Taramasso Maurizio, Maisano Francesco, Denti Paolo, Latib Azeem, La Canna Giovanni, Colombo Antonio, Alfieri Ottavio
Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy.
Division of Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
J Thorac Cardiovasc Surg. 2014 Dec;148(6):2743-50. doi: 10.1016/j.jtcvs.2014.03.036. Epub 2014 Mar 27.
The study objective was to report the midterm outcomes of MitraClip implantation in inoperable or high-risk surgical candidates with degenerative mitral regurgitation.
From October 2008, data of all high-risk or elderly patients with severe degenerative mitral regurgitation who underwent MitraClip implantation were prospectively collected.
Forty-eight high-risk consecutive patients with severe degenerative mitral regurgitation underwent MitraClip implantation (mean age, 78.5 ± 10.8 years; 56.6% of the patients were aged ≥ 80 years). Mean Society of Thoracic Surgeons score was 12% ± 10%, and 71% were in New York Heart Association class III or IV. Mean left ventricular ejection fraction was 57% ± 11%. The device was successfully implanted in 47 of 48 patients (98%). In-hospital mortality was 2%. The median intensive care unit stay was 22 hours; patients were discharged from the hospital in an average of 4.5 ± 2.4 days. Predischarge echocardiography showed a mitral regurgitation reduction to grade 2+ or less in 43 of 47 patients (91.5%). Actuarial survival was 89% ± 5.2% and 70.2% ± 9% at 1 and 2 years, respectively (82% ± 9% in patients aged <80 years and 95% ± 4.4% in patients aged ≥ 80 years at 1 year; P = .9). Freedom from mitral regurgitation 3+ or greater was 80% ± 7% at 1 year and 76.6% ± 7% at 2 years. At 1 year, 93% of survivors were in New York Heart Association class I or II (100% of patients aged <80 years and 88% of patients aged ≥ 80 years; P = .4). Significant quality of life improvements were documented. A significant improvement in 6-minute walk test performance was observed.
MitraClip therapy is a valuable alternative to surgery in high-risk and elderly patients with degenerative mitral regurgitation. Clinical benefits also are obtained in octogenarians.
本研究旨在报告经皮二尖瓣夹合术（MitraClip）植入术在无法进行手术或手术风险高的退行性二尖瓣反流患者中的中期疗效。
自2008年10月起，前瞻性收集所有接受MitraClip植入术的高风险或老年重度退行性二尖瓣反流患者的数据。
48例连续性高风险重度退行性二尖瓣反流患者接受了MitraClip植入术（平均年龄78.5±10.8岁；56.6%的患者年龄≥80岁）。胸外科医师协会平均评分为12%±10%，71%的患者为纽约心脏协会Ⅲ或Ⅳ级。平均左心室射血分数为57%±11%。48例患者中有47例（98%）成功植入该装置。住院死亡率为2%。重症监护病房中位住院时间为22小时；患者平均4.5±2.4天出院。出院前超声心动图显示，47例患者中有43例（91.5%）二尖瓣反流减轻至2+级或更低。1年和2年的精算生存率分别为89%±5.2%和70.2%±9%（年龄<80岁的患者1年时为82%±9%，年龄≥80岁的患者1年时为95%±4.4%；P = 0.9）。1年和2年时无3+级或更严重二尖瓣反流的比例分别为80%±7%和76.6%±7%。1年时，93%的幸存者为纽约心脏协会Ⅰ或Ⅱ级（年龄<80岁的患者为100%，年龄≥80岁的患者为88%；P = 0.4）。生活质量有显著改善。6分钟步行试验表现有显著改善。
对于高风险和老年退行性二尖瓣反流患者，MitraClip治疗是一种有价值的手术替代方案。八旬老人也能获得临床益处。
