Percutaneous mitral valve repair with MitraClip device in hemodynamically unstable patients: A systematic review.

BACKGROUND: Very few data exist on percutaneous mitral valve repair (PMVr) in unstable patients with concomitant moderate-severe mitral regurgitation (MR). The purpose of this systematic review was to evaluate baseline characteristics, management and clinical outcomes of critically ill patients undergoing PMVr with MitraClip. METHODS: We conducted a systematic review of the published data on MitraClip from its first use in 2003 to December 2020. Studies referring to critically ill patients in cardiogenic shock or acute refractory pulmonary edema were included. A total of 40 publications including 254 patients with significant MR (Grade 4 in 91%) were included. RESULTS: Mean age was 70 ± 12 years with mean Euroscore II and STS of 21 ± 13 and 20.5 ± 16, respectively. Clinical presentation was with cardiogenic shock and acute myocardial infarction in 72.8 and 60.0% of patients, respectively. Device success was achieved in 238 (93.7%) patients with a significant reduction in MR (Grade ≤ 2 in 91.8%, p < .001). The median weaning time from the procedure, to discontinuation of mechanical circulatory or respiratory support, was 2 days (IQR 1-4), with an in-hospital mortality and non-fatal complication rate of 12.6 and 9.1%, respectively. Kaplan-Meier curves estimated an overall mortality rate of 39.1% at 12-month follow-up, with persistent reduction in MR severity for survivors (Grade ≤ 2 in 81.3%) and one case of mitral valve reintervention. CONCLUSIONS: Percutaneous mitral valve repair with MitraClip device is a technically feasible and potentially viable management option in high-risk patients with cardiogenic shock or refractory pulmonary edema and concomitant moderate-severe MR. Prospective trials are required to confirm these findings, and definitively determine the value of MitraClip in hemodynamically unstable patients.

Electrocardiographic parameters in the clinically healthy Zamorano-leones donkey.

Limited information exists regarding electrocardiographic parameters in clinically healthy donkeys. The study was carried out in 75 healthy adult animals (40 females and 35 males) using the Einthoven standard II and base-apex leads. The P wave showed usually a bifid shape deflection. The QRS complex of the donkeys appeared in several forms: QR and R were the most frequent in limb lead II, and QS and QR in the base-apex lead. Most T waves presented a simple negative configuration in lead II and biphasic shape in the base-apex one. Mean heart rate value was 52 beats per minute. The direction of the QRS vector in lead II had a mean value of 91.4 degrees. We observed a lack of detected arrhythmias. Statistically significant differences were observed between sexes for several parameters. The electrocardiogram of Zamorano-leones donkey differs in several duration, amplitude and morphologic parameters from that of several breeds of horses and donkeys. This fact justifies obtaining values for a specific breed against which to compare values for the same breed.