University Medicine Rostock, Heart Center Rostock (Cardiology), Rostock, Germany.
J Interv Cardiol. 2012 Apr;25(2):180-9. doi: 10.1111/j.1540-8183.2011.00688.x. Epub 2011 Dec 21.
To evaluate the short-term outcome of patients predominantly at high risk treated with the MitraClip® device for severe mitral valve regurgitation (MR) using one or more clips.
We prospectively analyzed patients with highly symptomatic MR classified as inoperable (logistic EuroSCORE 24.16 ± 13.64%; STS-score 29.9 ± 14.5%) but subject to mitral valve repair with MitraClip® between May 2010 and January 2011. Thirty-three consecutive patients (57.6% male; age 77.8 ± 6.7 years) were enrolled and treated with either 1 (n = 7; 21.2%), 2 (n = 20; 60.6%), 3 (n = 4; 12.1%), or 4 (n = 2, 6.1%) clips. Grading of MR was performed by two-dimensional transesophageal echocardiography (2D-TEE) prior to TEE-guided clipping and before discharge.
MR was classified as functional in 23 (69.7%) and organic in 10 (30.3%) of the patients with MR-grade ≥ 3+ in 32 (97%) and = 4 in 1 patients (3%) before repair. Reduction in MR grade to grade ≤1+ was achieved in 81.7% and to 2 in 12.1% (P = 0.00072). Invasive pulmonary artery systolic pressure (PAPsyst) and pulmonary capillary wedge pressure (PCWP) v-wave decreased from 59.2 ± 18.6 to 46.9 ± 15.3 mmHg (P = 0.00014) and 21.2 ± 6.7 to 8.0 ± 3.3 mmHg (P = 0.0093), respectively, as measured immediately after clipping. Functional NYHA class improved from mean 3 (range 3 [90.9%] to 4 [9.1%]) to 2 in 84.9% (P = 0.00081) as obtained at discharge.
Mitral valve repair with MitraClip® using multiple clips is appropriate and safe in unselected patients resulting in reduced MR with positive impact on short-term functional capacity.
本研究旨在评估使用 MitraClip®装置对高度危险的重度二尖瓣反流（MR）患者进行治疗的短期疗效，这些患者采用了 1 个或多个夹子。
本研究前瞻性分析了 2010 年 5 月至 2011 年 1 月期间因高风险而接受 MitraClip®二尖瓣修复的高度症状性 MR 患者，这些患者被归类为手术禁忌（Logistic EuroSCORE 24.16±13.64%；STS 评分 29.9±14.5%）。33 例连续患者（57.6%为男性；年龄 77.8±6.7 岁）入选并接受治疗，采用 1 个（n=7；21.2%）、2 个（n=20；60.6%）、3 个（n=4；12.1%）或 4 个（n=2；6.1%）夹子。在 TEE 引导夹闭和出院前，通过二维经食管超声心动图（2D-TEE）对 MR 进行分级。
MR 分级≥3+的患者中，23 例（69.7%）为功能性，10 例（30.3%）为器质性，修复前 MR 分级为 4 级的患者有 1 例（3%），2 级的患者有 32 例（97%）。81.7%的患者 MR 分级降至≤1+，12.1%的患者降至 2 级（P=0.00072）。夹闭后即刻，经测量，肺动脉收缩压（PAPsyst）和肺毛细血管楔压（PCWP）v 波分别从 59.2±18.6mmHg 降至 46.9±15.3mmHg（P=0.00014）和从 21.2±6.7mmHg 降至 8.0±3.3mmHg（P=0.0093）。夹闭后即刻，84.9%（31/37）的患者纽约心脏协会（NYHA）心功能分级从平均 3 级（范围 3 级[90.9%]至 4 级[9.1%]）改善至 2 级（P=0.00081）。
在未经选择的患者中，使用多个夹子进行二尖瓣修复是安全且合适的，可减少 MR，对短期心功能有积极影响。
