Department of Echocardiography, Shanghai Institute of Medical Imaging, Shanghai Institute of Cardiovascular Disease, Shanghai, China.
Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Shanghai, China.
J Cardiothorac Surg. 2024 Jun 28;19(1):403. doi: 10.1186/s13019-024-02827-3.
There is limited data on the 2-year outcomes of transapical transcatheter edge-to-edge repair (TA-TEER) using the ValveClamp in patients with severe primary mitral regurgitation (MR) and its impact on myocardial deformation.
From July 2018 to March 2021, 53 patients with symptomatic severe primary MR underwent TA-TEER were enrolled. The endpoint was the composite of all-cause mortality, recurrent 3 + or 4 + MR, or need for mitral surgery.
Among the 53 patients who had successfully ValveClamp implantation, 8(15.1%) reached the composite endpoint. Significant improvement in left ventricular (LV) end-diastolic volume, pulmonary artery systolic pressure, NYHA functional class, and MR severity were observed (P < 0.05 for all). Univariate Cox's regression analysis revealed that LV end-diastolic volume index, LV end-systolic volume index, left atrial volume index, and pulmonary artery systolic pressure were associated with adverse events (P < 0.05 for all). On multivariate Cox regression analysis, left atrial volume index was independently associated with the endpoint (hazard ratio, 1.049; 95% CI, 1.009-1.091; P < 0.001) after adjustment for above echocardiographic parameters. LV global longitudinal strain and apical longitudinal strain in global and regional segments decreased at 30 days, but showed a recovery at 2 years with no significant difference compared to the baseline.
TA-TEER using the ValveClamp presented favorable safety and efficacy at 2-year. Myocardial deformation impairment was observed at 30 days post-procedure, but did not persist at 2 years.
在严重原发性二尖瓣反流（MR）患者中，使用 ValveClamp 进行经心尖经导管缘对缘修复（TA-TEER）的 2 年结果及其对心肌变形的影响数据有限。
从 2018 年 7 月至 2021 年 3 月，53 例有症状的严重原发性 MR 患者接受了 TA-TEER。终点是全因死亡率、复发性 3+或 4+MR 或需要二尖瓣手术的复合终点。
在成功进行 ValveClamp 植入的 53 例患者中，有 8 例（15.1%）达到了复合终点。LV 舒张末期容积、肺动脉收缩压、纽约心脏协会（NYHA）功能分级和 MR 严重程度均显著改善（所有 P 值均<0.05）。单因素 Cox 回归分析显示，LV 舒张末期容积指数、LV 收缩末期容积指数、左心房容积指数和肺动脉收缩压与不良事件相关（所有 P 值均<0.05）。多因素 Cox 回归分析显示，调整上述超声心动图参数后，左心房容积指数与终点独立相关（危险比，1.049；95%CI，1.009-1.091；P<0.001）。LV 整体纵向应变和心尖纵向应变在整体和节段区域在 30 天时下降，但在 2 年时恢复，与基线相比无显著差异。
使用 ValveClamp 的 TA-TEER 在 2 年时具有良好的安全性和疗效。在术后 30 天观察到心肌变形损伤，但在 2 年内并未持续存在。
