Division of Cardiology, University Heart Center Eppendorf, Hamburg, Germany.
EuroIntervention. 2015 Oct;11(6):673-81. doi: 10.4244/EIJY15M09_05.
Parachute® implantation (PI) is an attractive treatment option for patients with left ventricular apical aneurysms (LVAA). So far, only the retrograde approach has been approved for PI. Unfortunately, severe functional mitral regurgitation (MR) restricts PI. Thus, we were intrigued to combine PI and MitraClip therapy (MCT) as a new transvenous hybrid concept.
PI was performed via a transseptally placed MitraClip guide in six consecutive patients (age 73.8±5.2; 66% male). Immediately after PI, MR was treated by MCT. Invasive right and left heart haemodynamics were taken before and after PI and MCT, respectively. Procedural success was 100%. PI induced a numerical increase in cardiac output (CO: +36.4; p=0.15) and stroke volume (SV: +30.1%; p=0.09), despite some evidence of MR aggravation. Subsequent MCT successfully reduced MR at least to mild in five patients and to moderate in one patient. SV and CO demonstrated a further increase (SV: +44.3%, p=0.03; CO: +44.5%; p=0.03).
The study documents for the first time the feasibility of transseptal and transmitral PI. Nevertheless, pre-procedural MR seems to counteract the beneficial effects of PI. Hence, the combined transseptal approach of PI and MCT seems to be the appropriate strategy in patients with significant MR and LVAA.
降落伞®植入术（PI）是治疗左心室心尖部瘤（LVAA）的一种有吸引力的治疗选择。到目前为止，仅批准逆行方法进行 PI。不幸的是，严重的功能性二尖瓣反流（MR）限制了 PI 的应用。因此，我们有兴趣将 PI 和 MitraClip 治疗（MCT）结合起来，作为一种新的经静脉杂交概念。
连续 6 例患者（年龄 73.8±5.2；66%为男性）通过经房间隔放置的 MitraClip 导丝进行 PI。PI 后立即进行 MCT 治疗 MR。分别在 PI 和 MCT 前后进行有创右心和左心血液动力学检查。手术成功率为 100%。尽管存在 MR 加重的证据，但 PI 引起心输出量（CO：+36.4；p=0.15）和每搏输出量（SV：+30.1%；p=0.09）的数值增加。随后的 MCT 在 5 例患者中至少将 MR 降低到轻度，在 1 例患者中降低到中度。SV 和 CO 进一步增加（SV：+44.3%，p=0.03；CO：+44.5%，p=0.03）。
该研究首次记录了经房间隔和经二尖瓣 PI 的可行性。然而，术前 MR 似乎抵消了 PI 的有益作用。因此，在有明显 MR 和 LVAA 的患者中，PI 和 MCT 的联合经房间隔方法似乎是合适的策略。
