Xu Hang, Song Wu, Liu Sheng, Zhong Zhaoji
Department of Cardiovascular Surgery, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Chinese Academy of Medical Science, 100037 Beijing, China.
Rev Cardiovasc Med. 2022 Sep 28;23(10):332. doi: 10.31083/j.rcm2310332. eCollection 2022 Oct.
To assess the outcomes of transcatheter mitral valve repair (TMVr) for failed previous surgical mitral valve repair (MVr).
We searched Pubmed, Embase, and Cochrane Library databases for studies that reported the outcomes of TMVr for failed initial surgical MVr. Data were extracted by 2 independent investigators and subjected to meta-analysis. The 95% confidence interval (CI) was calculated for preoperative demographics, peri-operative outcomes, and follow-up outcomes using binary and continuous data from single-arm studies.
Eight single-arm studies were included, with a total of 212 patients, and mean follow-up ranged from 1.0 to 15.9 months. The pooled rate of residual procedural mitral regurgitation mild was 76% (95% CI: 67%84%; = 0%; 7 studies, 199 patients). During follow-up, mitral regurgitation mild was found in 68% of patients (95% CI: 52%82%; = 57%; 6 studies, 147 patients). Follow-up survival was 94% (95% CI: 88%98%; = 0%; 7 studies, 196 patients). 83% patients (95% CI: 75%89%; = 47%; 6 studies, 148 patients) were in NYHA class I or II.
TMVr for failed surgical MVr was safe and effective, which should be recommended in selected patients if technically feasible.
评估经导管二尖瓣修复术（TMVr）用于既往外科二尖瓣修复术（MVr）失败患者的治疗效果。
我们检索了PubMed、Embase和Cochrane图书馆数据库，以查找报告TMVr用于初始外科MVr失败患者治疗效果的研究。数据由2名独立研究人员提取并进行荟萃分析。使用单臂研究中的二元和连续数据，计算术前人口统计学、围手术期结果和随访结果的95%置信区间（CI）。
纳入8项单臂研究，共212例患者，平均随访时间为1.0至15.9个月。残余手术二尖瓣反流轻度的合并发生率为76%（95%CI：67%84%；I² = 0%；7项研究，199例患者）。随访期间，68%的患者出现二尖瓣反流轻度（95%CI：52%82%；I² = 57%；6项研究，147例患者）。随访生存率为94%（95%CI：88%98%；I² = 0%；7项研究，196例患者）。83%的患者（95%CI：75%89%；I² = 47%；6项研究，148例患者）纽约心脏协会（NYHA）心功能分级为I级或II级。
TMVr用于外科MVr失败患者是安全有效的，如果技术可行，应推荐给选定的患者。
