Department of Cardiology, Asklepios Klinik Sankt. Georg, Hamburg, Germany.
EuroIntervention. 2021 Apr 20;16(17):1447-1454. doi: 10.4244/EIJ-D-20-01008.
Failure of transcatheter mitral valve repair (fTMVR) therapy has a decisive prognostic influence, and complex retreatment is of higher risk. The aim of this analysis was to evaluate the survival outcome following percutaneous procedures and surgery after unsuccessful TMVR interventions for different aetiologies.
Of 824 consecutive patients who had been treated with the MitraClip device at our institution, between September 2009 and May 2019, 63 (7.6%) symptomatic patients with therapy failure and persistent or recurrent mitral regurgitation (MR) underwent reinterventions. An outcome analysis for primary (PMR) and secondary mitral regurgitation (SMR) and subsequent percutaneous versus surgical treatment was carried out. MitraClip reinterventions were performed in 36 patients (57.1%; n=26 SMR, n=10 PMR), while 27 (42.9%; n=13 SMR, n=14 PMR) underwent open heart surgery. Surgical patients with PMR showed lower mortality than patients with SMR (p<0.0001) and ReClip patients with PMR (p=0.073). Atrial fibrillation (HR 2.915, 95% CI: [1.311, 6.480]), prior open heart surgery (2.820 [1.215, 6.544]) and chronic obstructive pulmonary disease (2.506 [1.099, 5.714]) increased the risk of death. The level of post-interventional MR had no relevant impact on survival.
We conclude that, after SMR and failed TMVR, reclipping is an appropriate treatment option for symptomatic patients. For PMR patients, surgery must be favoured over a reclipping procedure. However, patients with atrial fibrillation, prior open heart surgery and chronic obstructive pulmonary disease are at risk of reduced survival after reinterventions.
经导管二尖瓣修复（TMVR）治疗失败具有决定性的预后影响，且复杂的再次治疗风险更高。本分析的目的是评估不同病因TMVR 干预治疗失败后行经皮手术和手术的生存结果。
在我院接受 MitraClip 装置治疗的 824 例连续患者中，2009 年 9 月至 2019 年 5 月期间，63 例（7.6%）有症状且治疗失败且持续性或复发性二尖瓣反流（MR）的患者接受了再次干预。对原发性（PMR）和继发性二尖瓣反流（SMR）以及随后的经皮与手术治疗进行了结果分析。MitraClip 再次干预在 36 例患者中进行（57.1%；n=26 SMR，n=10 PMR），而 27 例（42.9%；n=13 SMR，n=14 PMR）接受了心脏直视手术。PMR 手术患者的死亡率低于 SMR 患者（p<0.0001）和再次接受 MitraClip 治疗的 PMR 患者（p=0.073）。心房颤动（HR 2.915，95%CI：[1.311, 6.480]）、既往心脏直视手术（2.820 [1.215, 6.544]）和慢性阻塞性肺疾病（2.506 [1.099, 5.714]）增加了死亡风险。术后 MR 水平对生存无显著影响。
我们的结论是，在 SMR 和 TMVR 治疗失败后，重新夹闭是有症状患者的一种合适的治疗选择。对于 PMR 患者，手术必须优于重新夹闭。然而，患有心房颤动、既往心脏直视手术和慢性阻塞性肺疾病的患者再次干预后生存风险降低。
