Thomas Felix, Rader Florian, Siegel Robert J
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Cardiology. 2017;137(1):58-61. doi: 10.1159/000454800. Epub 2017 Jan 18.
Current nonpharmacological therapies for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM), including septal myectomy and alcohol septal ablation (ASA), carry significant risks for serious cardiac conduction abnormalities. We present a review of the currently available published data regarding the novel use of the relatively low-risk MitraClip® system in the treatment of symptomatic patients.
Data were collected from 4 separate studies on the use of the MitraClip on 15 symptomatic HOCM patients with systolic anterior motion (SAM) of the mitral valve apparatus. Information regarding the degree of mitral regurgitation (MR), left-ventricular outflow tract (LVOT) gradient, and NYHA class was consolidated.
After MitraClip treatment, all patients had a resolution of SAM, a reduction in MR, and a reduction in the LVOT gradient from a mean of 75.8 ± 39.7 to 11.0 ± 5.6 mm Hg. Nearly all patients demonstrated improvements in symptoms by either new NYHA class designations or improved exercise tolerance. The procedure was not associated with conduction abnormalities or arrhythmias.
MitraClip therapy may be a safe and effective treatment for symptomatic HOCM patients; it can help to avoid the potential risks associated with alternative therapies in high-risk surgical patients.
目前针对有症状的肥厚性梗阻性心肌病（HOCM）患者的非药物治疗，包括室间隔心肌切除术和酒精室间隔消融术（ASA），存在严重心脏传导异常的重大风险。我们对目前已发表的关于相对低风险的MitraClip®系统在有症状患者治疗中的新用途的数据进行综述。
从4项关于使用MitraClip治疗15例有症状的二尖瓣装置收缩期前向运动（SAM）的HOCM患者的独立研究中收集数据。汇总有关二尖瓣反流（MR）程度、左心室流出道（LVOT）梯度和纽约心脏协会（NYHA）分级的信息。
MitraClip治疗后，所有患者的SAM均得到缓解，MR减少，LVOT梯度从平均75.8±39.7降至11.0±5.6 mmHg。几乎所有患者通过新的NYHA分级或改善运动耐量，症状均有改善。该手术与传导异常或心律失常无关。
MitraClip治疗可能是有症状的HOCM患者的一种安全有效的治疗方法；它有助于避免高风险手术患者接受替代疗法所带来的潜在风险。
