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多个 MitraClip：压力梯度和反流之间的平衡术。

Multiple MitraClips: The balancing act between pressure gradient and regurgitation.

机构信息

Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga.

Department of Biostatistics and Data Science, UTHealth, School of Public Health, Houston, Tex.

出版信息

J Thorac Cardiovasc Surg. 2022 Apr;163(4):1319-1327.e1. doi: 10.1016/j.jtcvs.2020.05.049. Epub 2020 May 31.

DOI:10.1016/j.jtcvs.2020.05.049
PMID:32711989
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7704541/
Abstract

OBJECTIVE

Transcatheter mitral valve repair with the MitraClip is used for the symptomatic management of mitral regurgitation (MR). The challenge is reducing MR while avoiding an elevated mitral valve gradient (MVG). This study assesses how multiple MitraClips used to treat MR can affect valve performance.

METHODS

Six porcine mitral valves were assessed using an in vitro left heart simulator in the native, moderate-to-severe MR, and severe MR cases. MR cases were tested in the no-MitraClip, 1-MitraClip, and 2-MitraClip configurations. Mitral regurgitant fraction (MRF), MVG, and effective orifice area (EOA) were quantified.

RESULTS

Native MRF, MVG, and EOA were 14.22%, 2.59 mm Hg, and 1.64 cm, respectively. For moderate-to-severe MR, MRF, MVG, and EOA were 34.07%, 3.31 mm Hg, and 2.22 cm, respectively. Compared with the no-MitraClip case, 1 MitraClip decreased MRF to 18.57% (P < .0001) and EOA to 1.50 cm (P = .0002). MVG remained statistically unchanged (3.44 mm Hg). Two MitraClips decreased MRF to 14.26% (P < .0001) and EOA to 1.36 cm (P = .0001). MVG remained unchanged (3.29 mm Hg). For severe MR, MRF, MVG, and EOA were 59.79%, 4.98 mm Hg, and 2.73 cm, respectively. Compared with the no-MitraClip case, 1 MitraClip decreased MRF to 30.72% (P < .0001) and EOA to 1.82 cm (P < .0001); MVG remained unchanged (4.03 mm Hg). MVG remained statistically unchanged. Two MitraClips decreased MRF to 23.10% (P < .0001) and EOA to 1.58 cm (P < .0001); MVG remained statistically unchanged (3.82 mm Hg). Both MR models yielded no statistical difference between 1 and 2 MitraClips.

CONCLUSIONS

There is limited concern regarding elevation of MVG when reducing MR using 1 or 2 MitraClips, although 2 MitraClips did not significantly continue to reduce MRF.

摘要

目的

经导管二尖瓣修复术（MitraClip）用于治疗二尖瓣反流（MR）的症状性管理。挑战在于降低 MR 的同时避免二尖瓣瓣上梯度（MVG）升高。本研究评估了用于治疗 MR 的多个 MitraClip 如何影响瓣膜性能。

方法

使用体外左心模拟器评估 6 个猪二尖瓣在正常、中度至重度 MR 和重度 MR 情况下的情况。MR 病例分别在无 MitraClip、1 个 MitraClip 和 2 个 MitraClip 配置下进行测试。定量测量二尖瓣反流分数（MRF）、MVG 和有效瓣口面积（EOA）。

结果

正常 MRF、MVG 和 EOA 分别为 14.22%、2.59mm Hg 和 1.64cm。对于中度至重度 MR，MRF、MVG 和 EOA 分别为 34.07%、3.31mm Hg 和 2.22cm。与无 MitraClip 病例相比，1 个 MitraClip 将 MRF 降低至 18.57%（P<.0001）和 EOA 降低至 1.50cm（P=.0002）。MVG 统计学上无变化（3.44mm Hg）。两个 MitraClips 将 MRF 降低至 14.26%（P<.0001）和 EOA 降低至 1.36cm（P=.0001）。MVG 保持不变（3.29mm Hg）。对于重度 MR，MRF、MVG 和 EOA 分别为 59.79%、4.98mm Hg 和 2.73cm。与无 MitraClip 病例相比，1 个 MitraClip 将 MRF 降低至 30.72%（P<.0001）和 EOA 降低至 1.82cm（P<.0001）；MVG 保持不变（4.03mm Hg）。MVG 统计学上无变化。两个 MitraClips 将 MRF 降低至 23.10%（P<.0001）和 EOA 降低至 1.58cm（P<.0001）；MVG 统计学上无变化（3.82mm Hg）。两种 MR 模型中，使用 1 个或 2 个 MitraClip 时，MRV 升高的情况没有统计学差异。

结论

使用 1 个或 2 个 MitraClip 降低 MR 时，MVG 升高的问题不大，尽管 2 个 MitraClip 并不能显著继续降低 MRF。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8504/7704541/55da15cf228b/nihms-1599562-f0008.jpg
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