Ledwoch Jakob, Franke Jennifer, Baldus Stephan, Schillinger Wolfgang, Bekeredjian Raffi, Boekstegers Peter, Hink Ulrich, Kuck Karl-Heinz, Ouarrak Taoufik, Möllmann Helge, Nickenig Georg, Senges Jochen, Franzen Olaf, Sievert Horst
CardioVascular Center Frankfurt, Frankfurt, Germany,
Clin Res Cardiol. 2014 Nov;103(11):930-7. doi: 10.1007/s00392-014-0734-y. Epub 2014 Jun 13.
This analysis from the German Mitral Valve Registry investigates the impact of the learning curve with the MitraClip(®) technique on procedural success and complications.
Consecutive patients treated since 2009 in centers that performed more than 50 transcatheter mitral repairs were included. Results of the first half of the patients were compared to those of the second. Altogether 496 patients from 10 centers were included. Patients treated later had less common severe heart failure symptoms (patients with NYHA IV: 22.1 vs. 14.5 %, p < 0.05). The EuroSCORE I (22.0 vs. 23.0 %, p = ns) and Society of Thoracic Surgeons (STS) score (7.5 vs. 9.5 %, p = ns) did not differ between both groups. Procedural success was 95.6 % (238/249) in the first cases and 94.7 % (232/245, p = ns) subsequently. Also procedural time (104.3 vs. 119 min, p = ns) and complications did not decrease over time.
A learning curve using the MitraClip(®) device does not appear to significantly affect acute MR reduction, hospital and 30-day mortality. Most likely, the proctor system leads to already high initial procedure success and relatively short procedure time.
本项来自德国二尖瓣注册研究的分析探讨了MitraClip（®）技术学习曲线对手术成功率和并发症的影响。
纳入2009年以来在进行了超过50例经导管二尖瓣修复术的中心接受治疗的连续患者。将前半部分患者的结果与后半部分患者的结果进行比较。共纳入了来自10个中心的496例患者。后期治疗的患者中常见的严重心力衰竭症状较少（纽约心脏协会IV级患者：22.1%对14.5%，p<0.05）。两组之间的欧洲心脏手术风险评估系统I（22.0%对23.0%，p=无统计学意义）和胸外科医师协会（STS）评分（7.5%对9.5%，p=无统计学意义）无差异。首例手术成功率为95.6%（238/249），随后为94.7%（232/245，p=无统计学意义）。手术时间（104.3对119分钟，p=无统计学意义）和并发症也未随时间减少。
使用MitraClip（®）装置的学习曲线似乎不会显著影响急性二尖瓣反流的减少、住院率和30天死亡率。很可能，督导系统使初始手术成功率已经很高且手术时间相对较短。
