经导管二尖瓣缘对缘修复术后的结果；两种病理情况的比较。
Outcomes after Transcatheter Mitral Valve Edge to Edge Repair; a Comparison of Two Pathologies.
作者信息
El-Shurafa Haytham, Albabtain Monirah, Arafat Amr, Abdulsalam Weam, Alfonso Juan, Ashmeik Khalifa, Shah Aijaz, AlOtaiby Mohammad
机构信息
Department of Adult Cardiology.
Department of Cardiology Clinical Pharmacy.
出版信息
Acta Cardiol Sin. 2021 May;37(3):286-295. doi: 10.6515/ACS.202105_37(3).20201020A.
BACKGROUND
The clinical use of transcatheter mitral valve repairis growing. We aimed to compare the clinical and echocardiographic outcomes after transcatheter mitral valve repair using the edge-to-edge technique in patients with functional and degenerative mitral regurgitation (MR). Furthermore, we correlated the clinical and echocardiographic measurements.
METHODS
The study included 111 patients who underwent the MitraClip procedure from 2012 to 2018. The patients were divided into two groups according to the etiology; functional mitral regurgitation (FMR) (n = 88; 79.28%) and degenerative mitral regurgitation (DMR) (n = 23; 20.72%).
RESULTS
Advanced age (p = 0.002) and FMR (p = 0.001) increased coronary care unit stay, and history of heart failure hospitalization (p = 0.003). Advanced age (p = 0.022) and FMR (p < 0.001) also increased the duration of hospital stay. Severe renal impairment [hazard ratio (HR): 2.6; p < 0.001], female gender (HR: 3.9; p = 0.005), and history of stroke (HR: 5.6; p = 0.065) decreased survival, while post-procedure diuretics improved survival (HR: 0.3; p = 0.024). Moderate residual MR [sub-distribution hazard ratio (SHR): 4.1; p = 0.011], lower EuroSCORE (SHR: 0.9; p = 0.013), and lack of β-blockers (SHR: 0.2; p = 0.034) were predictors of MR recurrence. There were no significant correlations between NYHA class and pulmonary artery pressure (PASP) (p = 0.896), end-systolic (p = 0.856), and end-diastolic diameters (p = 0.965). There were significant improvements in left ventricular dimensions and PASP after MitraClip. However, these changes were not maintained over time. The grade of MR significantly improved after the procedure (p = 0.001), with no difference between groups (p = 0.89).
CONCLUSIONS
The MitraClip procedure showed positive results in terms of sustainable symptomatic relief, although this finding was not reflected in left ventricular dimensions. The technique is equally effective in FMR and DMR.
背景
经导管二尖瓣修复术的临床应用正在增加。我们旨在比较采用缘对缘技术对功能性和退行性二尖瓣反流（MR）患者进行经导管二尖瓣修复术后的临床和超声心动图结果。此外，我们还对临床和超声心动图测量结果进行了相关性分析。
方法
该研究纳入了2012年至2018年接受MitraClip手术的111例患者。根据病因将患者分为两组；功能性二尖瓣反流（FMR）（n = 88；79.28%）和退行性二尖瓣反流（DMR）（n = 23；20.72%）。
结果
高龄（p = 0.002）和FMR（p = 0.001）会增加冠心病监护病房住院时间以及心力衰竭住院史（p = 0.003）。高龄（p = 0.022）和FMR（p < 0.001）也会增加住院时间。严重肾功能损害[风险比（HR）：2.6；p < 0.001]、女性（HR：3.9；p = 0.005）和卒中史（HR：5.6；p = 0.065）会降低生存率，而术后使用利尿剂可提高生存率（HR：0.3；p = 0.024）。中度残余MR[亚分布风险比（SHR）：4.1；p = 0.011]、较低的欧洲心脏手术风险评估系统（EuroSCORE）（SHR：0.9；p = 0.013）以及未使用β受体阻滞剂（SHR：0.2；p = 0.034）是MR复发的预测因素。纽约心脏协会（NYHA）心功能分级与肺动脉压（PASP）（p = 0.896）、收缩末期（p = 0.856）和舒张末期直径（p = 0.965）之间无显著相关性。MitraClip术后左心室尺寸和PASP有显著改善。然而，这些变化并未随时间持续。术后MR分级显著改善（p = 0.001），两组之间无差异（p = 0.89）。
结论
MitraClip手术在持续缓解症状方面显示出积极结果，尽管这一结果未体现在左心室尺寸上。该技术在FMR和DMR中同样有效。
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