Minneapolis Heart Institute at Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN 55407 USA.
J Invasive Cardiol. 2020 Jun;32(6):228-231. doi: 10.25270/jic/19.00453. Epub 2020 May 9.
Severe mitral regurgitation (MR) complicated by cardiogenic shock has high operative mortality. Percutaneous leaflet repair with MitraClip (Abbott Vascular) is a less invasive alternative to surgery. The effectiveness and safety of this approach is unknown.
We retrospectively analyzed procedural characteristics of shock patients with severe MR treated with MitraClip in a tertiary, high-volume program (Abbott Northwestern Hospital, Minneapolis, Minnesota) during 2010-2019. The primary outcome of the study was 30-day survival free of significant MR (grade ≤2). One-year mortality was a secondary outcome.
Among 322 patients who underwent MitraClip implantation during the study period, 11 inoperable patients with severe MR and cardiogenic shock were included in this analysis. Mean patient age was 74 ± 11 years and 54% were male. The mechanism of MR was degenerative in 7 patients (63.6%) and functional in 4 patients (36.4%), including 1 post myocardial infarction, 1 with chronic ischemic heart disease, and 2 with end-stage non-ischemic cardiomyopathy. Hemodynamic support with intra-aortic balloon pump was used in 5 patients (45%). The A2-P2 scallop was the more common location for MitraClip insertion, and 27% of patients had >1 clip implanted. Median fluoroscopy time was 18.5 minutes (interquartile range [IQR], 10-22 minutes) and mean postprocedure gradient was 4.5 mm Hg (IQR, 3-5 mm Hg). At 30 days, eight patients (72.7%) were alive with MR grade ≤2. At 1 year, mortality was 66%, and was driven mainly by non-cardiac causes.
Among inoperable patients with severe MR and cardiogenic shock, percutaneous leaflet repair with MitraClip is associated with acceptable short-term effectiveness.
伴有心原性休克的重度二尖瓣反流（MR）具有较高的手术死亡率。经皮瓣叶修复术联合 MitraClip（雅培血管）是一种较手术更具侵入性的替代方法。但这种方法的有效性和安全性尚不清楚。
我们回顾性分析了 2010 年至 2019 年期间在一个三级大容量项目（明尼苏达州明尼阿波利斯市雅培西北医院）中接受 MitraClip 治疗的伴有严重 MR 和心原性休克的休克患者的手术特点。该研究的主要结局是 30 天无重度 MR（等级≤2）的存活率。一年死亡率为次要结局。
在研究期间接受 MitraClip 植入术的 322 例患者中，纳入了 11 例无法手术的严重 MR 合并心原性休克患者。患者平均年龄为 74±11 岁，54%为男性。7 例（63.6%）MR 机制为退行性，4 例（36.4%）为功能性，包括 1 例心肌梗死后，1 例慢性缺血性心脏病，2 例终末期非缺血性心肌病。5 例（45%）患者采用主动脉内球囊泵进行血流动力学支持。A2-P2 扇贝是 MitraClip 插入的更常见位置，27%的患者植入了>1 个夹子。中位数透视时间为 18.5 分钟（四分位距[IQR]，10-22 分钟），术后平均梯度为 4.5mmHg（IQR，3-5mmHg）。30 天时，8 例（72.7%）患者存活且 MR 分级≤2。1 年后，死亡率为 66%，主要由非心脏原因引起。
在无法手术的严重 MR 和心原性休克患者中，经皮瓣叶修复术联合 MitraClip 治疗具有可接受的短期疗效。
