Heart Center, University Hospital, Rostock, Germany.
Can J Cardiol. 2013 Apr;29(4):452-9. doi: 10.1016/j.cjca.2012.06.002. Epub 2012 Aug 24.
The objective of this study was to compare outcomes of surgical repair (SR) vs MitraClip (MC) implantation for severe mitral regurgitation (MR).
A retrospective analysis of patients treated within a single institution was performed. Patients had EuroSCORE [European System for Cardiac Operative Risk Evaluation] < 20%, left ventricular ejection fraction ≥45%, and grade 3+/4+ MR.
Fifty patients (24 [48%] MC group, 26 [52%] SR group) with EuroSCORE 7.9 ± 5.6 were included. The MC group included 24 (48%) and the SR group 26 (52%) patients. Patients in the MC group had a significantly more complex comorbid profile (P < 0.001). Successful MC placement was in 22 patients (91.7%) and SR in 26 (100%). At discharge, no patient had grade 3+/4+ MR. There were no in hospital or 30-day deaths. At follow-up (mean 526 ± 398 days), further mitral valve surgery was necessary in 1 (3.8%) patient in the SR group and in 2 (8.3%) patients in the MC group (P = 0.26). One-year freedom from composite end point (death, stroke, myocardial infarction, major bleeding, cardiac rehospitalization) was 75.5% (SR 83% vs MC 67%; P = 0.18). Degree of residual MR Degree of residual MR immediately after the procedure was equally distributed in both groups (P = 0.13) and the sole independent determinant for composite outcome (odds ratio, 16.9; P = 0.024).
MC in nonsurgical candidates and SR in surgical patients showed similar perioperative and follow-up outcomes at an institution experienced with both techniques. Neither MC nor SR were independently related to outcome whenever similar degrees of acute correction with minimal residual MR were achieved. However, these findings should be interpreted within the selection biases and the numerical limitations of the present study.
本研究旨在比较手术修复（SR）与 MitraClip（MC）植入治疗严重二尖瓣反流（MR）的结局。
对单中心治疗的患者进行回顾性分析。患者的欧洲心脏手术风险评估系统（EuroSCORE）<20%，左心室射血分数≥45%，且 MR 分级为 3+/4+。
共纳入 50 例患者（MC 组 24 例[48%]，SR 组 26 例[52%]），EuroSCORE 为 7.9±5.6。MC 组中 24 例（48%）和 SR 组中 26 例（52%）患者。MC 组患者的合并症更为复杂（P<0.001）。MC 组 22 例（91.7%）和 SR 组 26 例（100%）成功置入。出院时，无患者存在 3+/4+级 MR。无院内或 30 天死亡。随访（平均 526±398 天）时，SR 组中有 1 例（3.8%）和 MC 组中有 2 例（8.3%）患者需要再次行二尖瓣手术（P=0.26）。1 年复合终点（死亡、卒、心肌梗死、大出血、心脏再入院）无事件生存率为 SR 组 83%，MC 组 67%（P=0.18）。残余 MR 程度即刻残余 MR 在两组中的分布相同（P=0.13），是复合结局的唯一独立决定因素（比值比 16.9；P=0.024）。
MC 用于非手术候选者，SR 用于手术患者，在本中心两种技术均具有相似的围手术期和随访结局。在实现相似程度的急性矫正且残余 MR 最小的情况下，MC 和 SR 与结局均无独立相关性。然而，这些发现应在本研究的选择偏倚和数值局限性内进行解读。
