Medical Faculty, Department of Cardiology at University Hospital Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
Catheter Cardiovasc Interv. 2013 Oct 1;82(4):E552-63. doi: 10.1002/ccd.24809. Epub 2013 May 25.
To summarize our single Institution experience with staged total percutaneous management of aorto-mitral pathology.
Percutaneous treatment of aortic valve stenosis (AVS) and mitral valve regurgitation (MVR) has been recently proposed for patients at high surgical risk.
Data concerning consecutive patients undergoing percutaneous transcatheter AV implantation (TAVI) followed by MV repair with MitraClip® were prospectively collected and analyzed.
From January 2010 to February 2012 a total of 254 patients were referred to undergo TAVI in our Institution. Seventeen (6.7%) had preoperative severe MVR that remained unchanged after TAVI. Due to exacerbation of symptoms 12 patients were subsequently submitted to MV repair with the MitraClip® device. Mean age was 79 years (72-86 years), median Ambler score was 30.1 (17.2-42.6) and EuroSCORE 22.3 (10.2-48.6). Procedural success rate was 100%. Postprocedural hospitalization was 7.1 ± 2.7 and 4.6 ± 0.9 days after TAVI and MV repair, respectively. Six months follow-up echocardiography confirms improvement in LV-EF (37.2 ± 9.9 vs. 43.5 ± 10.7, P < 0.0001). No patient presents MVR exceeding grade I(+) or prosthetic aortic insufficiency > I grade and all patients experienced an improvement in functional status.
Percutaneous treatment of AVS and MVR is feasible and safe. A tailored approach should be considered to treat firstly the AVS and subsequently the MVR when severe MV dysfunction and symptoms persist. Short-term durability of this combined percutaneous approach seems encouraging and justifies the economical burden to treat patients that have no other option.
总结我们机构在经皮分期治疗主-二尖瓣病变方面的经验。
经皮治疗主动脉瓣狭窄（AVS）和二尖瓣反流（MVR）最近已被提议用于高手术风险患者。
前瞻性收集并分析了连续接受经导管主动脉瓣植入术（TAVI）后接受 MitraClip®二尖瓣修复术的患者的数据。
从 2010 年 1 月至 2012 年 2 月，共有 254 例患者在我院接受 TAVI。17 例（6.7%）术前有严重的 MVR，TAVI 后无变化。由于症状加重，12 例随后接受 MitraClip®装置进行 MV 修复。平均年龄为 79 岁（72-86 岁），中位数 Ambler 评分 30.1（17.2-42.6），EuroSCORE 22.3（10.2-48.6）。手术成功率为 100%。TAVI 和 MV 修复后住院时间分别为 7.1 ± 2.7 天和 4.6 ± 0.9 天。6 个月的超声心动图随访证实 LV-EF 改善（37.2 ± 9.9 与 43.5 ± 10.7，P <0.0001）。无患者出现 MVR 超过 I(+)级或人工主动脉瓣关闭不全> I 级，所有患者的功能状态均得到改善。
经皮治疗 AVS 和 MVR 是可行和安全的。当严重的 MV 功能障碍和症状持续存在时，应考虑采用针对性方法首先治疗 AVS，然后治疗 MVR。这种联合经皮方法的短期耐久性似乎令人鼓舞，并证明了治疗没有其他选择的患者的经济负担是合理的。
