Ostovar Roya, Claus Thomas, Hartrumpf Martin, Kuehnel Ralf Uwe, Braun Christian, Butter Christian, Albes Johannes M
Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau bei Berlin, Brandenburg Medical School, Germany.
Department of Cardiology, Heart Center Brandenburg, Bernau, Brandenburg Medical School, Germany.
Thorac Cardiovasc Surg. 2018 Oct;66(7):537-544. doi: 10.1055/s-0037-1606329. Epub 2017 Sep 18.
MitraClip (Abbott Inc.) is propagated as a palliative option for high-risk patients with mitral insufficiency considered not qualifying for surgical repair. A proportion of patients requires consecutive surgery because of technical failure or inappropriate clinical improvement. Furthermore, surgical reconstruction is impossible in almost all patients after MitraClip implantation. Consequently, these patients receive replacement although primary repair may have been possible. The outcome of those patients compared with patients receiving primary mitral valve replacement (MVR) or mitral valve repair (MVP) was analyzed.
A total of 23 patients were retrospectively analyzed after MVR following MitraClip. Overall, 46 patients with corresponding demographic data and risk profile receiving primary MVR (23 patients) or MVP (23 patients) were retrieved for matched pair analysis.
Mean age was 70 years in all groups, log European system for cardiac operative risk evaluation (EuroSCORE) was 22.47% ± 16.30 in MVR after MitraClip (MC), 22.34% ± 16.23 in MVP, and 22.33% ± 16.14 in MVR group. Preoperative left ventricular ejection fraction (LVEF) was 44%, and postoperative LVEF was 48% in all groups. The 30-day mortality was 21.7% in the MitraClip group whereas it was 4.3% in the MVR and 13.0% in the MVP group. The 1-year survival was 56.5% in the MitraClip group while it was 95.6% in the MVR group and 82.6% in the MVP group (Wilcoxon test: = 0.007; chisquare test: = 0.001 MitraClip vs. MVR; = 0.054 MitraClip vs. MVP).
Patients requiring surgical MVR after the previous MitraClip fared worse than matched cohorts receiving primary MVR or MVP. Indication for MitraClip should, therefore, be made very cautiously given the excellent results gained with primary surgery.
MitraClip（雅培公司）被宣传为二尖瓣关闭不全高危患者的一种姑息治疗选择，这些患者被认为不适合进行手术修复。一部分患者由于技术失败或临床改善不理想而需要进行二次手术。此外，几乎所有植入MitraClip后的患者都无法进行手术重建。因此，尽管可能原本可以进行初次修复，但这些患者仍接受瓣膜置换。分析了这些患者与接受初次二尖瓣置换术（MVR）或二尖瓣修复术（MVP）患者的结局。
对23例MitraClip术后接受MVR的患者进行回顾性分析。总体而言，检索出46例具有相应人口统计学数据和风险特征且接受初次MVR（23例患者）或MVP（23例患者）的患者进行配对分析。
所有组的平均年龄为70岁，MitraClip术后MVR组的欧洲心脏手术风险评估系统（EuroSCORE）对数为22.47%±16.30，MVP组为22.34%±16.23，MVR组为22.33%±16.14。所有组术前左心室射血分数（LVEF）为44%，术后LVEF为48%。MitraClip组的30天死亡率为21.7%，而MVR组为4.3%，MVP组为13.0%。MitraClip组的1年生存率为56.5%，而MVR组为95.6%，MVP组为82.6%（Wilcoxon检验：=0.007；卡方检验：MitraClip与MVR比较=0.001；MitraClip与MVP比较=0.054）。
先前接受MitraClip治疗后需要进行手术MVR的患者，其预后比接受初次MVR或MVP的配对队列患者更差。因此，鉴于初次手术取得的良好效果，MitraClip的适应证应非常谨慎地确定。
