Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy.
Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy.
Catheter Cardiovasc Interv. 2022 Sep;100(3):451-460. doi: 10.1002/ccd.30245. Epub 2022 May 29.
Mitral-valve transcatheter edge-to-edge repair (MV-TEER) is recommended in patients with severe functional mitral regurgitation (FMR) and in those with degenerative mitral regurgitation (DMR) not eligible to traditional surgery. Patients with a history of previous cardiac surgery are considered at high risk for surgical reintervention, but data are lacking regarding procedural and clinical outcomes.
aim of this study was to assess the efficacy and clinical results of MV-TEER in patients with previous cardiac surgery enrolled in the "multicentre Italian Society of Interventional Cardiology registry of transcatheter treatment of mitral valve regurgitation" (GIOTTO).
Patients with previous coronary artery bypass grafting (CABG), surgical aortic valve replacement (AVR), or mitral valve repair (MVR) were included. Those with multiple or combined previous cardiac surgeries were excluded. Clinical follow-up was performed at 30 days, 1 year, and 2 years. The primary endpoint was a composite of death or rehospitalization at 1- and 2-year follow-ups.
A total of 330 patients enrolled in the GIOTTO registry were considered (CABG 77.9%, AVR 14.2%, and MVR 7.9%). Most patients showed FMR (66.9%), moderate reduction of left ventricular (LV) ejection fraction, and signs of LV dilation. Procedural and device successes were 94.8% and 97%. At 1 and 2 years, the composite endpoint occurred are 29.1% and 52.4%, respectively. The composite outcome rates were similar across the three subgroups of previous cardiac surgery (p = 0.928) and between the FMR and DMR subgroups (p = 0.850) at 2 years. In a multivariate analysis, residual mitral regurgitation (rMR) ≥2+ was the main predictor of adverse events at 1 year (hazard ratio: 1.54 [95% confidence interval, CI: 1.00-2.38]; p = 0.050). This association was confirmed at 2 years of Kaplan-Meier analysis (p = 0.001).
MV-TEER is effective in these patients, regardless of the subtype of previous cardiac surgery and the MR etiology. An rMR ≥2+ is independently associated with adverse outcomes at 1-year follow-up.
二尖瓣瓣环成形术（MV-TEER）适用于严重功能性二尖瓣反流（FMR）和不符合传统手术适应证的退行性二尖瓣反流（DMR）患者。既往有心脏手术史的患者再次手术风险较高，但目前缺乏关于该术式的操作和临床结局的数据。
本研究旨在评估既往接受过心脏手术的患者行 MV-TEER 的疗效和临床结果，这些患者均来自“意大利介入心脏病学会多中心经导管二尖瓣反流治疗注册研究”（GIOTTO）。
纳入既往行冠状动脉旁路移植术（CABG）、主动脉瓣置换术（AVR）或二尖瓣修复术（MVR）的患者。排除既往行多次心脏手术或联合心脏手术的患者。在术后 30 天、1 年和 2 年进行临床随访。主要终点为 1 年和 2 年随访时的死亡或再住院复合终点。
GIOTTO 注册研究共纳入 330 例患者（CABG 占 77.9%，AVR 占 14.2%，MVR 占 7.9%）。大多数患者为 FMR（66.9%），左心室射血分数中度降低，左心室扩张。操作成功率和器械成功率分别为 94.8%和 97%。1 年和 2 年时，复合终点发生率分别为 29.1%和 52.4%。3 个既往心脏手术亚组（p=0.928）和 FMR 与 DMR 亚组（p=0.850）的复合结局发生率在 2 年时相似。多变量分析显示，残余二尖瓣反流（rMR）≥2+是 1 年时不良事件的主要预测因素（危险比：1.54 [95%置信区间：1.00-2.38]；p=0.050）。在 2 年的 Kaplan-Meier 分析中也得到了证实（p=0.001）。
MV-TEER 对既往接受过心脏手术的患者有效，无论其既往心脏手术类型和 MR 病因如何。rMR≥2+与 1 年时的不良结局独立相关。
