A heart team's perspective on interventional mitral valve repair: percutaneous clip implantation as an important adjunct to a surgical mitral valve program for treatment of high-risk patients.
A heart team's perspective on interventional mitral valve repair: percutaneous clip implantation as an important adjunct to a surgical mitral valve program for treatment of high-risk patients.
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心脏团队对介入二尖瓣修复术的看法：经皮夹子植入作为手术二尖瓣计划的重要辅助手段，用于治疗高危患者。
DOI：
10.1016/j.jtcvs.2011.09.033
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
H. Reichenspurner
中科院分区：
文献类型：
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作者：
H. Treede;J. Schirmer;V. Rudolph;O. Franzen;M. Knap;M. Schluter;L. Conradi;M. Seiffert;D. Koschyk;T. Meinertz;S. Baldus;H. Reichenspurner
二尖瓣外科修复术在存在严重心室功能降低和相关合并症的情况下具有较高的围手术期风险。我们试图评估在选定的二尖瓣返流3级或更严重的高手术风险患者中使用基于夹的经皮缘对缘修复系统进行基于导管的二尖瓣修复的可行性。（年龄75 ± 9岁; 63%为男性）患有症状性功能性（65%）、退行性（27%）或混合性（8%）二尖瓣返流的患者使用经皮夹系统对合二尖瓣前叶和后叶。二尖瓣手术的风险被认为较高，平均logistic欧洲心脏手术风险评价系统为44%（范围，21%-54%）。36%的患者术前左心室射血分数≤ 35%。一个由心脏病专家和心脏外科医生组成的跨学科心脏小组对所有患者进行了讨论。186名患者（92%）成功植入了经皮夹。患者使用1个金属夹（n = 125; 62%）、2个金属夹（n = 64; 32%）或3个或更多金属夹（n = 7; 3%）进行治疗。二尖瓣返流从术前到术后显著减少（P < .0001），并且在大多数患者的前12个月内保持稳定。30天死亡率为3.5%（7/202例患者）。住院时间为12 ± 10天，重症监护室中位住院时间为1天（范围：0-45天）。11名患者在经皮二尖瓣夹植入后中位38天（0-468天）需要手术瓣膜修复/置换。结论基于夹的经皮二尖瓣修复术对于有症状且手术风险高的患者是一种安全、低风险且有效的治疗选择，并且不排除后期手术修复。
OBJECTIVESurgical mitral valve repair carries an elevated perioperative risk in the presence of severely reduced ventricular function and relevant comorbidities. We sought to assess the feasibility of catheter-based mitral valve repair using a clip-based percutaneous edge-to-edge repair system in selected patients at high surgical risk with mitral regurgitation grade 3 or worse.METHODSBetween 2002 and January 2011, 202 consecutive patients without prior mitral valve surgery (age 75 ± 9 years; 63% were male) with symptomatic functional (65%), degenerative (27%), or mixed (8%) mitral regurgitation were treated with a percutaneous clip system for approximation of the anterior and posterior mitral leaflets. Risk for mitral valve surgery was considered high in terms of a mean logistic European System for Cardiac Operative Risk Evaluation of 44% (range, 21%–54%). Preprocedural left ventricular ejection fraction was 35% or less in 36% of patients. An interdisciplinary heart team of cardiologists and cardiac surgeons discussed all patients.RESULTSPercutaneous clip implantation was successful in 186 patients (92%). Patients were treated with 1 clip (n = 125; 62%), 2 clips (n = 64; 32%), or 3 or more clips (n = 7; 3%). Reduction in mitral regurgitation from pre- to postprocedure was significant (P < .0001) and remained stable within the first 12 months in the majority of patients. Thirty-day mortality was 3.5% (7/202 patients). Hospital stay was 12 ± 10 days, and median intensive care unit stay was 1 day (range, 0–45 days). Eleven patients required surgical valve repair/replacement at a median of 38 days (0–468 days) after percutaneous clip implantation.CONCLUSIONSClip-based percutaneous mitral valve repair is a safe, low-risk, and effective therapeutic option in symptomatic patients with a high risk for surgery and does not exclude later surgical repair.