Sauter Reinhard, Lin Chaolan, Magunia Harry, Schreieck Juergen, Dürschmied Daniel, Gawaz Meinrad, Patzelt Johannes, Langer Harald F
Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany.
University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany.
Int J Cardiol Heart Vasc. 2023 Mar 10;45:101190. doi: 10.1016/j.ijcha.2023.101190. eCollection 2023 Apr.
Percutaneous mitral valve repair (PMVR) has evolved to be a standard procedure in suitable patients with mitral regurgitation (MR) not accessible for open surgery. Here, we analyzed the influence of the number and positioning of the clips implanted during the procedure on MR reduction analyzing also sub-collectives of functional and degenerative MR (DMR).
We included 410 patients with severe MR undergoing PMVR using the MitraClip® System. MR and reduction of MR were analyzed by TEE at the beginning and at the end of the PMVR procedure. To specify the clip localization, we sub-divided segment 2 into 3 sub-segments using the segmental classification of the mitral valve.
We found an enhanced reduction of MR predominantly in DMR patients who received more than one clip. Implantation of only one clip led to a higher MR reduction in patients with functional MR (FMR) in comparison to patients with DMR. No significant differences concerning pressure gradients could be observed in degenerative MR patients regardless of the number of clips implanted. A deterioration of half a grade of the achieved MR reduction was observed 6 months post-PMVR independent of the number of implanted clips with a better stability in FMR patients, who got 3 clips compared to patients with only one clip.
In patients with FMR, after 6 months the reduction of MR was more stable with an increased number of implanted clips, which suggests that this specific patient collective may benefit from a higher number of clips.
经皮二尖瓣修复术（PMVR）已发展成为无法进行开放手术的二尖瓣反流（MR）合适患者的标准手术。在此，我们分析了手术过程中植入夹子的数量和位置对MR降低的影响，同时也分析了功能性和退行性MR（DMR）的亚组情况。
我们纳入了410例使用MitraClip®系统进行PMVR的重度MR患者。在PMVR手术开始和结束时通过经食管超声心动图（TEE）分析MR及MR的降低情况。为明确夹子定位，我们使用二尖瓣的节段分类将2区再细分为3个亚段。
我们发现，主要在接受多个夹子的DMR患者中，MR降低更为明显。与DMR患者相比，仅植入一个夹子时，功能性MR（FMR）患者的MR降低幅度更大。在退行性MR患者中，无论植入夹子的数量如何，均未观察到压力梯度有显著差异。PMVR术后6个月，观察到MR降低程度恶化半级，且与植入夹子的数量无关，FMR患者（植入3个夹子）与仅植入一个夹子的患者相比，稳定性更好。
在FMR患者中，术后6个月，随着植入夹子数量的增加，MR降低更稳定，这表明该特定患者群体可能从更多数量的夹子中获益。
