CardioVascular Center Frankfurt, Sankt Katharinen and University Hospital, Frankfurt, Germany.
EuroIntervention. 2012 Sep;8(5):587-90. doi: 10.4244/EIJV8I5A90.
For appropriately selected patients with severe mitral regurgitation, percutaneous mitral valve repair with the MitraClip® system is a promising alternative to open chest surgery. The procedure requires transoesophageal echocardiographic guidance and is performed under general anaesthesia. However, many patients undergoing percutaneous repair are at high risk for complications related to anaesthesia. We report our initial experience in the use of the MitraClip® system under deep sedation and local anaesthesia in five consecutive cases.
Five patients (two male, three female), median age 79 years (range 71 to 88 years), four with moderate to severe mitral regurgitation suitable for percutaneous repair, underwent the MitraClip® procedure under local anaesthesia and deep sedation. All procedures were completed without general anaesthesia. All patients received 2 mg of midazolam, and propofol was administered according to response during the course of the procedure with 20-60 mg required per case. The median duration of the procedures was 88 (74 to 193) minutes, and the median duration of procedural TEE was 64 (59 to 193) minutes. Four of five procedures were carried out successfully. Three patients required one clip and one patient required two clips. In one patient, the clip was eventually withdrawn and not implanted because it did not lead to an adequate reduction of mitral insufficiency.
The implantation of a MitraClip® is feasible under local anaesthesia and sedation. In patients at high risk for complications related to general anaesthesia, percutaneous mitral valve repair under local anaesthesia may be a viable alternative.
对于适当选择的严重二尖瓣反流患者，经皮二尖瓣修复术采用 MitraClip®系统是一种有前途的替代开胸手术的方法。该手术需要经食管超声心动图引导，并在全身麻醉下进行。然而，许多接受经皮修复的患者存在与麻醉相关的并发症的高风险。我们报告了在五例连续病例中在深度镇静和局部麻醉下使用 MitraClip®系统的初步经验。
五名患者（两名男性，三名女性），中位年龄 79 岁（范围 71 至 88 岁），四例为中度至重度二尖瓣反流，适合经皮修复，在局部麻醉和深度镇静下接受 MitraClip®手术。所有手术均无需全身麻醉完成。所有患者均接受 2 毫克咪达唑仑，根据手术过程中的反应给予丙泊酚，每个病例需要 20-60 毫克。手术的中位时间为 88 分钟（74 至 193 分钟），手术过程中经食管超声心动图的中位时间为 64 分钟（59 至 193 分钟）。五例中有四例成功完成。三名患者需要一个夹子，一名患者需要两个夹子。在一名患者中，夹子最终被撤回而未植入，因为它没有导致二尖瓣关闭不全的充分减少。
在局部麻醉和镇静下植入 MitraClip®是可行的。在因全身麻醉相关并发症而处于高风险的患者中，局部麻醉下的经皮二尖瓣修复术可能是一种可行的替代方法。
