Rozenbaum Zach, Vemulapalli Sreekanth, Shah Miloni, Kosinski Andrzej Stanislaw, Gnall Eric
Section of Cardiology, Tulane University, New Orleans, LA (Z.R.).
Duke Clinical Research Institute, Durham, NC (S.V., M.S., A.S.K.).
Circ Cardiovasc Interv. 2025 Mar;18(3):e014819. doi: 10.1161/CIRCINTERVENTIONS.124.014819. Epub 2025 Mar 18.
With the expansion of indications for mitral transcatheter edge-to-edge repair into nondegenerative etiologies, it is unknown whether changes in technical success and clinical outcomes have occurred.
The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/TVT) registry was analyzed from 2013 to 2023. Patients in shock were excluded. Patients were grouped by the mechanism of mitral regurgitation (MR) and divided into time periods.
Overall, 68 028 patients were included. The application of mitral transcatheter edge-to-edge repair has evolved over the past decade to include more nondegenerative etiologies-increasing from 19% to 43%. The biggest growth was observed in functional MR (atrial and ventricular). Excluding acute ischemic MR, the odds of technical success were significantly higher for all mechanisms compared with degenerative MR (DMR). Over time more procedures were performed using only 1 implanted device (64.7% during 2022-2023 versus 54.6% during 2013-2017), without negatively impacting technical success. In multivariable analyses, the risk of 1-year heart failure readmission for ventricular functional MR was not higher than for DMR (=0.10642), while patients with chronic ischemic MR and atrial MR had a 19% higher risk of 1-year heart failure readmission compared with DMR (=0.00493) even if they had a successful procedure. However, the risk of 1-year mortality was not higher in nondegenerative etiologies compared with DMR. There was no statistically significant interaction between MR mechanism and time in outcomes analyses, indicating that the effect of MR mechanism on the technical and 1-year clinical outcomes did not vary significantly over time.
The application of mitral transcatheter edge-to-edge repair for nondegenerative etiologies increased considerably. While the odds of technical success were higher for all etiologies except acute ischemic MR, a similar 1-year mortality risk was observed in nondegenerative etiologies compared with DMR in real-world settings. These data support the use of mitral transcatheter edge-to-edge repair in degenerative and nondegenerative etiologies.
随着二尖瓣经导管缘对缘修复术的适应症扩展至非退行性病因，技术成功率和临床结果是否发生变化尚不清楚。
对2013年至2023年胸外科医师协会/美国心脏病学会经导管瓣膜治疗（STS/TVT）注册研究进行分析。排除休克患者。根据二尖瓣反流（MR）机制对患者进行分组，并划分时间段。
总体纳入68028例患者。在过去十年中，二尖瓣经导管缘对缘修复术的应用有所发展，纳入了更多非退行性病因，从19%增至43%。功能性MR（心房和心室）增长最为显著。排除急性缺血性MR，与退行性MR（DMR）相比，所有机制的技术成功率显著更高。随着时间推移，仅使用1个植入装置进行的手术更多（2022 - 2023年期间为64.7%，而2013 - 2017年期间为54.6%），且未对技术成功率产生负面影响。在多变量分析中，心室功能性MR患者1年心力衰竭再入院风险不高于DMR患者（=0.10642），而慢性缺血性MR和心房MR患者即使手术成功，1年心力衰竭再入院风险仍比DMR患者高19%（=0.00493）。然而，与DMR相比，非退行性病因患者1年死亡率风险并未更高。在结局分析中，MR机制与时间之间无统计学显著交互作用，表明MR机制对技术和1年临床结局的影响未随时间发生显著变化。
二尖瓣经导管缘对缘修复术在非退行性病因中的应用显著增加。除急性缺血性MR外，所有病因的技术成功率均较高，在现实环境中，与DMR相比，非退行性病因患者1年死亡率风险相似。这些数据支持在退行性和非退行性病因中使用二尖瓣经导管缘对缘修复术。
