Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
Ann Thorac Surg. 2010 Jan;89(1):72-80; discussion p 80. doi: 10.1016/j.athoracsur.2009.08.063.
Percutaneous mitral repair with the MitraClip device (Evalve, Menlo Park, CA) has been reported. Preserving conventional surgical options in the event of percutaneous treatment failure is important. We describe surgical treatment at varying intervals after the MitraClip procedure in 32 patients.
One hundred seven patients with moderate-to-severe or severe mitral regurgitation who were either symptomatic (91%) or, if asymptomatic (9%), had evidence of left ventricular dysfunction were enrolled as part of the Endovascular Valve Edge-to-Edge REpair STudy (EVEREST) phase I registry study or as "roll-in" subjects in the EVEREST II study. Thirty-two of the 107 patients (30%) underwent surgery after an attempted MitraClip procedure.
Of the 32 patients undergoing post-clip mitral valve surgery, 23 patients (72%) had one or more clips implanted and 9 patients (28%) received no clip implant. The indications for mitral valve surgery in the 23 patients with a clip included partial clip detachment (n = 10), residual or recurrent mitral regurgitation greater than 2+ (n = 9), and other (atrial septal defect [n = 2], device malfunction [n = 1], and incorrectly diagnosed mitral stenosis [n = 1]). Twenty-seven of 31 patients (87%) underwent the surgical procedure planned before surgery (planned procedure unknown in 1 patient). Four of 25 patients (16%) with planned repair underwent mitral valve replacement.
Standard surgical options were preserved in patients who had surgery after percutaneous repair with the MitraClip device. Successful repair was feasible in the majority of patients after the MitraClip procedure, with repair performed as late as 18 months after clip implantation.
经皮二尖瓣修复术采用 MitraClip 装置（Evalve，Menlo Park，CA）已被报道。在经皮治疗失败的情况下保留传统的手术选择非常重要。我们描述了 32 例患者在 MitraClip 手术后不同时间间隔的手术治疗情况。
107 例中至重度或重度二尖瓣反流患者，其中 91%有症状，9%无症状但有左心室功能障碍证据，作为血管内瓣缘对缘修复研究（EVEREST）I 期注册研究的一部分或 EVEREST II 研究的“滚动”患者纳入研究。107 例患者中有 32 例（30%）在尝试 MitraClip 手术后接受了手术。
在接受二尖瓣手术后的 32 例患者中，23 例（72%）植入了一个或多个夹子，9 例（28%）未植入夹子。23 例夹合器患者行二尖瓣手术的指征包括部分夹合器分离（n=10）、残余或复发的二尖瓣反流大于 2+（n=9）和其他（房间隔缺损[n=2]、器械故障[n=1]和错误诊断的二尖瓣狭窄[n=1]）。31 例患者中的 27 例（87%）按术前计划进行了手术（1 例患者术前计划未知）。计划修复的 25 例患者中有 4 例（16%）行二尖瓣置换术。
在经皮 MitraClip 装置修复后行手术的患者保留了标准的手术选择。在大多数患者中，MitraClip 手术后可以进行成功的修复，修复时间可延迟至夹合器植入后 18 个月。
