急诊和紧急经导管二尖瓣修复术（MitraClip）的结果：与标准择期修复术的比较
The Results of Urgent and Emergent Transcatheter Mitral Valve Repair (MitraClip): A Comparison with Standard Elective Repair.
作者信息
Al-Tawil Mohammed, Sunny Jesvin T, Goulden Christopher J, Akhteruzzaman Tahiyyah, Alqeeq Basel F, Harky Amer
机构信息
Faculty of Medicine, Al-Quds University, Jerusalem.
Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK.
出版信息
Heart Views. 2024 Jan-Mar;25(1):13-20. doi: 10.4103/heartviews.heartviews_88_23. Epub 2024 Apr 12.
BACKGROUND
Mitral regurgitation (MR) is the most common valvular disease worldwide. MR has been managed surgically, with either a mitral valve replacement or repair. Percutaneous transcatheter mitral valve repair (TMVr) with MitraClip insertion has gained wide popularity and success over medical and surgical therapy for MR. Some patients with acute MR or decompensated heart failure could benefit from urgent TMVr. This meta-analysis aims to compare clinical outcomes of urgent versus elective TMVr.
METHODS
We performed a study-level meta-analysis to compare the clinical outcomes of urgent versus elective TMVr using the MitraClip system. The primary endpoint outcome was all-cause mortality. Additional outcomes included procedural success, postoperative acute kidney injury (AKI), stroke, and length of in-hospital stay.
RESULTS
Overall, 30-day mortality was significantly higher in the urgent group (odds ratio [OR]: 2.74; 95% confidence interval [CI] [2.17, 3.48]; < 0.00001; ² =0%). However, subgroup analysis of matched cohorts showed no significant difference between both groups (OR: 1.80; 95% CI [0.94, 3.46]; = 0.08; ² =0%). One-year mortality was similar between both groups (and: 1.67; 95% CI [0.96, 2.90]; = 0.07; ² =0%). Procedural success was similar between both groups (89.4% vs. 89.8%; = 0.43). Postoperative AKI was significantly higher in the urgent group (OR: 4.12; 95% CI [2.87, 5.91]; < 0.00001; ² =0%).
CONCLUSION
Urgent TMVr should be indicated in select populations as it is considered therapeutic with acceptable outcomes therein.
背景
二尖瓣反流（MR）是全球最常见的瓣膜疾病。MR的治疗方法包括外科手术，即二尖瓣置换或修复。经皮经导管二尖瓣修复术（TMVr）并植入MitraClip在治疗MR方面已比药物治疗和外科治疗更受欢迎且更为成功。一些急性MR或失代偿性心力衰竭患者可能从紧急TMVr中获益。本荟萃分析旨在比较紧急与择期TMVr的临床结局。
方法
我们进行了一项研究水平的荟萃分析，以比较使用MitraClip系统的紧急与择期TMVr的临床结局。主要终点结局是全因死亡率。其他结局包括手术成功率、术后急性肾损伤（AKI）、中风和住院时间。
结果
总体而言，紧急组的30天死亡率显著更高（优势比[OR]：2.74；95%置信区间[CI][2.17, 3.48]；P<0.00001；I² =0%）。然而，匹配队列的亚组分析显示两组之间无显著差异（OR：1.80；95% CI[0.94, 3.46]；P = 0.08；I² =0%）。两组之间的一年死亡率相似（OR：1.67；95% CI[0.96, 2.90]；P = 0.07；I² =0%）。两组之间的手术成功率相似（89.4%对89.8%；P = 0.43）。紧急组的术后AKI显著更高（OR：4.12；95% CI[2.87, 5.91]；P<0.00001；I² =0%）。
结论
紧急TMVr应在特定人群中使用，因为它被认为具有可接受的治疗效果。
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