Rassaf Tienush, Balzer Jan, Rammos Christos, Zeus Tobias, Hellhammer Katharina, v Hall Silke, Wagstaff Rabea, Kelm Malte
Division of Cardiology, Pulmonology and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Medical Faculty, Moorenstrasse 5, 40225, Düsseldorf, Germany.
Catheter Cardiovasc Interv. 2015 Apr;85(5):899-903. doi: 10.1002/ccd.25705. Epub 2014 Oct 28.
In patients with mitral regurgitation (MR), changes in cardiac stroke volume, and thus renal preload and afterload may affect kidney function. Percutaneous mitral valve repair (PMVR) with the MitraClip® system can be a therapeutic alternative to surgical valve repair. The influence of MitraClip® therapy on renal function and clinical outcome parameters is unknown.
Sixty patients with severe MR underwent PMVR using the MitraClip® system in an open-label observational study. Patients were stratified according to their renal function. All clips have been implanted successfully. Effective reduction of MR by 2-3 grades acutely improved KDOQI class. Lesser MR reduction (MR reduction of 0-1 grades) led to worsening of renal function in patients with pre-existing normal or mild (KDOQI 1-2) compared to severe (KDOQI 3-4) renal dysfunction. Reduction of MR was associated with improvement in Minnesota Living with Heart Failure Questionnaire (MLHFQ), NYHA-stadium, and 6-minute walk test.
Successful PMVR was associated with an improvement in renal function. The improvement in renal function was associated with the extent of MR reduction and pre-existing kidney dysfunction. Our data emphasize the relevance of PVMR to stabilize the cardiorenal axis in patients with severe MR.
在二尖瓣反流（MR）患者中，心搏量的变化以及由此导致的肾前负荷和后负荷的变化可能会影响肾功能。使用MitraClip®系统进行经皮二尖瓣修复（PMVR）可能是外科瓣膜修复的一种治疗选择。MitraClip®治疗对肾功能和临床结局参数的影响尚不清楚。
在一项开放标签的观察性研究中，60例重度MR患者使用MitraClip®系统进行了PMVR。根据肾功能对患者进行分层。所有夹子均成功植入。MR急性有效降低2-3级可使KDOQI分级急性改善。与严重（KDOQI 3-4）肾功能不全患者相比，MR降低程度较小（MR降低0-1级）会导致原有肾功能正常或轻度（KDOQI 1-2）患者的肾功能恶化。MR的降低与明尼苏达心力衰竭生活问卷（MLHFQ）、纽约心脏协会（NYHA）分级和6分钟步行试验的改善相关。
成功的PMVR与肾功能改善相关。肾功能的改善与MR降低的程度和原有的肾功能不全有关。我们的数据强调了PVMR对稳定重度MR患者的心肾轴的相关性。
