Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel; Department of Military Medicine, Hebrew University of Jerusalem, Tzameret Program, Israel.
Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel.
Int J Cardiol. 2024 Apr 1;400:131766. doi: 10.1016/j.ijcard.2024.131766. Epub 2024 Jan 10.
Transcatheter edge-to-edge repair (TEER) is typically used to treat mitral regurgitation (MR) in patients with high surgical risk. Increased post-procedural mitral valve gradient (MVG) may impact mortality and hospitalizations. We aim to evaluate and compare the absolute postprocedural MVG and the change in the MVG effect on outcomes for patients undergoing TEER therapy.
Patients who underwent TEER for severe MR were divided into two groups, initially by postprocedural absolute MVG, TTE-based at discharge, and then by the difference between preprocedural and postprocedural MVG. Primary endpoints included all-cause mortality and heart failure hospitalization (HFH) during one year after the procedure.
The study included 100 patients. The mean MVG increased from 3.39 mmHg immediately after the procedure to 4.83 mmHg the following day, an increase of 1.44 mmHg (p < 0.001). First stratification was by MVG on the day following the procedure - MVG ≤5 mmHg (n = 70) and MVG >5 mmHg (n = 30). There was no significant difference in rates of survival (88.6%, 93.3%, p = 0.716) or HFH (18.6%, 33.3%, p = 0.178). Second stratification was by the difference in preprocedural and postprocedural MVG- delta MVG <3 mmHg (n = 55) and delta MVG ≥3 mmHg (n = 45). While survival rates did not significantly differ (87.3% vs. 93.3%, p = 0.503), delta MVG ≥3 mmHg correlated with higher HFH rates (12.7% vs. 35.6%, p = 0.014).
The MVG of patients undergoing TEER usually increases on the day after the procedure compared to the immediate post-procedure MVG. Higher delta MVG is associated with higher HFH rate.
经导管缘对缘修复术（TEER）通常用于治疗手术风险较高的二尖瓣反流（MR）患者。术后二尖瓣瓣口梯度（MVG）增加可能会影响死亡率和住院率。我们旨在评估和比较接受 TEER 治疗的患者的绝对术后 MVG 以及 MVG 变化对结局的影响。
将因严重 MR 而接受 TEER 的患者分为两组，首先根据出院时 TTE 测量的术后即刻绝对 MVG 进行分组，然后根据术前和术后 MVG 的差值进行分组。主要终点包括术后 1 年内的全因死亡率和心力衰竭住院率（HFH）。
该研究纳入了 100 例患者。MVG 平均值从术后即刻的 3.39mmHg 增加到术后第 2 天的 4.83mmHg，增加了 1.44mmHg（p<0.001）。第一次分层是根据术后第 2 天的 MVG - MVG≤5mmHg（n=70）和 MVG>5mmHg（n=30）。生存率（88.6%，93.3%，p=0.716）或 HFH 发生率（18.6%，33.3%，p=0.178）无显著差异。第二次分层是根据术前和术后 MVG 的差值 - delta MVG<3mmHg（n=55）和 delta MVG≥3mmHg（n=45）。尽管生存率无显著差异（87.3% vs. 93.3%，p=0.503），但 delta MVG≥3mmHg 与更高的 HFH 发生率相关（12.7% vs. 35.6%，p=0.014）。
接受 TEER 的患者的 MVG 通常在术后第 2 天比术后即刻增加。更高的 delta MVG 与更高的 HFH 发生率相关。
