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

作者：Treede Hendrik^*; Schirmer Johannes; Rudolph Volker; Franzen Olaf; Knap Malgorzata; Schluter Michael; Conradi Lenard; Seiffert Moritz; Koschyk Dietmar; Meinertz Thomas; Baldus Stephan; Reichenspurner Hermann

来源：The Journal of Thoracic and Cardiovascular Surgery, 2012, 143(1): 78-84.

DOI：10.1016/j.jtcvs.2011.09.033

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 +/- 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 +/- 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. (J Thorac Cardiovasc Surg 2012;143:78-84)

• 出版日期2012-1