Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048-1804, USA.
J Am Coll Cardiol. 2011 Apr 19;57(16):1658-65. doi: 10.1016/j.jacc.2010.11.043.
The objective of this study was to evaluate the acute hemodynamic consequences of mitral valve (MV) repair with the MitraClip device (Abbott Vascular, Menlo Park, California).
Whether surgical correction of mitral regurgitation (MR) results in a low cardiac output (CO) state because of an acute increase in afterload remains controversial. The acute hemodynamic consequences of MR reduction with the MitraClip device have not been studied.
We evaluated 107 patients with cardiac catheterization before and immediately following percutaneous MV repair with the MitraClip device. In addition, pre- and post-procedural hemodynamic parameters were studied by transthoracic echocardiography.
MitraClip treatment was attempted in 107 patients, and in 96 (90%) patients, a MitraClip was deployed. Successful MitraClip treatment resulted in: 1) an increase in CO from 5.0 ± 2.0 l/min to 5.7 ± 1.9 l/min (p = 0.003); 2) an increase in forward stroke volume (FSV) from 57 ± 17 ml to 65 ± 18 ml (p < 0.001); and 3) a decrease in systemic vascular resistance from 1,226 ± 481 dyn·s/cm(5) to 1,004 ± 442 dyn·s/cm(5) (p < 0.001). In addition, there was left ventricular (LV) unloading manifested by a decrease in LV end-diastolic pressure from 11.4 ± 9.0 mm Hg to 8.8 ± 5.8 mm Hg (p = 0.016) and a decrease in LV end-diastolic volume from 172 ± 37 ml to 158 ± 38 ml (p < 0.001). None of the patients developed acute post-procedural low CO state.
Successful MV repair with the MitraClip system results in an immediate and significant improvement in FSV, CO, and LV loading conditions. There was no evidence of a low CO state following MitraClip treatment for MR. These favorable hemodynamic effects with the MitraClip appear to reduce the risk of developing a low CO state, a complication occasionally observed after surgical MV repair for severe MR.
本研究旨在评估经皮二尖瓣（Mitral Valve，MV）夹合器（Abbott Vascular，Menlo Park，California）修复二尖瓣反流（Mitral Regurgitation，MR）的急性血液动力学后果。
二尖瓣反流矫正后是否会因急性后负荷增加而导致心输出量（Cardiac Output，CO）降低，目前仍存在争议。二尖瓣夹合器治疗二尖瓣反流后对血液动力学的急性影响尚未得到研究。
我们评估了 107 例接受经皮 MV 夹合器修复的患者的心脏导管插入术前后的血液动力学参数。此外，还通过经胸超声心动图研究了术前和术后的血液动力学参数。
107 例患者尝试了 MV 夹合器治疗，其中 96 例（90%）患者成功植入了 MV 夹合器。成功的 MV 夹合器治疗导致：1）CO 从 5.0±2.0 l/min 增加到 5.7±1.9 l/min（p=0.003）；2）前向每搏量（Forward Stroke Volume，FSV）从 57±17 ml 增加到 65±18 ml（p＜0.001）；3）全身血管阻力（Systemic Vascular Resistance，SVR）从 1,226±481 dyn·s/cm(5) 降低至 1,004±442 dyn·s/cm(5)（p＜0.001）。此外，左心室（Left Ventricle，LV）的卸载导致 LV 舒张末期压力从 11.4±9.0 mm Hg 降低至 8.8±5.8 mm Hg（p=0.016）和 LV 舒张末期容积从 172±37 ml 降低至 158±38 ml（p＜0.001）。没有患者发生急性术后低 CO 状态。
二尖瓣夹合器系统修复二尖瓣反流后，即刻和显著改善 FSV、CO 和 LV 负荷状况。二尖瓣夹合器治疗 MR 后无 CO 降低的证据。二尖瓣夹合器的这些有利的血液动力学效果似乎降低了发展为低 CO 状态的风险，而这种低 CO 状态是严重二尖瓣反流手术后偶尔观察到的并发症。
