Mendirichaga Rodrigo, Singh Vikas, Blumer Vanessa, Rivera Manuel, Rodriguez Alex P, Cohen Mauricio G, O'Neill William W, Elmariah Sammy
Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida.
Structural Heart Diseases, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Am J Cardiol. 2017 Aug 15;120(4):708-715. doi: 10.1016/j.amjcard.2017.05.041. Epub 2017 May 30.
Transcatheter edge-to-edge mitral valve repair (TMVr) with MitraClip has proved to be safe and effective for high-risk surgical patients with severe symptomatic degenerative mitral regurgitation. There is paucity of data regarding its use in functional mitral regurgitation (FMR). The objective of this study was to evaluate the use of MitraClip in patients with symptomatic moderate or severe FMR and a high surgical risk. Medical libraries were systematically searched for studies assessing the use of MitraClip for patients with symptomatic moderate or severe FMR and a high surgical risk. Studies reporting safety and efficacy outcomes at 12 months were included in the analysis. A total of 12 studies including 1,695 patients (age 73 [interquartile range [IQR] 70.5 to 74], 69.8% men, left ventricular ejection fraction 32.5% [IQR 29.5 to 36], New York Heart Association class II to IV) who underwent TMVr with MitraClip were included in the analysis. Acute procedural success was 89% (IQR 85.5 to 92). Ischemic cardiomyopathy was the most common cause of left ventricular dysfunction. Over 2/3 of patients had known coronary artery disease, 35% a previous myocardial infarction, and 38.5% had a previous cardiac surgery. Survival to hospital discharge was 98% (IQR 97 to 100) and 30-day survival 97% (IQR 96 to 98). Overall survival at 12 months was 82% (IQR 77 to 87). Mitral valve re-intervention at 12 months was infrequent (3%; IQR 2 to 6.5). In conclusion, our pooled analysis suggests that TMVr with MitraClip is feasible, safe, and carries a low rate of mitral valve re-intervention at 12 months in patients with symptomatic moderate or severe FMR and a high surgical risk.
对于有严重症状的退行性二尖瓣反流的高危手术患者，使用MitraClip进行经导管二尖瓣缘对缘修复（TMVr）已被证明是安全有效的。关于其在功能性二尖瓣反流（FMR）中的应用数据较少。本研究的目的是评估MitraClip在有症状的中度或重度FMR且手术风险高的患者中的应用。系统检索医学文献库，查找评估MitraClip在有症状的中度或重度FMR且手术风险高的患者中的应用的研究。分析纳入了报告12个月时安全性和有效性结果的研究。共有12项研究，包括1695例患者（年龄73岁[四分位间距（IQR）70.5至74岁]，69.8%为男性，左心室射血分数32.5%[IQR 29.5至36]，纽约心脏协会心功能分级为II至IV级）接受了使用MitraClip的TMVr，纳入分析。急性手术成功率为89%（IQR 85.5至92）。缺血性心肌病是左心室功能障碍最常见的原因。超过2/3的患者患有已知的冠状动脉疾病，35%曾发生过心肌梗死，38.5%曾接受过心脏手术。出院生存率为98%（IQR 97至100），30天生存率为97%（IQR 96至98）。12个月时的总生存率为82%（IQR 77至87）。12个月时二尖瓣再次干预很少见（3%；IQR 2至6.5）。总之，我们的汇总分析表明，对于有症状的中度或重度FMR且手术风险高的患者，使用MitraClip进行TMVr是可行、安全的，且12个月时二尖瓣再次干预率较低。
