Fam Neil P, Ross Heather J, Verma Subodh
aDivision of Cardiology, St Michael's Hospital bDivision of Cardiology, Toronto General Hospital, University Health Network cDivision of Cardiac Surgery, Keenan Research Centre for Biomedical Science dLi Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.
Curr Opin Cardiol. 2016 Mar;31(2):169-75. doi: 10.1097/HCO.0000000000000261.
Guidelines indicate surgical intervention for patients with symptomatic severe mitral regurgitation or signs of left ventricular dilatation or dysfunction. However, many patients do not receive surgery because of age or comorbidities, and have poor outcomes with conservative therapy. Transcatheter mitral repair with MitraClip (Abbott Vascular, IL, USA) has recently emerged as a viable treatment option for high-risk patients with heart failure. This article will review current evidence supporting the use of MitraClip across the spectrum of patient risk and discuss future directions for this technology.
Both randomized and registry studies have demonstrated the efficacy and safety of MitraClip for mitral regurgitation reduction, with significant improvements in functional class and reductions in heart failure hospitalizations. With increasing global experience, a broader scope of patients and diseases can now be successfully treated, ranging from patients with failed surgical annuloplasty rings to those in cardiogenic shock. Ongoing randomized trials will further define the role of MitraClip in the management of heart failure patients with secondary mitral regurgitation.
MitraClip is a useful therapeutic tool for nonsurgical patients with advanced heart failure and severe mitral regurgitation. Further developments in device design and procedural technique will continue to expand the range of patients who can be treated, with a goal of reducing heart failure hospitalizations and improving quality of life.
指南指出，有症状的严重二尖瓣反流或左心室扩张或功能障碍迹象的患者应接受手术干预。然而，许多患者因年龄或合并症未接受手术，保守治疗效果不佳。经导管二尖瓣修复术（使用MitraClip，美国伊利诺伊州雅培血管公司）最近已成为高危心力衰竭患者的一种可行治疗选择。本文将综述支持在不同风险患者中使用MitraClip的现有证据，并讨论该技术的未来发展方向。
随机研究和注册研究均已证明MitraClip减少二尖瓣反流的有效性和安全性，功能分级有显著改善，心力衰竭住院次数减少。随着全球经验的增加，现在可以成功治疗更广泛的患者和疾病，从手术瓣环成形术失败的患者到心源性休克患者。正在进行的随机试验将进一步明确MitraClip在继发性二尖瓣反流心力衰竭患者管理中的作用。
MitraClip是晚期心力衰竭和严重二尖瓣反流非手术患者的一种有用治疗工具。设备设计和操作技术的进一步发展将继续扩大可治疗患者的范围，目标是减少心力衰竭住院次数并提高生活质量。
