Department of Cardiology, University Medical Centre Göttingen, Göttingen, Germany.
EuroIntervention. 2014;9(12):1407-17. doi: 10.4244/EIJV9I12A238.
MitraClip implantation is evolving as a potential alternative treatment to conventional surgery in high-risk patients with significant mitral regurgitation (MR). However, outcome predictors are under-investigated. The aim of this study was to identify predictors of midterm mortality and heart failure rehospitalisation after percutaneous mitral valve repair with MitraClip.
A total of 150 consecutive patients were followed for a median of 463 days. Survival analyses were performed for baseline characteristics, risk scores and failure of acute procedural success (APS) defined as persisting MR grade 3+ or 4+. Univariate significant risk stratifiers were tested in multivariate analyses using a Cox proportional hazards model. Overall survival was 96% at 30 days, 79.5% at 12 months, and 62% at two years. Multivariate analysis identified APS failure (HR 2.13, p=0.02), NYHA Class IV at baseline (HR 2.11, p=0.01) and STS score ≥12 (HR 2.20, p<0.0001) as significant independent predictors of all-cause mortality, and APS failure (HR 2.31, p=0.01) and NYHA Class IV at baseline (HR 1.89, p=0.03) as significant independent predictors of heart failure rehospitalisation. Furthermore, a post-procedural significant decrease in hospitalisation rate could only be observed after successful interventions (0.89±1.07 per year before vs. 0.54±0.96 after implantation, p=0.01). Patients with severely dilated and overloaded ventricles who did not meet EVEREST II eligibility criteria were at higher risk of APS failure.
The failure of acute procedural success proved to have the most important impact on outcome after MitraClip implantation.
在高危、重度二尖瓣反流（MR）患者中，二尖瓣夹合术作为一种替代传统手术的潜在治疗方法不断发展。然而，对于预后预测因素的研究还不够充分。本研究旨在确定经皮二尖瓣修复术后中期死亡率和心力衰竭再入院的预测因素。
共对 150 例连续患者进行了中位数为 463 天的随访。对基线特征、风险评分和急性手术成功率（APS）失败（定义为持续 MR 3+或 4+）进行生存分析。使用 Cox 比例风险模型对单变量显著风险分层因素进行多变量分析。30 天时总体生存率为 96%，12 个月时为 79.5%，2 年时为 62%。多变量分析显示，APS 失败（HR 2.13，p=0.02）、基线 NYHA 分级 IV（HR 2.11，p=0.01）和 STS 评分≥12（HR 2.20，p<0.0001）是全因死亡率的独立显著预测因素，APS 失败（HR 2.31，p=0.01）和基线 NYHA 分级 IV（HR 1.89，p=0.03）是心力衰竭再入院的独立显著预测因素。此外，仅在成功干预后才能观察到住院率的显著下降（植入前每年 0.89±1.07，植入后每年 0.54±0.96，p=0.01）。不符合 EVEREST II 入选标准的心室严重扩张和超负荷患者的 APS 失败风险更高。
急性手术成功率失败是二尖瓣夹合术后结果的最重要影响因素。
