Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
JACC Cardiovasc Interv. 2022 Sep 12;15(17):1731-1740. doi: 10.1016/j.jcin.2022.06.005. Epub 2022 Aug 22.
Atrial secondary mitral regurgitation (ASMR) is a subtype of SMR that has a poor prognosis, and thus far, evidence of the therapeutic options for the management of ASMR is limited.
This study aimed to investigate the effectiveness of transcatheter edge-to-edge repair (TEER) for ASMR.
The study retrospectively analyzed consecutive patients who underwent MitraClip at the Heart Center Bonn. ASMR was defined as cases that met all of the following criteria: 1) normal mitral leaflets without organic disorder; 2) left ventricular ejection fraction >50%; and 3) absence of LV enlargement and segmental abnormality. The primary outcome measure was MR reduction to ≤1+, and its predictors were explored in a logistic regression analysis.
Among 415 patients with SMR, 118 patients met the criteria for ASMR (mean age 80 ± 8 years, 39.8% male). The technical success rate was 94.1%, and MR reduction to ≤1+ after TEER was achieved in 94 (79.7%) patients with ASMR. The in-hospital mortality rate was 2.5%. In multivariable logistic analysis, a large left atrial volume index and low leaflet-to-annulus index were associated with a lower incidence of MR reduction to ≤1+ after TEER for ASMR. In addition, the use of a newer generation of the MitraClip systems (NTR/XTR or G4 systems) was associated with a higher incidence of MR reduction to ≤1+.
TEER is a safe and feasible therapeutic option for patients with ASMR. Assessments of left atrial volume index and leaflet-to-annulus index may assist with patient selection for TEER in patients with ASMR.
继发性二尖瓣反流（SMR）中的一种亚类为三尖瓣继发性二尖瓣反流（ASMR），其预后较差，到目前为止，关于 ASMR 管理的治疗选择的证据有限。
本研究旨在探讨经导管缘对缘修复（TEER）治疗 ASMR 的效果。
该研究回顾性分析了在波恩心脏中心接受 MitraClip 治疗的连续患者。ASMR 的定义为符合以下所有标准的病例：1）二尖瓣瓣叶正常，无器质性病变；2）左心室射血分数＞50%；3）左心室无扩大和节段性异常。主要转归指标为 MR 减少至≤1+，并通过逻辑回归分析探讨其预测因素。
在 415 例 SMR 患者中，有 118 例符合 ASMR 标准（平均年龄 80±8 岁，39.8%为男性）。技术成功率为 94.1%，在接受 TEER 治疗的 118 例 ASMR 患者中，94 例（79.7%）MR 减少至≤1+。院内死亡率为 2.5%。多变量逻辑分析显示，左心房容积指数大且瓣环面积指数低与 TEER 后 MR 减少至≤1+的发生率较低相关。此外，使用新一代的 MitraClip 系统（NTR/XTR 或 G4 系统）与 MR 减少至≤1+的发生率较高相关。
TEER 是治疗 ASMR 患者的一种安全且可行的治疗选择。评估左心房容积指数和瓣环面积指数可能有助于选择适合 TEER 的 ASMR 患者。
