Wei Peijian, Feng Shuyi, Zhang Fengwen, Li Hang, Zhuang Donglin, Jiang Hong, Zhao Guangzhi, Dong Jing, Wang Cheng, Ouyang Wenbin, Wang Shouzheng, Fang Fang, Pan Xiangbin
Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Catheter Cardiovasc Interv. 2025 Feb;105(3):707-719. doi: 10.1002/ccd.31359. Epub 2024 Dec 24.
Mitral valve transcatheter edge-to-edge repair (M-TEER) was initially indicated for central degenerative mitral regurgitation (DMR) lesions, but advancements in technology have enabled successful treatment in an increasing number of noncentral DMR patients.
This study aims to compare procedural outcomes and prognosis between noncentral DMR patients, outside clinical trial anatomical criteria, and central DMR patients undergoing M-TEER.
Drug-refractory moderate-to-severe DMR patients treated with M-TEER at Fuwai Hospital from January 2021 to February 2024 were retrospectively analyzed. Patients were categorized into central (N = 77) and noncentral (N = 59) lesion groups. Baseline characteristics, procedural outcomes, and prognoses were collected and compared.
There were no significant differences in baseline characteristics and preoperative echocardiographic parameters between the groups except for left ventricular ejection fraction. Both groups exhibited similar procedural success rates (central: 93.51% vs. noncentral: 91.53%, p = 0.92) with comparable procedural complication rates. The ideal M-TEER success rate at discharge for noncentral DMR patients was similar to that for central DMR patients (83.05% vs. 71.43%, p = 0.11). Kaplan-Meier analysis indicated similar 3-year recurrence-free survival rates (noncentral: 94.9% vs. central: 90.3%, p = 0.46). Cox regression analysis identified higher discharge mitral valve gradient and a leaflet-to-annulus index ≤ 1.2 as independent risk factors for recurrence or death.
Noncentral DMR patients undergoing M-TEER achieve similar procedural success rates without increased risk of complications compared to central DMR patients. The seemingly higher success rate in noncentral DMR patients may be due to the smaller impact on valve area, warranting further investigation.
二尖瓣经导管缘对缘修复术（M-TEER）最初适用于中心性退行性二尖瓣反流（DMR）病变，但技术的进步已使越来越多非中心性DMR患者得以成功治疗。
本研究旨在比较不符合临床试验解剖学标准的非中心性DMR患者与接受M-TEER的中心性DMR患者的手术结果和预后。
回顾性分析2021年1月至2024年2月在阜外医院接受M-TEER治疗的药物难治性中重度DMR患者。患者分为中心性病变组（N = 77）和非中心性病变组（N = 59）。收集并比较基线特征、手术结果和预后。
除左心室射血分数外，两组间基线特征和术前超声心动图参数无显著差异。两组手术成功率相似（中心性：93.51% vs. 非中心性：91.53%，p = 0.92），手术并发症发生率相当。非中心性DMR患者出院时理想的M-TEER成功率与中心性DMR患者相似（83.05% vs. 71.43%，p = 0.11）。Kaplan-Meier分析显示3年无复发生存率相似（非中心性：94.9% vs. 中心性：90.3%，p = 0.46）。Cox回归分析确定出院时二尖瓣梯度较高和瓣叶-瓣环指数≤1.2是复发或死亡的独立危险因素。
与中心性DMR患者相比，接受M-TEER的非中心性DMR患者手术成功率相似，且并发症风险未增加。非中心性DMR患者看似较高的成功率可能是由于对瓣膜面积影响较小，有待进一步研究。
