心房功能性二尖瓣反流的经导管边缘到边缘修复术后残余二尖瓣反流的影响:MITRA-PRO 登记的结果。

IF 2.1 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Catheterization and Cardiovascular Interventions Pub Date : 2024-09-26 DOI:10.1002/ccd.31242
Dennis Rottländer MD, Jörg Hausleiter MD, Thomas Schmitz MD, Alexander Bufe MD, Melchior Seyfarth MD, Ralph Stephan von Bardeleben MD, Harald Beucher MD, Taoufik Ouarrak, Steffen Schneider, Peter Boekstegers MD, MITRA-PRO Investigators
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引用次数: 0

摘要

背景:经导管边缘到边缘修补术(TEER)的出现是为了解决高手术风险患者的无症状心房功能性二尖瓣反流(aFMR)问题。目的:与心室功能性二尖瓣反流(vFMR)相比,经导管边缘到边缘修补术(TEER)对aFMR患者残余二尖瓣反流(MR)的影响尚无临床数据:方法:在MITRA-PRO登记中,纳入了846名患有FMR并接受MitraScore评估以量化残余MR的患者(722名vFMR患者和124名aFMR患者):与vFMR相比,aFMR患者在TEER术后残留MR方面的程序结果相似(TEER术后的MitraScore为2.5 ± 1.8 vs. 2.7 ± 1.9),而vFMR患者植入的TEER装置数量增加。无论是否存在相关残余 MR(MitraScore ≥ 4),aFMR 的 1 年生存率均优于 vFMR,而两种 MR 实体的 1 年再住院率相当。二尖瓣 TEER 1 年后,aFMR 和轻度残余 MR 患者的死亡率(6.6% 对 10.3%)和再住院率(29.1% 对 46.2%)均较低。然而,与vFMR相比,MitraScore≥4并不是aFMR死亡率的独立预测因素,这表明对残余MR有更好的耐受性:结论:残留 MR 是预测 vFMR 患者 1 年死亡率的独立指标,而在 aFMR 患者中,MitraScore ≥4 与较高的死亡率相关,但在多变量分析中并非独立预测指标。因此,通过二尖瓣 TEER 使 MR 最小化对 vFMR 患者的生存至关重要,而 aFMR 患者在术后 1 年对明显残余 MR 的耐受性更好。
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Impact of residual mitral regurgitation after transcatheter edge-to-edge repair in atrial functional mitral regurgitation: Results from MITRA-PRO registry

Background

Transcatheter edge-to-edge repair (TEER) has emerged to address symptomatic atrial functional mitral regurgitation (aFMR) in patients who are at high operative risk.

Aims

No clinical data is available on the impact of residual mitral regurgitation (MR) following TEER in aFMR compared to ventricular functional MR (vFMR).

Methods

In the MITRA-PRO registry, 846 patients with FMR and MitraScore assessment for residual MR quantification were included (722 patients with vFMR and 124 patients with aFMR).

Results

Compared to vFMR similar procedural results in regard of residual MR following TEER were found in aFMR patients (MitraScore post TEER 2.5 ± 1.8 vs. 2.7 ± 1.9), while the amount of implanted TEER devices was increased in vFMR. 1-year survival was better in aFMR compared to vFMR regardless of relevant residual MR (MitraScore ≥ 4), while 1-year rehospitalization was comparable for both MR entities. Patients with aFMR and mild residual MR had a lower mortality rate (6.6% vs. 10.3%) and rehospitalization rate (29.1% vs. 46.2%) 1 year after mitral TEER. However, in contrast to vFMR a MitraScore ≥4 was no independent predictor of mortality in aFMR indicating a better tolerance toward residual MR.

Conclusions

Residual MR is an independent predictor of 1-year mortality in vFMR patients, whereas in aFMR patients, a MitraScore of ≥4 is associated with higher mortality but is not an independent predictor in multivariate analysis. Therefore, minimizing MR through mitral TEER is crucial for survival in vFMR patients, while aFMR patients tolerate significant residual MR better 1 year after the procedure.

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来源期刊
CiteScore
5.40
自引率
8.70%
发文量
419
审稿时长
2 months
期刊介绍: Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.
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