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先前经皮缘对缘二尖瓣修复术（PMVR）治疗的患者行 TAVR 会影响 MR 的改善。

Previous TAVR in patients undergoing percutaneous edge-to-edge mitral valve repair (PMVR) affects improvement of MR.

机构信息

University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tübingen, Tübingen, Germany.

Affiliated Hospital of Qingdao University, Department of Cardiology, Qingdao, Shandong, China.

出版信息

PLoS One. 2018 Oct 19;13(10):e0205930. doi: 10.1371/journal.pone.0205930. eCollection 2018.

DOI:10.1371/journal.pone.0205930
PMID:30339701
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6195292/
Abstract

BACKGROUND

Patients after transcatheter aortic valve replacement (TAVR) and persistent severe mitral regurgitation (MR) are increasingly treated with percutaneous edge-to-edge mitral valve repair (PMVR). The impact of a former TAVR on PMVR procedures is not clear.

METHODS AND RESULTS

We retrospectively analyzed 332 patients undergoing PMVR using the MitraClip system with respect to procedural and clinical outcome. 21 of these 332 patients underwent TAVR before PMVR. Intra-procedural transthoracic (TTE) and transesophageal echocardiograms (TEE) immediately before and after clip implantation as well as invasive hemodynamic measurements were evaluated. At baseline, we found a significantly smaller mitral valve anterior-posterior diameter in the TAVR cohort (p < 0.001). A reduction of MR by at least three grades was achieved in a smaller fraction in the TAVR cohort as compared to the cohort with a native aortic valve (p = 0.02). Accordingly, we observed a smaller post-procedural cardiac output in the TAVR cohort (p = 0.02).

CONCLUSION

PMVR in patients who had a TAVR before, is associated with altered MR anatomy before and a reduced improvement of MR after the procedure. Future larger and prospective studies will have to determine, whether a previous TAVR influences long-term clinical outcome of patients undergoing PMVR.

摘要

背景

经导管主动脉瓣置换术（TAVR）后持续存在严重二尖瓣反流（MR）的患者越来越多地接受经皮缘对缘二尖瓣修复术（PMVR）治疗。以前的 TAVR 对 PMVR 手术的影响尚不清楚。

方法和结果

我们回顾性分析了 332 例使用 MitraClip 系统行 PMVR 的患者，分析了手术过程和临床结果。这 332 例患者中有 21 例在 PMVR 前接受了 TAVR。评估了 PMVR 前和 PMVR 后即刻经胸（TTE）和经食管超声心动图（TEE）以及有创血液动力学测量结果。在基线时，我们发现 TAVR 组的二尖瓣前-后直径明显较小（p < 0.001）。与主动脉瓣天然组相比，TAVR 组的 MR 减少至少三个等级的比例较小（p = 0.02）。相应地，我们观察到 TAVR 组的术后心输出量较小（p = 0.02）。

结论

在先前接受过 TAVR 的患者中进行 PMVR 与术前 MR 解剖结构改变以及术后 MR 改善程度降低有关。未来更大规模的前瞻性研究将不得不确定以前的 TAVR 是否会影响接受 PMVR 的患者的长期临床结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5092/6195292/873e2a9c7977/pone.0205930.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5092/6195292/fa8488a7c738/pone.0205930.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5092/6195292/91996fe316cd/pone.0205930.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5092/6195292/3b26c0faedc7/pone.0205930.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5092/6195292/873e2a9c7977/pone.0205930.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5092/6195292/fa8488a7c738/pone.0205930.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5092/6195292/91996fe316cd/pone.0205930.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5092/6195292/3b26c0faedc7/pone.0205930.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5092/6195292/873e2a9c7977/pone.0205930.g004.jpg

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