Department of General and Interventional Cardiology, University Heart Centre, Hamburg, Germany.
Eur J Heart Fail. 2011 May;13(5):569-76. doi: 10.1093/eurjhf/hfr029. Epub 2011 Apr 6.
To assess the feasibility, short-term durability and clinical outcomes of MitraClip® therapy for mitral regurgitation (MR) in patients with end-stage heart failure and a severely reduced left ventricular (LV) ejection fraction.
We analysed retrospectively collected data from seven European centres. Included in the study were 50 heart failure patients [mean age 70 ± 11 years, 38 men (76%)] with a LV ejection fraction ≤25% and MR of at least grade 3+. All patients had functional MR, were in New York Heart Association (NYHA) functional class III or IV, and their mean logistic EuroSCORE was 34%. The patients underwent a total of 53 MitraClip® procedures; one or more clips were implanted in 50 procedures (48 patients), for an acute procedural success rate of 94%. Severity of MR was reduced in all successfully treated patients, 44 (92%) were discharged with MR ≤2+. Thirty-day mortality was 6%; cumulative survival at 6 months was 81.2%. Clinical and echocardiographic 6-month follow-up data were obtained from 32 and 31 successfully treated patients, respectively. At 6 months, MR ≤2+ was present in 27 (87%) of 31 patients, and 23 (72%) of 32 patients were in NYHA functional class I or II. Six-minute walk distance improved significantly, and significant reductions in LV volumes indicative of reverse LV remodelling were concordant with significant reductions in N-terminal pro-brain natriuretic peptide plasma levels.
MitraClip® therapy reduces functional MR in patients with end-stage heart failure and marked LV dysfunction and entails clinical benefit at 6 months.
评估 MitraClip® 治疗终末期心力衰竭伴严重左心室（LV）射血分数降低患者二尖瓣反流（MR）的可行性、短期耐久性和临床结果。
我们回顾性分析了来自欧洲 7 个中心的数据。研究纳入了 50 例心力衰竭患者（平均年龄 70±11 岁，38 名男性（76%）），LV 射血分数≤25%，MR 至少为 3+级。所有患者均为功能性 MR，纽约心脏协会（NYHA）心功能分级 III 或 IV 级，平均逻辑 EuroSCORE 为 34%。患者共接受 53 次 MitraClip®手术；50 例（48 例）手术中植入了 1 个或多个夹子，急性手术成功率为 94%。所有成功治疗的患者的 MR 严重程度均降低，44 例（92%）出院时 MR≤2+。30 天死亡率为 6%；6 个月累计生存率为 81.2%。32 例成功治疗的患者中有 31 例获得了 6 个月的临床和超声心动图随访数据，分别有 27 例（87%）和 23 例（72%）患者在 NYHA 心功能分级 I 或 II 级。6 分钟步行距离显著改善，LV 容积减少提示 LV 逆重构，与 N 末端脑利钠肽前体（NT-proBNP）血浆水平显著降低一致。
MitraClip®治疗可降低终末期心力衰竭伴严重 LV 功能障碍患者的功能性 MR，并在 6 个月时带来临床获益。
