De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy.
Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.
Int J Cardiol. 2019 May 15;283:131-133. doi: 10.1016/j.ijcard.2019.02.039. Epub 2019 Feb 21.
No data regarding the safety of continuous-flow left ventricular assist device (CF-LVAD) implantation in patients with previous MitraClip have been reported. Thus, it remains unknown whether an initial treatment strategy with MitraClip therapy might complicate future heart failure management in patients who are also considered for CF-LVAD.
We retrospectively identified 6 patients (median age of 62 years; 2 women) who had been treated with MitraClip, that were eventually implanted with a CF-LVAD (all Heartware HVAD) in 3 hospitals between 2013 and 2018.
Patients were treated in 4 cases with 2 clips, and in 2 cases with 1 clip. Median time from MitraClip implantation to CF-LVAD implant was 282 days (interquartile range 67 to 493), and median time on CF-LVAD support was 401 days (interquartile range 105 to 492 days). Two patients underwent a heart transplant, 3 patients died on support, and 1 is alive on support. In all cases, there was a reduction of functional mitral regurgitation without MitraClip-related complications.
Based on this small case series, implantation of a CF-LVAD appears safe in patients with a previously positioned MitraClip system, at least, with 1 or 2 clips in place, with no need for additional mitral valve surgery.
目前尚无关于在先前接受 MitraClip 治疗的患者中植入持续血流左心室辅助装置 (CF-LVAD) 的安全性数据。因此，尚不清楚最初采用 MitraClip 治疗策略是否会使那些也被认为适合 CF-LVAD 的患者在未来的心力衰竭管理中变得复杂。
我们回顾性地确定了 6 名患者（中位年龄 62 岁；2 名女性），他们在 2013 年至 2018 年间在 3 家医院接受了 MitraClip 治疗，最终植入了 CF-LVAD（均为 Heartware HVAD）。
4 例患者接受了 2 个夹子治疗，2 例患者接受了 1 个夹子治疗。从 MitraClip 植入到 CF-LVAD 植入的中位时间为 282 天（四分位距 67 至 493），CF-LVAD 支持的中位时间为 401 天（四分位距 105 至 492 天）。2 例患者接受了心脏移植，3 例患者在支持下死亡，1 例患者在支持下存活。在所有情况下，功能性二尖瓣反流均减少，且无与 MitraClip 相关的并发症。
基于这项小病例系列研究，在至少有 1 或 2 个夹子的情况下，先前植入的 MitraClip 系统的患者中植入 CF-LVAD 似乎是安全的，无需进行额外的二尖瓣手术。
