Lee Ching Wei, Sung Shih Hsien, Huang Wei Ming, Tsai Yi Lin, Chen Hsiang Yao, Hsu Chiao Po, Shih Chun Che, Chung Kuo Piao
Division of Cardiology, Department of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
Department of Medical Affairs and Planning, National Yang-Ming University, Taipei, Taiwan, R.O.C.
Korean Circ J. 2019 Jun;49(6):532-541. doi: 10.4070/kcj.2018.0417. Epub 2019 Feb 20.
Age is a traditional risk factor for open-heart surgery. The efficacy and safety of transcatheter edge-to-edge mitral valve repair, using MitraClip (Abbott Vascular), has been demonstrated in patients with severe mitral regurgitation (MR). Since octogenarians or older patients are usually deferred to receive open-heart surgery, the main interest of this study is to elucidate the procedural safety and long-term clinical impact of MitraClip in elderly patients.
Patients with symptomatic severe MR were evaluated by the heart team. For those with high or prohibitive surgical risks, transcatheter mitral valve repair was performed in hybrid operation room. Transthoracic echocardiography (TTE), blood tests, and six-minute walk test (6MWT) were performed before, 1-month, 6-months, and 1 year after index procedure.
A total of 46 consecutive patients receiving MitraClip procedure were enrolled. Nineteen patients (84.2±4.0 years) were over 80-year-old and 27 (73.4±11.1 years) were younger than 80. Compare to baseline, the significant reduction in MR severity was achieved after the procedure and sustained. All the patients benefited from significant improvement in New York Heart Association functional class. The 6-minute walk test (6MWT) increased from 259±114 to 319±92 meters (p=0.03) at 1 year. The overall 1-year survival rate was 80% in the elderly and 88% in those <80 years, p=0.590. Baseline 6MWT was a predictor for all-cause mortality (odds ratio, 0.99; 95% confidence interval, 0.982-0.999; p=0.026) after the MitraClip procedure.
Trans-catheter edge-to-edge mitral valve repairs are safe and have positive clinical impact in subjects with severe MR, even in advanced age.
年龄是心脏直视手术的传统风险因素。使用MitraClip（雅培血管）进行经导管二尖瓣缘对缘修复术治疗严重二尖瓣反流（MR）患者的有效性和安全性已得到证实。由于八旬老人或更年长的患者通常不考虑接受心脏直视手术，本研究的主要关注点是阐明MitraClip在老年患者中的手术安全性和长期临床影响。
有症状的严重MR患者由心脏团队进行评估。对于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。在索引手术前、术后1个月、6个月和1年进行经胸超声心动图（TTE）、血液检查和六分钟步行试验（6MWT）。
共纳入46例连续接受MitraClip手术的患者。19例患者（84.2±4.0岁）年龄超过80岁，27例（73.4±11.1岁）年龄小于80岁。与基线相比，术后MR严重程度显著降低且持续存在。所有患者的纽约心脏协会功能分级均有显著改善。1年时，六分钟步行试验（6MWT）从259±114米增加到319±92米（p=0.03）。老年患者的总体1年生存率为80%，<80岁患者为88%，p=0.590。基线6MWT是MitraClip手术后全因死亡率的预测指标（比值比，0.99；95%置信区间，0.982-0.999；p=0.026）。
经导管二尖瓣缘对缘修复术即使在高龄严重MR患者中也是安全的，并且具有积极的临床影响。
