{"title":"瓣膜心脏团队治疗二尖瓣返流患者的治疗决策过程和预后分析","authors":"M.L. Marie Luciani","doi":"10.1016/j.acvdsp.2023.04.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p><span>Due to the aging of the population and the diversification of treatment options, finding the right treatment for the right patient becomes a challenge, especially </span>in patients<span> with mitral regurgitation (MR), which is a heterogenous and complex disease, with numerous etiologies. Aims of this study are to describe the profile of patients referred to the Valvular Heart Team (VHT) for management of mitral regurgitation, to highlight the selection process and the main factors guiding allocation for different treatment options, to assess clinical outcomes after treatment.</span></p></div><div><h3>Method</h3><p>All patients with mitral regurgitation referred to the VHT between January 1st, 2014, and April 30th, 2021, in University Hospital of Tours, were included.</p></div><div><h3>Results</h3><p>MR patients referred to our VHT were, mostly, old (mean: 74.2 years), symptomatic (96%), at high or intermediate risk according to “European Society of Cardiology” criteria (44%). Most of them had comorbidities, 34% had LVEF<!--> <!--><<!--> <span>50% and 70% a severe primary MR. In 81% of cases, invasive management was decided (surgery [44%], percutaneous edge- to-edge mitral repair [TEER] [35%], transcatheter mitral valve replacement [1.6%]) and in 19% of cases, medical treatment was decided. Distribution of treatments changed significantly (</span><em>P</em> <!--><<!--> <!-->0.01) over time, with a progressive increase in TEER. History of cardiac surgery (<em>P</em> <!-->=<!--> <!-->0.015), EuroScore II<!--> <!-->><!--> <!-->4% (<em>P</em> <!-->=<!--> <span>0.012), STS score > 8% (</span><em>P</em> <!-->=<!--> <span>0.037), frailty<span> according to the Katz index (</span></span><em>P</em> <!-->=<!--> <!-->0.029), LVEF < 50% (<em>P</em> <!--><<!--> <!-->0.001), TAPSE<!--> <!--><<!--> <!-->15 mm (<em>P</em> <!--><<!--> <!-->0,01) secondary MR (<em>P</em> <!--><<!--> <!-->0.001) and leaflets calcifications (<em>P</em> <!-->=<!--> <!-->0.027) were the main factors significantly associated with the choice of a conservative treatment. In 86% of cases, VHT decisions could be implemented.</p></div><div><h3>Conclusion</h3><p>VHT is a centerpiece in the current management of patients with MR, it opts and more and more, for percutaneous treatments. The organization and the smooth running of VHT meetings will be a real issue in the future, with the increase in patients referred and we will have to find solutions (<span>Fig. 1</span>).</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Pages 243-244"},"PeriodicalIF":18.0000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Analysis of therapeutic decision-making process and prognosis in patients referred to the Valvular Heart Team for management of mitral regurgitation\",\"authors\":\"M.L. Marie Luciani\",\"doi\":\"10.1016/j.acvdsp.2023.04.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p><span>Due to the aging of the population and the diversification of treatment options, finding the right treatment for the right patient becomes a challenge, especially </span>in patients<span> with mitral regurgitation (MR), which is a heterogenous and complex disease, with numerous etiologies. Aims of this study are to describe the profile of patients referred to the Valvular Heart Team (VHT) for management of mitral regurgitation, to highlight the selection process and the main factors guiding allocation for different treatment options, to assess clinical outcomes after treatment.</span></p></div><div><h3>Method</h3><p>All patients with mitral regurgitation referred to the VHT between January 1st, 2014, and April 30th, 2021, in University Hospital of Tours, were included.</p></div><div><h3>Results</h3><p>MR patients referred to our VHT were, mostly, old (mean: 74.2 years), symptomatic (96%), at high or intermediate risk according to “European Society of Cardiology” criteria (44%). Most of them had comorbidities, 34% had LVEF<!--> <!--><<!--> <span>50% and 70% a severe primary MR. In 81% of cases, invasive management was decided (surgery [44%], percutaneous edge- to-edge mitral repair [TEER] [35%], transcatheter mitral valve replacement [1.6%]) and in 19% of cases, medical treatment was decided. Distribution of treatments changed significantly (</span><em>P</em> <!--><<!--> <!-->0.01) over time, with a progressive increase in TEER. History of cardiac surgery (<em>P</em> <!-->=<!--> <!-->0.015), EuroScore II<!--> <!-->><!--> <!-->4% (<em>P</em> <!-->=<!--> <span>0.012), STS score > 8% (</span><em>P</em> <!-->=<!--> <span>0.037), frailty<span> according to the Katz index (</span></span><em>P</em> <!-->=<!--> <!-->0.029), LVEF < 50% (<em>P</em> <!--><<!--> <!-->0.001), TAPSE<!--> <!--><<!--> <!-->15 mm (<em>P</em> <!--><<!--> <!-->0,01) secondary MR (<em>P</em> <!--><<!--> <!-->0.001) and leaflets calcifications (<em>P</em> <!-->=<!--> <!-->0.027) were the main factors significantly associated with the choice of a conservative treatment. In 86% of cases, VHT decisions could be implemented.</p></div><div><h3>Conclusion</h3><p>VHT is a centerpiece in the current management of patients with MR, it opts and more and more, for percutaneous treatments. The organization and the smooth running of VHT meetings will be a real issue in the future, with the increase in patients referred and we will have to find solutions (<span>Fig. 1</span>).</p></div>\",\"PeriodicalId\":8140,\"journal\":{\"name\":\"Archives of Cardiovascular Diseases Supplements\",\"volume\":\"15 3\",\"pages\":\"Pages 243-244\"},\"PeriodicalIF\":18.0000,\"publicationDate\":\"2023-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of Cardiovascular Diseases Supplements\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1878648023001428\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases Supplements","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1878648023001428","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
Analysis of therapeutic decision-making process and prognosis in patients referred to the Valvular Heart Team for management of mitral regurgitation
Introduction
Due to the aging of the population and the diversification of treatment options, finding the right treatment for the right patient becomes a challenge, especially in patients with mitral regurgitation (MR), which is a heterogenous and complex disease, with numerous etiologies. Aims of this study are to describe the profile of patients referred to the Valvular Heart Team (VHT) for management of mitral regurgitation, to highlight the selection process and the main factors guiding allocation for different treatment options, to assess clinical outcomes after treatment.
Method
All patients with mitral regurgitation referred to the VHT between January 1st, 2014, and April 30th, 2021, in University Hospital of Tours, were included.
Results
MR patients referred to our VHT were, mostly, old (mean: 74.2 years), symptomatic (96%), at high or intermediate risk according to “European Society of Cardiology” criteria (44%). Most of them had comorbidities, 34% had LVEF < 50% and 70% a severe primary MR. In 81% of cases, invasive management was decided (surgery [44%], percutaneous edge- to-edge mitral repair [TEER] [35%], transcatheter mitral valve replacement [1.6%]) and in 19% of cases, medical treatment was decided. Distribution of treatments changed significantly (P < 0.01) over time, with a progressive increase in TEER. History of cardiac surgery (P = 0.015), EuroScore II > 4% (P = 0.012), STS score > 8% (P = 0.037), frailty according to the Katz index (P = 0.029), LVEF < 50% (P < 0.001), TAPSE < 15 mm (P < 0,01) secondary MR (P < 0.001) and leaflets calcifications (P = 0.027) were the main factors significantly associated with the choice of a conservative treatment. In 86% of cases, VHT decisions could be implemented.
Conclusion
VHT is a centerpiece in the current management of patients with MR, it opts and more and more, for percutaneous treatments. The organization and the smooth running of VHT meetings will be a real issue in the future, with the increase in patients referred and we will have to find solutions (Fig. 1).
期刊介绍：
Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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