Abstract 4370001: Outcomes of Mitral Valve Transcatheter Edge-to-Edge Repair in Patients with Cardiogenic Shock: A Nationwide Cohort Analysis

Background: Transcatheter edge-to-edge repair (TEER) has emerged as an important therapeutic option for patients with severe mitral regurgitation (MR), even in the challenging context of cardiogenic shock (CS). However, real-world data on the outcomes of TEER in this high-risk population are limited. This study aimed to evaluate the incidence of mortality, procedural complications, and heart failure hospitalizations following TEER in patients with MR and CS. Methods: This retrospective cohort study used TriNetX, a federated health research network including data from 101 healthcare organizations across the U.S. Adult patients diagnosed with CS (ICD-10 R57.0) and nonrheumatic MR (ICD-10 I34.0) who underwent TEER (ICD-10-PCS 02UG3JZ) between 2005 and 2025 were included. Outcomes assessed up to one year post-procedure included all-cause mortality, heart failure hospitalizations, pacemaker implantation, stroke, valve thrombosis, recurrent MR, and mechanical complications. Statistical analyses included risk proportions, hazard ratios (HRs), and 95% confidence intervals (CIs). Results: Among 1,463 patients undergoing TEER for MR in the setting of CS, all-cause mortality at one year was 28.9% (n=424), reflecting the high-risk nature of this population (HR not available). Heart failure hospitalizations were documented in 11.2% (n=27/241 evaluable patients; HR not calculated due to limited cohort size). Pacemaker implantation occurred in 1.4% (n=20), stroke in 4.4% (n=58/1,314 evaluable patients; HR not available), valve thrombosis in 0.7% (n=10), recurrent MR in 0.9% (n=13), and mechanical complications in 1.0% (n=14). Kaplan-Meier survival analysis indicated a survival probability of 68.6% at one year post-TEER. Conclusions: In this large, real-world cohort of patients with cardiogenic shock undergoing TEER, nearly one-third experienced mortality within one year, underscoring the critical prognosis in this population. Although procedural complications such as valve thrombosis, device-related issues, and pacemaker implantation were infrequent, heart failure hospitalizations remained a notable concern. These findings highlight the need for careful patient selection and aggressive post-procedural management strategies to optimize outcomes in this high-risk group. Future studies should explore mechanisms of heart failure exacerbations and refine strategies to identify patients who may derive the greatest benefit from TEER in the setting of CS.