Heart Center Rostock, University Hospital Rostock, Rostock, Germany.
Cardiovasc Ther. 2014 Apr;32(2):66-73. doi: 10.1111/1755-5922.12058.
Edge-to-edge repair of mitral regurgitation (MR) with the MitraClip(®) (MC) system is increasingly applied in advanced heart failure. Our objective was to compare outcomes in patients with mild-to-moderate and severe systolic heart failure.
Between February 2010 and July 2012, 121 patients with MR of at least grade 3+ and a mean EuroSCORE II of 10.6% underwent MC implantation. Thirty-nine had a left ventricular ejection fraction (LVEF) of ≤30% (group A) and 82 of >30% (group B). Procedural success was comparable in both groups (100% vs. 95.2%) with multiple (>2) clip implantation in 34% and 25% of patients, respectively. At 12 months, absolute reduction in MR grade (2.3 vs. 2.2) and relative reduction in mitral valve orifice area (48% vs. 42%) were also comparable. New York Heart Association class had improved independent from baseline LVEF (P < 0.001). In-hospital mortality was low in both groups (2.6% vs. 2.4%), but there was a strong trend for higher 12-month mortality in group A (34% vs. 18%, P = 0.05) with no significant difference in the overall rate of major adverse cerebrovascular and cardiac events (36.8% vs. 28.9%, P = 0.38). On multivariate analysis, MR grade after repair was the strongest predictor of mortality (OR 2.121, 95% CI 1.095-4.109), whereas systolic impairment was no independent predictor.
Percutaneous mitral valve repair led to comparable symptomatic improvement in patients with mild-to-moderately or severely reduced LV function. LV-EF < 30% was not an independent predictor of short-term mortality, which was mainly governed by residual MR after repair.
使用 MitraClip（®）（MC）系统对二尖瓣反流（MR）进行边缘对边缘修复，在心力衰竭加重患者中应用日益广泛。我们的目的是比较轻中度和重度收缩性心力衰竭患者的结局。
2010 年 2 月至 2012 年 7 月，121 例 MR 至少为 3+级且平均 EuroSCORE II 为 10.6%的患者接受了 MC 植入术。39 例左心室射血分数（LVEF）≤30%（A 组），82 例＞30%（B 组）。两组的手术成功率相当（100%比 95.2%），分别有 34%和 25%的患者需要植入多个（>2 个）夹子。12 个月时，MR 分级的绝对降低（2.3 级比 2.2 级）和二尖瓣瓣口面积的相对降低（48%比 42%）也相当。纽约心脏协会（NYHA）心功能分级的改善与基线 LVEF 无关（P<0.001）。两组院内死亡率均较低（2.6%比 2.4%），但 A 组 12 个月死亡率有升高趋势（34%比 18%，P=0.05），总体重大不良心脑血管事件发生率无显著差异（36.8%比 28.9%，P=0.38）。多变量分析显示，修复后的 MR 分级是死亡率的最强预测因素（OR 2.121，95%CI 1.095-4.109），而收缩功能障碍不是独立的预测因素。
经皮二尖瓣修复术可使左心室功能轻度至中度或重度降低的患者获得相当的症状改善。LV-EF<30%不是短期死亡率的独立预测因素，而主要取决于修复后的残余 MR。
