Department of Cardiovascular Surgery, University Heart Center, Hamburg, Germany.
J Thorac Cardiovasc Surg. 2012 Jan;143(1):78-84. doi: 10.1016/j.jtcvs.2011.09.033. Epub 2011 Oct 27.
Surgical 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.
Between 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.
Percutaneous 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.
Clip-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.
在严重左心室功能障碍和相关合并症存在的情况下，外科二尖瓣修复术围手术期风险增加。我们旨在评估在外科手术风险较高、二尖瓣反流 3 级或更严重的选择患者中，使用基于夹合器的经皮缘对缘修复系统进行二尖瓣修复的可行性。
2002 年至 2011 年 1 月期间，202 例既往无二尖瓣手术史的连续患者（年龄 75±9 岁；63%为男性）接受了经皮夹合系统治疗，用于前、后二尖瓣叶的接近。二尖瓣手术风险被认为很高，平均欧洲心脏手术风险评估系统（European System for Cardiac Operative Risk Evaluation）为 44%（范围 21%-54%）。术前左心室射血分数在 36%的患者中小于等于 35%。心脏科医生和心脏外科医生的跨学科心脏团队讨论了所有患者。
186 例患者（92%）成功植入经皮夹合器。患者接受 1 个夹合器（n=125；62%）、2 个夹合器（n=64；32%）或 3 个或更多夹合器（n=7；3%）治疗。与术前相比，术后二尖瓣反流显著减少（P<.0001），并且在大多数患者中在前 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，中位数重症监护病房住院时间为 1 天（范围 0-45 天）。11 例患者在经皮夹合器植入后中位数 38 天（0-468 天）需要进行手术瓣膜修复/置换。
基于夹合器的经皮二尖瓣修复术是一种安全、低风险、有效的治疗选择，适用于手术风险高且有症状的患者，并且不排除以后的手术修复。
