Mohammed Hassan Mh, Farah Ahmed, Plicht Bjoern, El-Garhy Mohammad, Janicke Ilse, Yousef Amr, AbdelWahab Mohammad Abdelkader, Taha Nasser M, Schoels Wolfgang, Buck Thomas
Cardiology Department, Faculty of Medicine, Minia University Minia, Egypt.
Westfalen Heart Center Dortmund, Germany.
Interv Cardiol. 2023 Feb 17;18:e03. doi: 10.15420/icr.2021.28. eCollection 2023.
Transcatheter mitral valve repair (TMVR) using the MitraClip has become a well-established interventional therapy and is usually performed in elderly patients. The objective of this study was to assess 2-year clinical outcomes of TMVR in patients aged <65 years at three heart centres with severe mitral regurgitation (MR) and no surgical options.
A retrospective study analysed data of 36 patients aged <65 years treated with TMVR . All patients were refused surgery by Heart Team decision. Baseline MR was assessed by biplane vena contracta width in two perpendicular views (mean 8.35 ± 1.87 mm). Degenerative MR was detected in 11 patients (30.6%); functional MR was detected in 25 patients (69.4%).
Acute procedural success was accomplished in 88.9% of patients. No procedure-related mortality during the first 30 days was detected. Over an average of 2 years of follow-up, all-cause mortality was 19.4% and cardiovascular death was 11.1% owing to advanced heart failure. The average follow-up period was 25.8 months (median was 20 months). Statistically significant difference (p-value <0.01) was detected for N-terminal prohormone of brain natriuretic peptide (pg/ml) at baseline (mean 9,870 ± 10,819; median 7,748) compared to follow-up visits (mean 7,645 ± 11,292; median 3,263). New York Heart Association functional class improvement was achieved in 69% of patients. A second intervention (reclipping) was required in two patients to correct recurrent significant MR.
TMVR in patients aged <65 years refused surgical repair provides satisfactory clinical outcomes at 2 years. Future studies should evaluate the outcomes of MitraClip in this population in a larger cohort.
使用MitraClip进行经导管二尖瓣修复术（TMVR）已成为一种成熟的介入治疗方法，通常用于老年患者。本研究的目的是评估在三个心脏中心对年龄<65岁、患有严重二尖瓣反流（MR）且无手术选择的患者进行TMVR的2年临床结局。
一项回顾性研究分析了36例接受TMVR治疗的年龄<65岁患者的数据。所有患者均经心脏团队决定拒绝手术。通过在两个垂直视图中测量双平面腔静脉宽度评估基线MR（平均8.35±1.87mm）。11例患者（30.6%）检测到退行性MR；25例患者（69.4%）检测到功能性MR。
88.9%的患者手术即刻成功。未检测到30天内与手术相关的死亡。平均随访2年，全因死亡率为19.4%，因晚期心力衰竭导致的心血管死亡为11.1%。平均随访期为25.8个月（中位数为20个月）。与随访时相比，基线时脑钠肽前体N端（pg/ml）差异有统计学意义（p值<0.01）（基线时平均9870±10819；中位数7748；随访时平均7645±11292；中位数3263）。69%的患者纽约心脏协会心功能分级得到改善。两名患者需要进行二次干预（再次夹合）以纠正复发性严重MR。
对于拒绝手术修复的年龄<65岁患者，TMVR在2年时可提供令人满意的临床结局。未来研究应在更大队列中评估MitraClip在该人群中的结局。
