Division of Cardiology, Department of Medicine Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
Division of Cardiology, Department of Medicine Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2018 Apr;81(4):305-310. doi: 10.1016/j.jcma.2017.11.006. Epub 2017 Dec 29.
The transcatheter edge-to-edge mitral valve repair, using MitraClip, has been a safe and effective treatment for severe mitral regurgitation (SMR) in the westerners. However, the therapeutic results of the MitralClip in Taiwan remained elucidated.
Patients with symptomatic SMR were evaluated by the heart team. For those with high or prohibitive surgical risks, transcatheter mitral valve repair was performed in hybrid operation room. During procedure, continuous hemodynamic monitoring was conducted. Transthoracic echocardiography (TTE), blood tests, and six-minute walk test (6MWT) were performed before and 1-month after surgery.
A total of 20 patients (73.4 ± 11.1 years, 85% male) with a mean Euroscore II of 13.2 ± 17.7% and a mean STS score of 8.7 ± 9.0% for mortality were enrolled. After a mean procedural time of 239 ± 95 min, an average of 1.8 ± 0.7 clips were used in each procedure. The procedural successful rate was 95% to achieve mild residual mitral regurgitation. Cardiac output was increased from 3.6 ± 0.9 to 4.6 ± 1.4 (p = 0.008) and V-wave of left atrial pressure declined from 24.4 ± 9.8 to 19.3 ± 7.1 (p = 0.030) immediately during the index procedure. There was no peri-procedural death, myocardial infarction, stroke or any events requiring emergent cardiac surgery. All patients experienced significant improvement in heart failure symptoms. The 6-min walk distance increased from 219.6 ± 118.4 m to 279.1 ± 111.6 (p = 0.04) at 1 month. The echocardiogram further showed significant improvements of mitral regurgitation, pulmonary artery systolic pressure, and the left ventricular end-diastolic volume.
Trans-catheter edge-to-edge mitral valve repairs are safe and effective in Asians with symptomatic SMR, regarding the improvements of clinical symptoms and exercise capacities. MitraClips is also associated with reverse remodeling of pulmonary hypertension and left ventricular size in patients with SMR.
经导管缘对缘二尖瓣修复术（MitraClip）在西方人群中已被证明是一种安全有效的重度二尖瓣反流（SMR）治疗方法。然而，MitraClip 在台湾的治疗效果仍有待阐明。
有症状的 SMR 患者由心脏团队进行评估。对于那些手术风险高或禁忌的患者，在杂交手术室进行经导管二尖瓣修复术。手术过程中进行持续的血流动力学监测。术前和术后 1 个月进行经胸超声心动图（TTE）、血液检查和 6 分钟步行试验（6MWT）。
共纳入 20 名患者（73.4±11.1 岁，85%为男性），平均 Euroscore II 为 13.2±17.7%，平均 STS 评分为 8.7±9.0%用于死亡率。平均手术时间为 239±95 分钟后，平均每个手术使用 1.8±0.7 个夹子。手术成功率为 95%，达到轻度残余二尖瓣反流。心输出量从 3.6±0.9 增加到 4.6±1.4（p=0.008），左心房压力的 V 波从 24.4±9.8 下降到 19.3±7.1（p=0.030）在指数手术期间立即。围手术期无死亡、心肌梗死、卒中和任何需要紧急心脏手术的事件。所有患者心力衰竭症状均显著改善。6 分钟步行距离从 219.6±118.4 米增加到 279.1±111.6（p=0.04）在 1 个月。超声心动图进一步显示二尖瓣反流、肺动脉收缩压和左心室舒张末期容积均有显著改善。
经导管缘对缘二尖瓣修复术在有症状的 SMR 亚洲人群中是安全有效的，可改善临床症状和运动能力。MitraClip 还与 SMR 患者的肺动脉高压和左心室大小的逆重构相关。
