经导管二尖瓣夹合术的临床结果介绍

目的 评估经导管二尖瓣夹合术（MitraClip）治疗中重度或重度二尖瓣反流患者的安全性和有效性.方法 2013年10月至2014年3月,使用MitraClip系统对10例有症状的中重度（1例）或重度（9例）二尖瓣反流患者行经导管二尖瓣修复术,分析10例患者手术即刻效果和30d随访结果.结果 10例患者的平均年龄（74±10.6）岁,功能性反流8例,器质性反流2例.所有手术均成功开展,顺利置入1个（5例）或2个（5例）MitraClip.手术即刻效果提示,5例患者二尖瓣反流下降3级,5例患者下降2级,未发生相关并发症.30d超声心动图随访提示,所有患者二尖瓣反流较术前降低≥2级,左心室射血分数（LVEF）由（40.2±11.9）％提高到（44.8±11.6）％,左心房内径和舒张期左心室内径分别由（6.4±0.5） cm和（6.1±0.8） cm缩小至（6.0±0.5） cm和（6.0±0.8） cm.所有患者的主观症状较术前有不同程度的改善,纽约心功能分级均较术前提高1级,生活质量评分和6 min步行试验分别由（0.7±0.2）和（279.0±123.0）m提高到（0.9±0.1）和（347.0±91.0）m.结论 本中心初步经验提示,经导管二尖瓣夹合术（MitraClip）可以带来超声心动图指标的改善和早期的临床获益,是安全有效的,但中远期效果有待于进一步随访.

A single center experience of transcatheter mitral valve repair

Objective To evaluate the safety and efficacy of transcatheter mitral valve repair for the Chinese patients with moderate-to-severe or severe mitral regurgitation （MR） by using MitraClip system.Methods From October 2013 to March 2014,10 symptomatic patients with moderate-to-severe （n=1） or severe （n=9） MR were performed transcatheter mitral valve repair by using the MitraClip system.Immediate results of the 10 patients as well as 30 d follow up results were analyzed.Results The mean age was （74±10.6） years.Degenerative and functional regurgitation were 20％ （n=2） and 80％ （n=8）,respectively.All of the procedures were successful and five patients received one MitraClip while the other five patients received two.Acute MR reduction by 3 grades was achieved in 5 patients and by 2 grades in the other 5 patients （reduction 2 grades in 100％）.No complication was found in all the patients.Thirtyday follow-up showed that MR reduction by 2 grades was achieved in all the patients.Increase of LVEF was observed from （40.2±11.9）％ to （44.8±11.6）％,and decrease of the diameter of LA and LVEDD from （6.4±0.5） cm and （6.1±0.8） cm to （6.0±0.5） cm and （6.0±0.8） cm.For clinical follow up,10 patients were found promotion in symptom and heart function （NYHA）.Assessment of quality of life （AQoL） and 6 minutes walk test ameliorated from （0.7±0.2） and （279±123） m to （0.9±0.1） and （347±91） m,respectively.Conclusions Our initial experience with transcatheter mitral valve repair using the MitraClip system demonstrated that the procedure was safe and effective,resulting in substantial echocardiographic and early clinical improvement.However,the long term benefit of MitraClip should be validated through follow up.