经导管二尖瓣缘对缘修复治疗心房和心室继发性二尖瓣反流：REPAIR研究的见解
Transcatheter Edge-to-Edge Repair for Atrial and Ventricular Secondary Mitral Regurgitation: Insights From the REPAIR Study.
作者信息
von Stein Philipp, Stolz Lukas, Haurand Jean Marc, Gröger Matthias, Rudolph Felix, Mustafa Donika, Jobst Jannik, Mues Christoph Alexander, Mahabadi Amir Abbas, Hoerbrand Isabel A, Schulz Carl, Sugiura Atsushi, von Stein Jennifer, Iliadis Christos, Lurz Philipp, Gerçek Muhammed, Horn Patrick, Kessler Mirjam, Ascione Guido, Rassaf Tienush, Weber Marcel, Schofer Niklas, Konstandin Mathias, Schindhelm Florian, Möllmann Helge, Unsöld Bernhard, Guthoff Henning, Baldus Stephan, Rottbauer Wolfgang, Rudolph Volker, Granada Juan F, Hausleiter Jörg, Pfister Roman, Mauri Victor
机构信息
Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Cologne, Germany; Cardiovascular Research Foundation, New York, New York, USA; Center for Cardiovascular Medicine ABCD, Aachen - Bonn - Cologne - Düsseldorf, Germany. Electronic address: https://twitter.com/philippvstein.
Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany.
出版信息
JACC Cardiovasc Interv. 2025 Aug 25;18(16):2020-2032. doi: 10.1016/j.jcin.2025.05.031. Epub 2025 Jun 25.
BACKGROUND
Secondary mitral regurgitation (SMR) has 2 phenotypes: atrial (aSMR) and ventricular (vSMR). The role of mitral valve transcatheter edge-to-edge repair (M-TEER) in aSMR remains less defined, with limited evidence on the PASCAL implant (Edwards Lifesciences).
OBJECTIVES
The authors sought to evaluate and compare outcomes of SMR phenotypes undergoing M-TEER.
METHODS
REPAIR (REgistry of PAscal for mItral Regurgitation) is an investigator-initiated, multicenter registry of patients undergoing M-TEER. aSMR was defined by left atrial dilation with preserved left ventricular size and ejection fraction. Outcomes included MR ≤1+ at discharge, technical success, NYHA functional class improvement, and 1-year survival.
RESULTS
Among 915 patients (166 [18%] aSMR, 749 [82%] vSMR), the median follow-up was 491 days (Q1-Q3: 360-833 days). MR ≤1+ was achieved in 77.2% vs 71.4% (P = 0.162), with technical success in 97.0% vs 98.3% (P = 0.446). NYHA functional class improved in both phenotypes (P < 0.001), with 61.2% vs 61.3% in functional class ≤II at follow-up (P > 0.999). One-year survival was 88.4% (95% CI: 82.8%-94.4%) vs 86.0% (95% CI: 83.1%-89.0%; P = 0.346). In aSMR patients, 1-year survival was significantly lower in patients with baseline tricuspid regurgitation (TR) grade ≥moderate compared with those with <moderate TR (84.3% [95% CI: 77.0%-92.3%] vs 100.0% [95% CI: 100.0%-100.0%]; P = 0.041). In vSMR patients, survival was similar between ≥moderate and <moderate baseline TR (83.9% [95% CI: 79.8%-88.2%] vs 89.3% [95% CI: 85.0%-93.8%]; P = 0.051).
CONCLUSIONS
M-TEER effectively reduces MR to ≤1+ and improves symptoms in both aSMR and vSMR. Particularly in aSMR, ≥moderate baseline TR is linked to worse outcomes, warranting consideration as an additional treatment target.
背景
继发性二尖瓣反流（SMR）有两种表型：心房型（aSMR）和心室型（vSMR）。二尖瓣经导管缘对缘修复术（M-TEER）在aSMR中的作用仍不太明确，关于帕斯卡植入物（爱德华生命科学公司）的证据有限。
目的
作者试图评估和比较接受M-TEER的SMR表型的结果。
方法
REPAIR（帕斯卡二尖瓣反流注册研究）是一项由研究者发起的、对接受M-TEER的患者进行的多中心注册研究。aSMR的定义为左心房扩张且左心室大小和射血分数保持正常。结果包括出院时二尖瓣反流≤1+、技术成功、纽约心脏协会（NYHA）功能分级改善和1年生存率。
结果
在915例患者中（166例[18%]为aSMR，749例[82%]为vSMR），中位随访时间为491天（第一四分位数-第三四分位数：360-833天）。二尖瓣反流≤1+的实现率在aSMR组为77.2%，在vSMR组为71.4%（P = 0.162），技术成功率在aSMR组为97.0%，在vSMR组为98.3%（P = 0.446）。两种表型的NYHA功能分级均有改善（P < 0.001），随访时功能分级≤II级的比例在aSMR组为61.2%，在vSMR组为61.3%（P > 0.999）。1年生存率在aSMR组为88.4%（95%置信区间：82.8%-94.4%），在vSMR组为86.0%（95%置信区间：83.1%-89.0%；P = 0.346）。在aSMR患者中，基线三尖瓣反流（TR）分级≥中度的患者1年生存率显著低于TR <中度的患者（84.3%[95%置信区间：77.0%-92.3%]对100.0%[95%置信区间：100.0%-100.0%]；P = 0.041）。在vSMR患者中，基线TR≥中度和<中度的患者生存率相似（83.9%[95%置信区间：79.8%-88.2%]对89.3%[95%置信区间：85.0%-93.8%]；P = 0.051）。
结论
M-TEER可有效将二尖瓣反流降低至≤1+，并改善aSMR和vSMR患者的症状。特别是在aSMR中，≥中度的基线TR与更差的预后相关，值得作为一个额外的治疗靶点加以考虑。
Zotero 插件