Acute outcomes of MitraClip therapy for mitral regurgitation in high-surgical-risk patients: emphasis on adverse valve morphology and severe left ventricular dysfunction
Acute outcomes of MitraClip therapy for mitral regurgitation in high-surgical-risk patients: emphasis on adverse valve morphology and severe left ventricular dysfunction
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DOI：
10.1093/eurheartj/ehq050
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发表时间：
2010-06-01
影响因子：
39.3
通讯作者：
Meinertz, Thomas
中科院分区：
文献类型：
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作者：
Franzen, Olaf;Baldus, Stephan;Meinertz, Thomas
我们试图评估使用MitraClip系统在二尖瓣关闭不全(MR)和GT；=3级+的高手术风险患者中使用基于导管的二尖瓣修复的可行性。在51名有症状的功能性患者[n=35(69%)]或器质性MR[n=16(31%)]的连续患者[73+/-10年；34(67%)男性]中进行MitraClip治疗。Logistic EuroSCORE评分平均为29+/-22%，胸科医师学会评分为15+/-11分，左心室射血分数为36+/-17%。在35名患者(69%)中，二尖瓣形态不良和/或严重左心功能不全。49例(96%)成功植入MitraClip。大多数患者[n=34/49(69%)]接受了单枚夹子治疗，14例患者(29%)接受了两枚夹子，1例患者接受了三枚夹子。平均置器时间为105±65分钟，平均透视时间为44±28分钟。与手术相关的MR严重程度降低为1级16例(31%)，2级24例(47%)，3级9例(18%)。在49名成功治疗的患者中，44名(90%)在出院时有临床改善[术前48名患者(98%)，术后16名患者(33%)，NYHA功能分级=III级(P<；0.0001)]。没有发生与手术相关的主要不良事件，也没有住院期间的死亡。结果显示，对于二尖瓣形态不良和/或严重左心功能不全的高手术风险患者，使用MitraClip系统进行二尖瓣修补术是可行的。
We sought to assess the feasibility of catheter-based mitral valve repair using the MitraClip system in high-surgical-risk patients with mitral regurgitation (MR) >= grade 3+.MitraClip therapy was performed in 51 consecutive patients [73 +/- 10 years; 34 (67%) men] with symptomatic functional [n = 35 (69%)] or organic MR [n = 16 (31%)]. Mean logistic EuroSCORE was 29 +/- 22%; Society of Thoracic Surgeons score was 15 +/- 11. Left ventricular (LV) ejection fraction was 36 +/- 17%. In 35 patients (69%), adverse mitral valve morphology and/or severe LV dysfunction were present. MitraClip implantation was successful in 49 patients (96%). Most patients [n = 34/49 (69%)] were treated with a single clip, whereas 14 patients (29%) received two clips and one patient received three clips. Mean device and fluoroscopy times were 105 +/- 65 min and 44 +/- 28 min, respectively. Procedure-related reduction in MR severity was one grade in 16 patients (31%), two grades in 24 patients (47%), and three grades in 9 patients (18%). Forty-four of the 49 successfully treated patients (90%) showed clinical improvement at discharge [NYHA functional class >= III in 48 patients (98%) before and 16 patients (33%) after the procedure (P < 0.0001)]. There were no procedure-related major adverse events and no in-hospital mortality.Mitral valve repair using the MitraClip system was shown to be feasible in patients at high surgical risk primarily determined by an adverse mitral valve morphology and/or severe LV dysfunction.