Hamm Karsten, Zacher Michael, Hautmann Martina, Gietzen Frank, Halbfass Philipp, Kerber Sebastian, Diegeler Anno, Schieffer Bernhard, Barth Sebastian
Department of Cardiology, Cardiovascular Center Bad Neustadt, Bad Neustadt, Germany.
Department of Cardiac Surgery, Cardiovascular Center Bad Neustadt, Bad Neustadt, Germany.
Catheter Cardiovasc Interv. 2017 Aug 1;90(2):313-320. doi: 10.1002/ccd.26806. Epub 2016 Sep 21.
We sought to determine the effects of experience on the Mitraclip procedure steps as well as procedure safety and functional results.
MR has proven deleterious in heart failure. Mitraclip therapy evolved an important option in patients with severely reduced left ventricular function (LVEF).
Between 2011 and 2016, 126 consecutive patients were grouped in three groups and investigated in a prospective observational study. We evaluated the duration of procedural steps, safety endpoints, and functional results.
The median logistic EuroScore was 32% (7-40%). Ninety-five percent of patients were in NYHA-stage ≥III and 51% had a LVEF <30%. Groups were homogeneous as to their baseline NYHA status and right heart catheterization data. Echocardiography data are comparable, albeit with a decreasing effective regurgitant orifice area (0.44 ± 0.21 group I vs. 0.34 ± 0.22 group III, P = 0.02). Frailty was less frequent and baseline 6 min walking test results improved from group I to group III. Duration of a first clip placement decreased from 106 ± 50 to 50 ± 21 min (P < 0.001). Total procedure time decreased from 221 ± 70 to 144 ± 68 (P < 0.001). The number of clips implanted increased from 66 to 79 (P = 0.02). MitraClip implantation was effective in either group but the combined safety endpoint was reached less frequent in group III (P = 0.01). There was no difference in MACCE rate, 30 day- or intrahospital-mortality between groups.
Safety and duration of procedure steps improved substantially with experience. MR reduction was sustained from the beginning without further improvement. Patient selection is a key factor for success. © 2016 Wiley Periodicals, Inc.
我们试图确定经验对二尖瓣夹合术操作步骤、手术安全性及功能结果的影响。
二尖瓣反流已被证实在心力衰竭中具有有害作用。二尖瓣夹合术已成为左心室功能严重降低（左心室射血分数，LVEF）患者的一项重要治疗选择。
在2011年至2016年期间，126例连续患者被分为三组，并进行了一项前瞻性观察研究。我们评估了操作步骤的持续时间、安全性终点及功能结果。
逻辑欧洲心脏手术风险评估系统（EuroScore）中位数为32%（7%-40%）。95%的患者处于纽约心脏协会（NYHA）心功能分级≥III级，51%的患者LVEF<30%。各组在基线NYHA状态及右心导管检查数据方面具有同质性。超声心动图数据具有可比性，尽管有效反流口面积逐渐减小（I组为0.44±0.21，III组为0.34±0.22，P=0.02）。衰弱情况较少见，且从I组到III组，基线6分钟步行试验结果有所改善。首次夹合放置的持续时间从106±50分钟降至50±21分钟（P<0.001）。总手术时间从221±70分钟降至144±68分钟（P<0.001）。植入夹子的数量从66个增加到79个（P=0.02）。二尖瓣夹合术在两组中均有效，但III组达到联合安全性终点的频率较低（P=0.01）。各组之间主要不良心血管和脑血管事件（MACCE）发生率、30天或院内死亡率无差异。
随着经验的增加，手术步骤的安全性和持续时间有显著改善。二尖瓣反流从一开始就持续降低，未进一步改善。患者选择是成功的关键因素。©2016威利期刊公司
