Department of Anesthesiology, Weill Cornell Medicine, New York, NY.
Department of Anesthesiology, Weill Cornell Medicine, New York, NY.
J Cardiothorac Vasc Anesth. 2022 May;36(5):1279-1287. doi: 10.1053/j.jvca.2021.09.006. Epub 2021 Sep 10.
Three-dimensional transesophageal echocardiography (TEE) is widely used to guide decision-making for mitral repair. The relative impact of surgical mitral valve repair (MVr) and MitraClip on annular remodeling is unknown. The aim was to determine the impact of both mitral repair strategies on annular geometry, including the primary outcome of annular circumference and area.
This was a retrospective observational study of patients who underwent mitral intervention between 2016 and 2020.
Weill Cornell Medicine, a single, large, academic medical center.
The population comprised 50 patients with degenerative mitral regurgitation (MR) undergoing MVr.
Elective MVr and TEE.
Patients undergoing MitraClip or surgical MVr were matched (1:1) for sex and coronary artery disease. Mitral annular geometry indices were quantified on intraprocedural three-dimensional TEE. Mild or less MR on follow-up transthoracic echocardiography defined optimal response. Patients undergoing MitraClip were older (80 ± eight v 66 ± six years; p < 0.001) but were otherwise similar to surgical patients. Patients undergoing MitraClip had larger baseline left atrial and ventricular sizes, increased tenting height, and volume (p < 0.01), with a trend toward increased annular area (p = 0.23). MitraClip and surgery both induced immediate mitral annular remodeling, including decreased area, circumference, and tenting height (p < 0.001), with greater remodeling with surgical repair. At follow-up (4.1 ± 9.0 months) optimal response (≤ mild MR) was ∼twofold more common with surgery than MitraClip (81% v 46%; p = 0.02). The relative reduction in annular circumference (odds ratio [OR] 1.05 [1.00-1.09] per cm; p = 0.04) and area (OR 1.03 [1.00-1.05] per cm; p = 0.049) were both associated with optimal response.
Surgical MVr and MitraClip both reduce annular size, but repair-induced remodeling is greater with surgery and associated with an increased likelihood of optimal response.
经胸超声心动图（TEE）三维成像广泛用于指导二尖瓣修复的决策。外科二尖瓣修复术（MVr）和 MitraClip 对瓣环重塑的相对影响尚不清楚。本研究旨在确定这两种二尖瓣修复策略对瓣环几何结构的影响，包括主要的瓣环周长和面积结果。
这是一项回顾性观察研究，纳入 2016 年至 2020 年间接受二尖瓣介入治疗的患者。
Weill Cornell Medicine，一个单一的、大型的学术医疗中心。
研究人群包括 50 例退行性二尖瓣反流（MR）患者，行 MVr 治疗。
择期 MVr 和 TEE。
MitraClip 或外科 MVr 患者按性别和冠状动脉疾病进行 1:1 匹配。术中三维 TEE 定量测量二尖瓣环几何结构指标。随访时经胸超声心动图显示轻度或以下的 MR 定义为最佳反应。MitraClip 组患者年龄较大（80±8 岁比 66±6 岁；p<0.001），但其他方面与外科患者相似。MitraClip 组患者基线时左心房和心室较大，隔瓣叶游离缘运动幅度和容积增加（p<0.01），瓣环面积有增大趋势（p=0.23）。MitraClip 和手术均可即刻诱导二尖瓣环重塑，包括瓣环面积、周长和隔瓣叶游离缘运动幅度减小（p<0.001），手术修复的重塑效果更显著。在随访（4.1±9.0 个月）时，手术治疗的最佳反应（≤轻度 MR）发生率明显高于 MitraClip 组（81%比 46%；p=0.02）。瓣环周长（优势比 [OR] 每增加 1cm 为 1.05 [1.00-1.09]；p=0.04）和瓣环面积（OR 每增加 1cm 为 1.03 [1.00-1.05]；p=0.049）的相对减小与最佳反应相关。
外科 MVr 和 MitraClip 均可减小瓣环大小，但修复诱导的重塑在手术治疗中更为显著，并与最佳反应的可能性增加相关。
