Braun Daniel, Lesevic Hasema, Orban Martin, Michalk Fabian, Barthel Petra, Hoppe Katharina, Sonne Carolin, Pache Jürgen, Mehilli Julinda, Kastrati Adnan, Hausleiter Jörg, Massberg Steffen
Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter, Deutsches Herzzentrum, TU München, Munich, Germany; Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Munich, Germany.
Catheter Cardiovasc Interv. 2014 Jul 1;84(1):137-46. doi: 10.1002/ccd.25331. Epub 2014 Jan 6.
To prospectively assess the outcome of percutaneous edge-to-edge repair in patients with degenerative versus functional mitral regurgitation (MR).
The optimal patient population eligible for percutaneous edge-to-edge repair has yet to be defined.
We analyzed 119 patients treated by percutaneous edge-to-edge repair for symptomatic MR, 72 patients with degenerative and 47 patients with functional MR. The primary endpoints were defined as procedural success (MR grade reduction ≥1 grade) as well as a composite endpoint defined as freedom from MR 3+ or 4+, mitral valve reintervention and death 12 months after clip implantation. In patients with successful clip placement we further analyzed MR grade, New York Heart Association (NYHA) functional class, distance in the 6 min walking test and left ventricular volumes 12 months after clip implantation.
The primary success rate of all intended clipping procedures was 83.3% for degenerative and 89.4% for functional MR (P = 0.42). Regarding the composite endpoint we observed an event free survival of 59.7% in patients treated for degenerative MR and 63.8% in patients treated for functional MR (P = 0.73). We observed a highly significant reduction in MR grade as well as improvement in NYHA functional status in both groups 12 months after clip implantation. However, there was a more pronounced MR grade reduction in patients treated for degenerative MR compared with patients treated for functional MR.
Percutaneous edge-to-edge repair of the mitral valve is feasible and comparably effective in patients with degenerative and functional MR.
前瞻性评估经皮缘对缘修复术治疗退行性二尖瓣反流（MR）与功能性二尖瓣反流患者的疗效。
适合经皮缘对缘修复术的最佳患者群体尚未确定。
我们分析了119例接受经皮缘对缘修复术治疗有症状MR的患者，其中72例为退行性MR患者，47例为功能性MR患者。主要终点定义为手术成功（MR分级降低≥1级）以及一个复合终点，即夹合器植入后12个月无3+或4+级MR、二尖瓣再次干预及死亡。对于夹合器放置成功的患者，我们进一步分析了夹合器植入后12个月的MR分级、纽约心脏协会（NYHA）心功能分级、6分钟步行试验距离和左心室容积。
所有预期夹合手术的主要成功率在退行性MR患者中为83.3%，在功能性MR患者中为89.4%（P = 0.42）。关于复合终点，我们观察到退行性MR患者的无事件生存率为59.7%，功能性MR患者为63.8%（P = 0.73）。夹合器植入后12个月，两组的MR分级均显著降低，NYHA心功能状态均有所改善。然而，与功能性MR患者相比，退行性MR患者的MR分级降低更为明显。
经皮二尖瓣缘对缘修复术在退行性和功能性MR患者中是可行的且疗效相当。
