Dokollari Aleksander, Sicouri Serge, Ridwan Khalid, Rodriguez Roberto, Gnall Eric, Harish Jarrett, Shah Ashish, Ghorpade Nitin, Bisleri Gianluigi, Kjelstrom Stephanie, Montone Georgia, Abramson Sandra, Hawthorne Katie, Goldman Scott, Gray William, Ramlawi Basel
Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA; Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA; Department of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, MB.
Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA.
Curr Probl Cardiol. 2024 Jan;49(1 Pt B):102064. doi: 10.1016/j.cpcardiol.2023.102064. Epub 2023 Aug 30.
To analyze clinical and echocardiographic outcomes after transcatheter edge-to-edge repair (TEER) with mitral valve clip device (MitraClip-TM) for functional vs degenerative mitral valve regurgitation (MR). All consecutive 185 patients undergoing TEER between January 2019 and March 2023 were included in the study. A propensity-adjusted analysis investigated differences among functional vs degenerative MR mechanism groups. Preoperatively, functional vs degenerative MR included 43 vs 142 patients, respectively. Mean ejection fraction (EF) values were 37% vs 57.8%, mean STS-PROM risk score was 7% vs 4% while patients with severe MR included 29 (67.4%) vs 129 (90.9%) patients, respectively. Postoperatively, functional MR patients experienced a higher incidence of prolonged postoperative length of stay (LOS), reduced creatinine clearance, and EF<50% compared to the degenerative MR group. Mean EF was 35.9% vs 56.2% (P < 0.0001) and 1 (2.3%) vs 16 (11.3%) patients had residual severe MR (P = 0.01) in functional vs degenerative MR groups, respectively. At 30-days follow-up, all-cause death incidence was 1 (2.3%) vs 3 (2.1%) patients in functional vs degenerative MR, respectively (P = 0.9). At a mean of 1.6-years follow-up, all-cause death (P = 0.01), major adverse cardiovascular and cerebrovascular events (MACCE) (P = 0.02), cardiac death (P = 0.01) and hazard ratio for all-cause death higher in functional vs degenerative MR group. Mean EF was 39.7% vs 56% (P < 0.001) while residual severe MR was 4 (9.3%) vs 34 (24.5%) (P = 0.1) in functional vs degenerative MR groups, respectively. TEER with MitraClip device showed a higher incidence of all-cause death, cardiac death, and MACCE at follow-up for functional compared to degenerative MR after TEER.
分析使用二尖瓣夹装置（MitraClip-TM）进行经导管缘对缘修复（TEER）治疗功能性与退行性二尖瓣反流（MR）后的临床和超声心动图结果。纳入2019年1月至2023年3月期间连续接受TEER的185例患者进行研究。倾向调整分析研究了功能性与退行性MR机制组之间的差异。术前，功能性与退行性MR患者分别为43例和142例。平均射血分数（EF）值分别为37%和57.8%，平均STS-PROM风险评分分别为7%和4%，而重度MR患者分别为29例（67.4%）和129例（90.9%）。术后，与退行性MR组相比，功能性MR患者术后住院时间延长、肌酐清除率降低和EF<50%的发生率更高。功能性与退行性MR组的平均EF分别为35.9%和56.2%（P<0.0001），分别有1例（2.3%）和16例（11.3%）患者存在残余重度MR（P=0.01）。在30天随访时，功能性与退行性MR患者的全因死亡发生率分别为1例（2.3%）和3例（2.1%）（P=0.9）。在平均1.6年的随访中，功能性与退行性MR组的全因死亡（P=0.01）、主要不良心血管和脑血管事件（MACCE）（P=0.02）、心源性死亡（P=0.01）以及全因死亡风险比更高。功能性与退行性MR组的平均EF分别为39.7%和56%（P<0.001），而残余重度MR分别为4例（9.3%）和34例（24.5%）（P=0.1）。与退行性MR相比，使用MitraClip装置进行TEER后，功能性MR在随访时全因死亡、心源性死亡和MACCE的发生率更高。
