12340The University of Texas Health Science Center at Houston, TX, USA.
8785University of California San Francisco, CA, USA.
Innovations (Phila). 2022 Jan-Feb;17(1):42-49. doi: 10.1177/15569845211070568.
Up to 28% of patients may need mitral valve (MV) surgery after transcatheter edge-to-edge repair (TEER). This study evaluates the outcomes of minimally invasive MV surgery after TEER. International multicenter registry of minimally invasive MV surgery after TEER between 2013 and 2020. Subgroups were stratified by the number of devices implanted (≤1 vs >1), as well as time interval from TEER to surgery (≤1 year vs >1 year). A total of 56 patients across 13 centers were included with a mean age of 73 ± 11 years, and 50% were female. The median Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) score for MV replacement was 8% (Q1-Q3 = 5% to 11%) and the ratio of observed to expected mortality was 0.9. The etiology of mitral regurgitation (MR) prior to TEER was primary MR in 75% of patients and secondary MR in 25%. There were 30 patients (54%) who had >1 device implanted. The median time between TEER and surgery was 252 days (33 to 636 days). Hemodynamics, including MR severity, MV area, and mean gradient, significantly improved after minimally invasive surgery and sustained to 1-year follow-up. In-hospital and 30-day mortality was 7.1%, and 1-year actuarial survival was 85.6% ± 6%. Minimally invasive MV surgery after TEER may be achieved as predicted by the STS PROM. Most patients underwent MV replacement instead of repair. As TEER is applied more widely, patients should be informed about the potential need for surgical intervention over time after TEER. These discussions will allow better informed consent and post-procedure planning.
在经导管缘对缘修复（TEER）后，多达 28%的患者可能需要二尖瓣（MV）手术。本研究评估了 TEER 后微创 MV 手术的结果。
这是一项 2013 年至 2020 年间国际微创 MV 手术后 TEER 多中心注册研究。亚组按植入设备数量（≤1 个与＞1 个）以及 TEER 与手术的时间间隔（≤1 年与＞1 年）分层。
共纳入 13 个中心的 56 例患者，平均年龄 73±11 岁，50%为女性。MV 置换的胸外科学会预测死亡率（STS PROM）评分中位数为 8%（Q1-Q3 = 5%至 11%），观察到的死亡率与预期死亡率之比为 0.9。TEER 前二尖瓣反流（MR）的病因在 75%的患者中为原发性 MR，在 25%的患者中为继发性 MR。有 30 例（54%）患者植入了＞1 个设备。TEER 与手术之间的中位时间为 252 天（33 至 636 天）。微创手术后，血流动力学，包括 MR 严重程度、MV 面积和平均梯度显著改善，并持续到 1 年随访。住院和 30 天死亡率分别为 7.1%，1 年实际生存率为 85.6%±6%。TEER 后微创 MV 手术可能符合 STS PROM 预测。大多数患者接受 MV 置换而非修复。随着 TEER 的广泛应用，应该告知患者在 TEER 后随时间推移进行手术干预的潜在需求。这些讨论将使患者更好地知情同意并为术后计划。
