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OBJECTIVES: We aimed to assess the influence of type of operation on outcomein degenerative mitral regurgitation. METHODS: We compared outcomes in 278 consecutive patients who underwentmitral valve repair (167 patients), replacement with subvalvularpreservation (22 patients) and without subvalvular preservation(89 patients) for degenerative mitral regurgitation. RESULTS: There was a trend towards lower mortality with repair and replacementwith subvalvular preservation compared to replacement withoutsubvalvular preservation. Thirty-day mortality was 1·2%vs 0·0% vs 4·7% (ns) respectively. Six-year survivalwas, respectively, 67·8±7·4% (P=0·088)vs 80·8±11·0% (P=0·25 vs 63·3±5·9%for all-cause death, 78·5±6·8% (P=0·063)vs 95·5±4·4% (P=0·092) vs 67·6±5·9%for all complication-related death and 80·5±6·9%(P=0·076) vs 100·0±0·0% (P=0·045)vs 72· ± 5·8% for complication-relateddeath due to myocardial failure. Multivariate analysis confirmedindependent beneficial effects from repair compared to replacementwithout subvalvular preservation on complication-related death(hazard ratio 0·42, P=0·010) and death from myocardialfailure (hazard ratio 0·40 P=0·014), and fromrepair compared to mechanical replacement on thromboembolism(hazard ratio 0·45, P=0·029) and anticoagulation-relatedhaemorrhage (hazard ratio 0·19, P=0·026). CONCLUSIONS: Mitral valve repair is superior to replacement. The greatestsurvival advantage is in reduced mortality from myocardial failure.Repair should be the operation of choice for degenerative mitralregurgitation. 相似文献
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Konstantinos Spargias MD D. Scott Lim MD Raj Makkar MD Saibal Kar MD Robert M. Kipperman MD William W. O′Neill MD Martin K. C. Ng MBBS PhD Robert L. Smith MD Neil P. Fam MD Michael J. Rinaldi MD Christopher O. Raffel MBBS Darren L. Walters MBBS Justin Levisay MD Matteo Montorfano MD Azeem Latib MD John D. Carroll MD Georg Nickenig MD Stephan Windecker MD Leo Marcoff MD Gideon N. Cohen MD Ulrich Schäfer MD John G. Webb MD Molly Szerlip MD 《Catheterization and cardiovascular interventions》2023,102(1):145-154
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二尖瓣反流(Mitral valve regurgitation,MR)逐渐成为心脏瓣膜病中最常见的疾病之一。虽然外科手术在治疗MR中起到重要作用,但由于围手术期的风险过大、老年人基础情况较差等原因,许多患者禁忌外科手术。近年来,经导管治疗MR装置的出现,给治疗MR带来了新的选择,但同时也面临着许多挑战。本文综述了经导管治疗MR装置的技术特征及其临床试验的结果。 相似文献
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Nicolas Brugger MD Mohammad Kassar MD George C. M. Siontis MD Sonja Widmer MD Taishi Okuno MD Mirjam G. Winkel MD Noé Corpataux MD Christoph Gräni MD Lutz Büllesfeld MD Lukas Hunziker MD Thomas Pilgrim MD Stephan Windecker MD Fabien Praz MD 《Catheterization and cardiovascular interventions》2021,98(7):1404-1412
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Percutaneous edge‐to‐edge repair of the mitral valve in patients with degenerative versus functional mitral regurgitation 下载免费PDF全文
Daniel Braun MD Hasema Lesevic MD Martin Orban MD Fabian Michalk MD Petra Barthel MD Katharina Hoppe MD Carolin Sonne MD Jürgen Pache MD Julinda Mehilli MD Adnan Kastrati MD Jörg Hausleiter MD Steffen Massberg MD 《Catheterization and cardiovascular interventions》2014,84(1):137-146
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Major consequences of untreated severe mitral regurgitation (MR) includes heart failure, ventricular remodeling and pulmonary hypertension leading to significant morbidity and mortality. MitraClip is the most widely used device for treatment of severe MR. To overcome some of the shortcomings of MitraClip, novel devices like PASCAL mitral valve repair system are developed. We performed a single arm meta-analysis for patients with severe mitral regurgitation (MR) undergoing PASCAL mitral valve repair system. The results showed that 93.8% patients had reduction in MR grade, with an average operative time of 88 min and an average increase of 86.33 m in 6-min walk test. 相似文献
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Francesco De Felice MD Luca Paolucci MD Carmine Musto MD PhD Alberta Cifarelli MD Silvio Coletta MD Mauro Pennacchi MD PhD Rocco Stio MD PhD Domenico Gabrielli MD Carmelo Grasso MD Corrado Tamburino MD PhD Marianna Adamo MD PhD Paolo Denti MD Arturo Giordano MD PhD Federico De Marco MD PhD Matteo Montorfano MD Cesare Baldi MD Annalisa Mongiardo MD Ida Monteforte MD Diego Maffeo MD Cristina Giannini MD PhD Gabriele Crimi MD Giuseppe Tarantini MD PhD Antonio Popolo Rubbio MD Francesco Bedogni MD 《Catheterization and cardiovascular interventions》2023,102(2):310-317
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The MitraClip Asia‐Pacific registry: Differences in outcomes between functional and degenerative mitral regurgitation 下载免费PDF全文
Edgar Tay MBBS Nasir Muda MBBS Jonathan Yap MBBS David W.M. Muller MD Teguh Santoso MBBS Darren L. Walters MD Xianbao Liu MD Eric Yamen MD Paul Jansz MD James Yip MBBS Robaayah Zambahari MBBS Jurgen Passage MD Zee Pin Ding MBBS Jian'an Wang MD Gregory Scalia MD Amiliana M. Soesanto MBBS Khung Keong Yeo MBBS 《Catheterization and cardiovascular interventions》2016,87(7):E275-E281
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Masahiro Dohi 《中国心血管病研究杂志》2010,8(10):793-793
Repair durability for degenerative mitral regurgitation is excellent. Although the main reason for reoperation is residual or recurrent regurgitation, Postoperative mitral stenosis is extremely rare. 相似文献
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《Indian heart journal》2016,68(3):399-404
Mitral valve disease affects more than 4 million people in the United States. The gold standard of treatment in these patients is surgical repair or replacement of the valve with a prosthesis. The MitraClip (Abbott Vascular, Menlo Park, CA) is a new technology, which offers an alternative to open surgical repair or replacement via a minimally invasive route. We present an evidence-based clinical update that provides an overview of this technology as it relates to managing patients with significant mitral regurgitation. This review article is particularly useful to noninterventional cardiologists and interventional cardiologists who will be managing patients with this novel technology in increased volumes over the next decade but who do not perform this procedure. 相似文献
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Ryan Markham Stephen Kyranis Nicholas Aroney Katherine Lau Karl Poon Gregory Scalia Darren Walters 《Internal medicine journal》2018,48(4):382-390
Mitral regurgitation (MR) is a valvular heart disease associated with significant morbidity and mortality. Transcatheter mitral valve intervention (TMVI) repairs or replaces the mitral valve through small arterial and venous entry sites and so avoids risks associated with open heart surgery. Transcatheter devices targeting components of the mitral apparatus are being developed to repair or replace it. Numerous challenges remain including developing more adaptable devices and correction of multiple components of the mitral annulus to attain durable results. The mitral valve apparatus is a complex structure and understanding of the mechanisms of MR is essential in the development of TMVI. There will likely be a complementary role between surgery and TMVI in the near future. 相似文献
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GALLINO A.; JENNI R.; HURNI R.; HIRZEL H. O.; KRAYENBUHL H. P.; EGLOFF L.; ROTHLIN M.; SCHONBECK M.; TURINA M. 《European heart journal》1987,8(7):902-905
In this study we present the results of 105 consecutive patientswith pure mitral regurgitation who underwent surgical treatment.In all patients mitral regurgitation was associated with mitralvalve prolapse: 54 patients underwent mitral valvuloplasty and51 patients mitral valve replacement. Clinical assessment and echocardiography were used as follow-upcriteria at one year after surgery. After mitral valvuloplasty,NYH A decreased from 2.7±0.8 to 1.1±0.7 (P<0.01)and workload capacity increased from 65±28% to 96±25%(P<0.001); left endsystolic atrial dimension and enddiastolicdimension decreased from 6.2±0.8 to 4.8±1.2 cm(P<0.001) and from 7.2±1.3 to 5.9±0.8 cm (P<0.01);ventricular contraction fraction did not change significantly. After mitral valve replacement, clinical and echocardiographicimprovement was significant but less remarkable than after valvuloplasty;ventricular contraction fraction fell from 39±7% to 29±8%in contrast to patients undergoing mitral valvuloplasty in whomno significant change occurred. Complications were rare in both groups though only a minorityof patients undergoing mitral valvuloplasty received anticoagulants.We conclude that mitral valvuloplasty in patients with puremitral regurgitation associated with mitral valve prolapse givesexcellent results, particularly regarding left ventricular functionwhen compared with the patients after mitral valve replacement. 相似文献
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GALLINO A.; JENNI R.; HURNI R.; HIRZEL H. O.; KRAYENBUHL H. P.; EGLOFF L.; ROTHLIN M.; SCHONBECK M.; TURINA M. 《European heart journal》1987,8(8):902-905
In this study we present the results of 105 consecutive patientswith pure mitral regurgitation who underwent surgical treatment.In all patients mitral regurgitation was associated with mitralvalve prolapse: 54 patients underwent mitral valvuloplasty and51 patients mitral valve replacement. Clinical assessment and echocardiography were used as follow-upcriteria at one year after surgery. After mitral valvuloplasty,NYH A decreased from 2.7±0.8 to 1.1±0.7 (P<0.01)and workload capacity increased from 65±28% to 96±25%(P<0.001); left endsystolic atrial dimension and enddiastolicdimension decreased from 6.2±0.8 to 4.8±1.2 cm(P<0.001) and from 7.2±1.3 to 5.9±0.8 cm (P<0.01);ventricular contraction fraction did not change significantly. After mitral valve replacement, clinical and echocardiographicimprovement was significant but less remarkable than after valvuloplasty;ventricular contraction fraction fell from 39±7% to 29±8%in contrast to patients undergoing mitral valvuloplasty in whomno significant change occurred. Complications were rare in both groups though only a minorityof patients undergoing mitral valvuloplasty received anticoagulants.We conclude that mitral valvuloplasty in patients with puremitral regurgitation associated with mitral valve prolapse givesexcellent results, particularly regarding left ventricular functionwhen compared with the patients after mitral valve replacement. 相似文献