume tertiary care academic medical center.ParticipantsAll consecutive patients with severe MR who underwent elective or urgent MitraClip procedures between December 15, 2015, and October 26, 2020.InterventionsMR repair with MitraClip.Measurements And Main ResultsAs expected, patients in the urgent MitraClip group required a higher level of preprocedural care, and there were significant differences in baseline demographic and clinical variables as compared to the elective group. To reduce baseline characteristics heterogeneity, propensity matching was performed for age, left ventricular systolic dysfunction, congestive heart failure, chronic obstructive pulmonary disease, and smoking histories, using the nearest-neighbor matching with a caliper of 0.2 and with replacement. The final study cohort included 89 urgent and 252 matched elective cases, with a suitable alignment between the treatment groups. Propensity-matched urgent MitraClip patients experienced a longer hospital length of stay (p < 0.001), increased intensive care unit admissions (19% v 4%, p < 0.001) and mechanical ventilation (6.7% v 1.6%, p = 0.023), postprocedural atrial fibrillation (11% v 4.4%, p = 0.036), pericardial effusion (10% v 2.4%, p = 0.005), and acute kidney injury (7.9% v 2%, p = 0.016). Furthermore, patients in the urgent cohort incurred significantly higher 30-day cardiovascular mortality (6.7% v 2%, p = 0.039), increased 30-day (16% v 5.6%, p = 0.006), and 1-year (33% v 20%, p = 0.021) readmission rates. However, there were no statistically significant differences in 30-day and 1-year overall and 1-year cardiovascular mortality.ConclusionsUrgent MitraClip repairs can be performed successfully, when needed, in critically ill patients with severe MR. Despite the procedural success, patients undergoing urgent MitraClip repair remain at high risk for adverse outcomes in the short- and intermediate-term and incur increased cardiovascular mortality and morbidity. Further efforts are required to develop strategies to optimize short and intermediate outcomes in this vulnerable group of patients.Copyright © 2021 Elsevier Inc. All rights reserved.

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