Rottländer Dennis, Golabkesh Milad, Degen Hubertus, Ögütcü Alev, Saal Martin, Haude Michael
Department of Cardiology, Rheinland Klinikum Neuss, Neuss, Germany.
Department of Cardiology, Krankenhaus Porz am Rhein, Cologne, Germany.
Catheter Cardiovasc Interv. 2022 May;99(6):1839-1847. doi: 10.1002/ccd.30157. Epub 2022 Mar 21.
We aimed to compare indirect mitral annuloplasty using the Carillon Mitral Contour System and edge-to-edge repair via MitraClip in atrial functional mitral regurgitation (aFMR).
In patients with left ventricular dilation, both edge-to-edge repair and indirect mitral annuloplasty are effective in reducing mitral regurgitation, while no clinical trial has compared both interventional methods in aFMR.
In a retrospective single-center analysis, 41 patients with aFMR underwent either edge-to-edge mitral valve repair (MitraClip group, n = 20) or indirect annuloplasty (Carillon group, n = 21).
Both treatment groups showed high procedural success (100%) and low complication rates. Both treatment groups showed a comparable reduction of New York Heart Association (NYHA) classification postimplantation, after 3- and 12-months follow-up. Quantitative reduction in echocardiographic FMR parameters was significantly pronounced in the MitraClip group (reduction in vena contracta MitraClip vs. Carillon: postimplantation -74.6 ± 25.8 vs. -29.1 ± 17.8%, 3-months follow-up -65.8 ± 31.2 vs. -33.9 ± 17.5%, 12-months follow-up -50.8 ± 27.9 vs. -23.9 ± 17.0%, p < 0.05). Qualitative mitral valve assessment showed improved FMR class postimplantation, at 3-and 12-months follow-up in both treatment groups. Edge-to-edge repair revealed better results with lower average FMR classification compared to indirect coronary sinus-based annuloplasty. After 12-months left atrial (LA) volume was significantly reduced in the Carillon group, while in the MitraClip group no LA remodeling was found (reduction in LA volume MitraClip vs. Carillon at 12 months: +9.6 ± 25.1% vs. -12.3 ± 12.7%, p < 0.05).
Both indirect mitral valve annuloplasty and edge-to-edge repair are feasible and safe in patients with aFMR, while the reduction in FMR was pronounced in the edge-to-edge repair group.
我们旨在比较使用Carillon二尖瓣轮廓系统进行的间接二尖瓣环成形术与通过MitraClip进行的缘对缘修复治疗功能性二尖瓣反流（aFMR）的效果。
在左心室扩张的患者中，缘对缘修复和间接二尖瓣环成形术在减少二尖瓣反流方面均有效，但尚无临床试验比较这两种介入方法在aFMR中的效果。
在一项回顾性单中心分析中，41例aFMR患者接受了缘对缘二尖瓣修复术（MitraClip组，n = 20）或间接环成形术（Carillon组，n = 21）。
两个治疗组均显示出较高的手术成功率（100%）和较低的并发症发生率。在3个月和12个月的随访后，两个治疗组植入后纽约心脏协会（NYHA）分级的降低程度相当。MitraClip组超声心动图FMR参数的定量降低更为显著（MitraClip组与Carillon组的收缩期瓣口面积减少：植入后分别为-74.6±25.8%和-29.1±17.8%，3个月随访时分别为-65.8±31.2%和-33.9±17.5%，12个月随访时分别为-50.8±27.9%和-23.9±17.0%，p<0.05）。定性二尖瓣评估显示，两个治疗组植入后以及3个月和12个月随访时FMR分级均有所改善。与基于冠状静脉窦的间接环成形术相比，缘对缘修复显示出更好的效果，平均FMR分级更低。12个月后，Carillon组左心房（LA）容积显著减小，而MitraClip组未发现LA重塑（12个月时MitraClip组与Carillon组的LA容积减少：分别为+9.6±25.1%和-12.3±12.7%，p<0.05）。
间接二尖瓣环成形术和缘对缘修复在aFMR患者中均可行且安全，而缘对缘修复组FMR的降低更为显著。
