Buzzatti Nicola, Maisano Francesco, Latib Azeem, Taramasso Maurizio, Denti Paolo, La Canna Giovanni, Colombo Antonio, Alfieri Ottavio
Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy.
Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
Am J Cardiol. 2015 Feb 15;115(4):487-92. doi: 10.1016/j.amjcard.2014.11.031. Epub 2014 Nov 29.
Octogenarians affected by mitral regurgitation (MR) are an increasing high-risk population. MitraClip repair is emerging as a promising option for this kind of patients. In this retrospective study, the outcomes of patients aged ≥80 years, affected by isolated degenerative MR, who underwent isolated transcatheter (n = 25) or surgical (n = 35, 29 repairs and 6 replacements) mitral intervention from September 2008 to February 2014 were compared. MitraClip patients had higher mean age (84.5 ± 3.2 vs 81.9 ± 2.0 years, p <0.01), median Logistic Euroscore 19.4 (11.1 to 29.0) versus 8.4 (7.0 to 10.1) (p <0.01), median Society of Thoracic Surgeons predicted mortality 5.3 (3.5 to 6.6) versus 2.7 (2.3 to 3.9) (p <0.01), and more advanced New York Heart Association class (III to IV in 68% vs 37%, p = 0.02). At 30 days, 1 death occurred in the MitraClip group (p = 0.2). MitraClip was associated with significantly less complications (p <0.05) but more residual MR >2 (p <0.01). Two-year actuarial survival rate was 90% for MitraClip versus 97% for surgery (p <0.01). Higher Society of Thoracic Surgeons mortality was associated with reduced follow-up survival rate (p = 0.01). Two-year actuarial freedom from MR >2 was 70% versus 100%, respectively (p <0.01). New York Heart Association class and quality of life improved after MitraClip and were similar to surgical patients. Recurrent MR >2 was not significantly associated with follow-up mortality in this elderly setting. After the introduction of MitraClip, octogenarian patients with isolated degenerative MR receiving mitral treatment significantly increased (p <0.01). In conclusion, MitraClip patients, despite being older, more symptomatic, and affected by more co-morbidities showed significantly reduced postoperative complications. Two-year mortality was higher in the MitraClip group likely because of co-morbidities. Transcatheter mitral repair resulted in more octogenarians being treated compared with the past.
受二尖瓣反流（MR）影响的八旬老人是一个不断增加的高危人群。MitraClip修复术正成为这类患者的一个有前景的选择。在这项回顾性研究中，比较了2008年9月至2014年2月期间年龄≥80岁、患有单纯退行性二尖瓣反流、接受单纯经导管二尖瓣介入治疗（n = 25）或外科手术治疗（n = 35，其中29例修复和6例置换）的患者的治疗结果。接受MitraClip治疗的患者平均年龄更高（84.5±3.2岁对81.9±2.0岁，p<0.01），Logistic Euroscore中位数为19.4（11.1至29.0）对8.4（7.0至10.1）（p<0.01），胸外科医师协会预测死亡率中位数为5.3（3.5至6.6）对2.7（2.3至3.9）（p<0.01），纽约心脏协会心功能分级更高级（III至IV级在MitraClip组中占68%，而手术组中占37%，p = 0.02）。在30天时，MitraClip组有1例死亡（p = 0.2）。MitraClip治疗相关并发症显著更少（p<0.05），但残余二尖瓣反流>2级的情况更多（p<0.01）。MitraClip组的两年精算生存率为90%，而手术组为97%（p<0.01）。胸外科医师协会预测的更高死亡率与随访生存率降低相关（p = 0.01）。两年精算无二尖瓣反流>2级的发生率分别为70%和100%（p<0.01）。MitraClip治疗后纽约心脏协会心功能分级和生活质量得到改善，且与手术患者相似。在这个老年患者群体中，复发性二尖瓣反流>2级与随访死亡率无显著相关性。引入MitraClip后，接受二尖瓣治疗的患有单纯退行性二尖瓣反流的八旬老人患者显著增加（p<0.01）。总之，接受MitraClip治疗的患者尽管年龄更大、症状更明显且合并症更多，但术后并发症显著减少。MitraClip组两年死亡率更高可能是由于合并症。与过去相比，经导管二尖瓣修复术使更多八旬老人得到了治疗。
