A heart team¡¯s perspective on interventional mitral valve repair: Percutaneous clip implantation as an important adjunct to a surgical mitral valve program for treatment of high-risk patients

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• 作者：Hendrik Treede ; MD^a ; ^{treede@uke.de} ; Johannes Schirmer ; MD^a ; Volker Rudolph ; MD^b ; Olaf Franzen ; MD^b ; Malgorzata Knap ; MD^b ; Michael Schluter ; PhD^b ; Lenard Conradi ; MD^a ; Moritz Seiffert ; MD^a ; Dietmar Koschyk ; MD^b ; Thomas Meinertz ; MD^b ; Stephan Baldus ; MD^b ; Hermann Reichenspurner ; MD ; PhD^a
• 关键词：22 ; 35.4 ; 35.4.1
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：2012
• 出版时间：January, 2012
• 年：2012
• 卷：143
• 期：1
• 页码：78-84
• 全文大小：573 K

文摘

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Objective

Surgical mitral valve repair carries an elevated perioperative risk in the presence of severely reduced ventricular function and relevant comorbidities. We sought to assess the feasibility of catheter-based mitral valve repair using a clip-based percutaneous edge-to-edge repair system in selected patients at high surgical risk with mitral regurgitation grade 3 or worse.

Methods

Between 2002 and January 2011, 202 consecutive patients without prior mitral valve surgery (age 75 ¡À 9 years; 63 % were male) with symptomatic functional (65 % ), degenerative (27 % ), or mixed (8 % ) mitral regurgitation were treated with a percutaneous clip system for approximation of the anterior and posterior mitral leaflets. Risk for mitral valve surgery was considered high in terms of a mean logistic European System for Cardiac Operative Risk Evaluation of 44 % (range, 21 % -54 % ). Preprocedural left ventricular ejection fraction was 35 % or less in 36 % of patients. An interdisciplinary heart team of cardiologists and cardiac surgeons discussed all patients.

Results

Percutaneous clip implantation was successful in 186 patients (92 % ). Patients were treated with 1 clip (n?=?125; 62 % ), 2 clips (n?=?64; 32 % ), or 3 or more clips (n?=?7; 3 % ). Reduction in mitral regurgitation from pre- to postprocedure was significant (P?<?.0001) and remained stable within the first 12 months in the majority of patients. Thirty-day mortality was 3.5 % (7/202 patients). Hospital stay was 12 ¡À 10 days, and median intensive care unit stay was 1 day (range, 0-45 days). Eleven patients required surgical valve repair/replacement at a median of 38 days (0-468 days) after percutaneous clip implantation.

Conclusions

Clip-based percutaneous mitral valve repair is a safe, low-risk, and effective therapeutic option in symptomatic patients with a high risk for surgery and does not exclude later surgical repair.