Alnaimi Anas, Mause Sebastian Frederik, Alachkar Nawar, Schröder Jörg W, Burgmaier Mathias, Altiok Ertunc, Marx Nikolaus, Reith Sebastian, Almalla Mohammad
Department of Internal Medicine I, Cardiology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany.
Faculty of Applied Healthcare Science, Deggendorf Institute of Technology, Deggendorf, Germany.
Front Cardiovasc Med. 2025 Jul 25;12:1585522. doi: 10.3389/fcvm.2025.1585522. eCollection 2025.
Percutaneous mitral valve repair using the MitraClip System is a well-established therapeutic option for patients with symptomatic mitral regurgitation. This procedure is usually performed via venous femoral access using a 24-French guiding catheter. Since vascular complications and bleeding remain a relevant limitation, we now compared access closure using subcutaneous absorbable double purse string suture (DPSS) and Z-suture technique following MitraClip procedure.
249 patients (mean age 76 ± 8 years) who underwent MitraClip procedure at our institution were included. Venous closure was performed using Z-suture technique in 140 patients and DPSS technique in 109 patients. Vascular complications and bleeding events were assessed according to the Mitral Valve Academic Research Consortium (MVARC) criteria.
MVARC minor and major vascular complications were comparable after closure with Z-suture and DPSS-technique (4.3% vs. 0.9%, = 0.11 and 1.4% vs. 0.9%, = 0.71, respectively). However, development of AV-fistula and requirement of access related surgical intervention was more often observed in the Z-suture group (5% vs. 0%, = 0.018 and 3.5% vs. 0%, = 0.045). MVARC minor and major, non-life-threatening bleeding did not differ between the two groups (10.7% vs. 12.9%, = 0.61 and 0.7% vs. 0.0%, = 0.38). Similarly, overall transfusion rates and access related blood transfusion rates were comparable (11.4% vs. 15.5%, = 0.34 and 4.3% vs. 2.7%, = 0.52).
Large caliber venous access closure with DPSS technique was feasible, safe, and effective to achieve haemostasis after MitraClip procedure. Compared with Z-suture, use of DPSS closure was associated with a lower rate of required access related surgical intervention and postinterventional AV-fistula.
使用MitraClip系统进行经皮二尖瓣修复术是有症状二尖瓣反流患者一种成熟的治疗选择。该手术通常通过股静脉入路，使用24F引导导管进行。由于血管并发症和出血仍然是一个相关限制因素，我们现在比较了MitraClip手术后使用皮下可吸收双荷包缝线（DPSS）和Z形缝合法进行入路闭合的情况。
纳入在我们机构接受MitraClip手术的249例患者（平均年龄76±8岁）。140例患者使用Z形缝合法进行静脉闭合，109例患者使用DPSS技术。根据二尖瓣学术研究联盟（MVARC）标准评估血管并发症和出血事件。
Z形缝合法和DPSS技术闭合后，MVARC轻微和严重血管并发症相当（分别为4.3%对0.9%，P = 0.11和1.4%对0.9%，P = 0.71）。然而Z形缝合组更常观察到动静脉瘘的发生和与入路相关的手术干预需求（5%对0%，P = 0.018和3.5%对0%，P = 0.045）。两组之间MVARC轻微和严重的非危及生命出血无差异（10.7%对12.9%，P = 0.61和0.7%对0.0%，P = 0.38）。同样，总体输血率和与入路相关的输血率相当（11.4%对15.5%，P = 0.34和4.3%对2.7%，P = 0.52）。
DPSS技术进行大口径静脉入路闭合在MitraClip手术后实现止血是可行、安全且有效的。与Z形缝合相比，使用DPSS闭合与所需的与入路相关的手术干预率和介入后动静脉瘘发生率较低相关。
