Eggebrecht Holger, Schelle Sibylle, Puls Miriam, Plicht Björn, von Bardeleben Ralph Stephan, Butter Christian, May Andreas E, Lubos Edith, Boekstegers Peter, Ouarrak Taoufik, Senges Jochen, Schmermund Axel
Cardioangiological Center Bethanien, Frankfurt.
Department of Cardiology, University Medical Centre Göttingen, Göttingen.
Catheter Cardiovasc Interv. 2015 Oct;86(4):728-35. doi: 10.1002/ccd.25838. Epub 2015 Feb 12.
To analyze risk and outcomes of complications during and after MitraClip implantation using multicenter data from the prospective German Transcatheter Mitral Valve Interventions (TRAMI) registry.
Data of 828 patients (mean age: 76.0 [71-81] years, 327 (40%) females) undergoing MitraClip implantation in Germany between 2010 and 2013 were analyzed. Most patients (85%) underwent elective procedures with on average implantation of 1.4 ± 0.6 clips. Emergent cardiac surgery was not required; a single patient died intraoperatively. During the in-hospital period, complications occurred in 215 (25.9%) patients, of which 106 (12.8%) were considered major. Major bleeding complications were among the most frequent major complications (7.4%), while rates of pericardial tamponade (1.9%) and clip-specific complications (embolization: 0%, partial clip detachment: 1.9%) were low. In-hospital death, stroke or myocardial infarction (MACCE) occurred in 2.2, 0.9, and 0% patients, respectively. Patients with complications appeared to be older and more critically ill pre-interventionally; in-hospital mortality was significantly higher as compared to those without procedural complications.
MitraClip implantation appears to be a safe treatment option with low rates of MACCE and clip-specific complications. Nevertheless, MitraClip therapy is not without complications. Careful patient selection and improvements in preventing peri-procedural bleeding have the potential of reducing post-procedural complications and improving outcomes.
利用来自前瞻性德国经导管二尖瓣干预（TRAMI）注册研究的多中心数据，分析MitraClip植入术中及术后并发症的风险和结局。
分析了2010年至2013年期间在德国接受MitraClip植入术的828例患者（平均年龄：76.0[71 - 81]岁，327例（40%）为女性）的数据。大多数患者（85%）接受择期手术，平均植入1.4±0.6个夹子。无需紧急心脏手术；1例患者术中死亡。在住院期间，215例（25.9%）患者发生并发症，其中106例（12.8%）被认为是严重并发症。严重出血并发症是最常见的严重并发症之一（7.4%），而心包填塞发生率（1.9%）和夹子特异性并发症（栓塞：0%，部分夹子脱落：1.9%）发生率较低。住院死亡、中风或心肌梗死（主要不良心血管事件，MACCE）分别发生在2.2%、0.9%和0%的患者中。有并发症的患者在干预前似乎年龄更大且病情更危重；与无手术并发症的患者相比，住院死亡率显著更高。
MitraClip植入术似乎是一种安全的治疗选择，主要不良心血管事件和夹子特异性并发症发生率较低。然而，MitraClip治疗并非没有并发症。仔细的患者选择以及预防围手术期出血方面的改进有可能减少术后并发症并改善结局。
