Baylor University Medical Center, Baylor Heart and Vascular Hospital, Heart Hospital Baylor Plano, Dallas, Texas, USA.
Am J Cardiol. 2011 Sep 15;108(6):882-7. doi: 10.1016/j.amjcard.2011.05.013. Epub 2011 Jul 7.
Percutaneous mitral valve repair with the MitraClip has been shown to decrease mitral regurgitation (MR) severity, left ventricular volumes, and functional class in patients with severe (3+ or 4+) MR. Determination of which patients are optimal candidates for MitraClip therapy versus surgery has not been rigorously evaluated. Transesophageal echocardiography was prospectively performed in 113 consecutive patients referred for potential MitraClip therapy under the REALISM continued access registry. MR severity was assessed quantitatively in all patients. Mitral valve anatomy and feasibility of MitraClip placement were assessed by transesophageal echocardiography and clinical parameters. MR was degenerative (mitral valve prolapse) in 60 patients (53%), functional (anatomically normal) in 44 (39%), and thickened with restricted motion (Carpentier IIIB classification) in 9 (8%). MR was mild in 19 patients (17%), moderate in 27 (24%), and severe (3 to 4+) in 67 (59%) by Transesophageal echocardiography. MitraClip placement was performed in only 17 of 113 patients (15%); all were successful. Surgical mitral valve repair was performed in 25 patients (22%), mitral valve replacement in 12 (11%). Most patients (59 of 113, 52%) were treated medically, usually because MR was not severe enough to warrant intervention. In conclusion, most patients referred for MitraClip therapy do not have severe enough MR to warrant intervention. Of those with clinical need for intervention, surgery is more often recommended for anatomic or clinical reasons. Three-dimensional transesophageal echocardiography with quantitative assessment of MR severity is helpful in evaluating these patients.
经皮二尖瓣修复术联合 MitraClip 已被证实可降低重度（3+或 4+）二尖瓣反流（MR）患者的 MR 严重程度、左心室容积和功能分级。但尚未严格评估哪些患者是 MitraClip 治疗而非手术的最佳候选者。REALISM 连续准入注册研究前瞻性地对 113 例连续转诊至 MitraClip 治疗的患者进行了经食管超声心动图检查。所有患者均进行了 MR 严重程度的定量评估。通过经食管超声心动图和临床参数评估二尖瓣解剖结构和 MitraClip 放置的可行性。MR 病因包括退行性（二尖瓣脱垂）60 例（53%）、功能性（解剖结构正常）44 例（39%）和因增厚导致运动受限（Carpentier IIIB 分类）9 例（8%）。经食管超声心动图显示，MR 轻度 19 例（17%）、中度 27 例（24%）、重度（3 至 4+）67 例（59%）。113 例患者中仅 17 例（15%）进行了 MitraClip 放置，均成功。25 例（22%）患者进行了二尖瓣修复手术，12 例（11%）患者进行了二尖瓣置换术。大多数患者（113 例中的 59 例，52%）接受了药物治疗，通常是因为 MR 不够严重，无需干预。总之，大多数转诊至 MitraClip 治疗的患者的 MR 严重程度不足以进行干预。对于有临床干预需求的患者，由于解剖或临床原因，手术更为常见。MR 严重程度的三维经食管超声心动图定量评估有助于评估这些患者。
