Hagnäs Magnus J, Grasso Carmelo, Di Salvo Maria Elena, Caggegi Anna, Barbanti Marco, Scandura Salvatore, Milici Annalisa, Motta Gessica, Bentivegna Agnese, Sardone Andrea, Capodicasa Luigi, Giuffrida Angelo, Biancari Fausto, Mäkikallio Timo, Capodanno Davide, Tamburino Corrado
Department of Internal Medicine, Heart Smithy, Lapland Central Hospital, 96101 Rovaniemi, Finland.
Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria, "Policlinico-Vittorio Emanuele", University of Catania, 95123 Catania, Italy.
J Clin Med. 2021 Oct 16;10(20):4748. doi: 10.3390/jcm10204748.
To investigate how the changes of left ventricle ejection fraction (LVEF) between admission and discharge affected the long-term outcome in patients who underwent percutaneous edge-to-edge mitral valve repair for secondary mitral regurgitation.
An acute impairment of LVEF after surgical repair of mitral regurgitation, known as afterload mismatch, has been associated with increased all-cause mortality. Afterload mismatch after percutaneous edge-to-edge mitral valve repair has been postulated to be a transient phenomenon.
This study is based on a single-center, retrospective, observational registry of patients who underwent percutaneous edge-to-edge mitral valve repair with the MitraClip (Abbot Vascular) system for the treatment of symptomatic, moderate-to-severe mitral regurgitation. We included data on 399 patients who underwent percutaneous edge-to-edge mitral valve repair for secondary mitral regurgitation. Expert echocardiographers assessed LVEF before the procedure and at discharge. The patients were divided into three groups according to the difference of periprocedural LVEF measurements: unchanged ( = 318), improved ( = 40), and decreased ( = 41) LVEF.
The median follow-up time was 2.0 years. When adjusted for gender, NYHA class and estimated glomerular filtration rate, decreased postprocedural LVEF was associated with an increased risk of death (adjusted HR 2.05, 95% CI 1.26-3.34) and increased postprocedural LVEF with a reduced risk of death (adjusted HR 0.47, 95% CI 0.24-0.91) compared to unchanged LVEF. Among patients who underwent percutaneous edge-to-edge mitral valve repair, decreased postprocedural LVEF was associated with increased mortality, while improved LVEF was associated with lower mortality compared to unchanged LVEF.
探讨因继发性二尖瓣反流接受经皮缘对缘二尖瓣修复术的患者，入院时与出院时左心室射血分数（LVEF）的变化如何影响其长期预后。
二尖瓣反流手术修复后LVEF的急性损害，即后负荷不匹配，与全因死亡率增加相关。经皮缘对缘二尖瓣修复术后的后负荷不匹配被认为是一种短暂现象。
本研究基于一项单中心、回顾性、观察性注册研究，纳入了使用MitraClip（雅培血管）系统进行经皮缘对缘二尖瓣修复术以治疗有症状的中重度二尖瓣反流的患者。我们纳入了399例因继发性二尖瓣反流接受经皮缘对缘二尖瓣修复术患者的数据。专业超声心动图检查人员在术前和出院时评估LVEF。根据围手术期LVEF测量值的差异将患者分为三组：LVEF无变化（n = 318）、改善（n = 40）和降低（n = 41）。
中位随访时间为2.0年。在对性别、纽约心脏协会（NYHA）心功能分级和估计肾小球滤过率进行校正后，与LVEF无变化相比，术后LVEF降低与死亡风险增加相关（校正后风险比[HR] 2.05，95%置信区间[CI] 1.26 - 3.34），而术后LVEF升高与死亡风险降低相关（校正后HR 0.47，95% CI 0.24 - 0.91）。在接受经皮缘对缘二尖瓣修复术的患者中，与LVEF无变化相比，术后LVEF降低与死亡率增加相关，而LVEF改善与死亡率降低相关。
