二尖瓣瓣环钙化患者使用专用装置进行经导管二尖瓣置换术后的疗效。

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2024-09-23 DOI:10.1016/j.jcin.2024.07.038

Augustin Coisne MD, PhD , Sebastian Ludwig MD , Andrea Scotti MD , Walid Ben Ali MD, PhD , Jessica Weimann MSc , Alison Duncan MD , John G. Webb MD , Daniel Kalbacher MD , Tanja K. Rudolph MD , Georg Nickenig MD , Jörg Hausleiter MD , Hendrik Ruge MD , Matti Adam MD , Anna S. Petronio MD , Nicolas Dumonteil MD , Lars Søndergaard MD , Marianna Adamo MD , Damiano Regazzoli MD , Andrea Garatti MD , Tobias Schmidt MD , Thomas Modine MD, PhD

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引用次数: 0

摘要

背景：二尖瓣反流（MR）和形态学上存在相关二尖瓣环钙化（MAC）的患者是一个具有挑战性的表型亚群，其治疗选择有限：本研究旨在评估使用专用设备经导管二尖瓣置换术（TMVR）治疗二尖瓣环钙化患者的可行性：方法：根据无或轻度二尖瓣环钙化（MACnone/mild）与中度或重度二尖瓣环钙化（MACmod/sev）的存在情况，对接受TMVR且有CHOICE-MI（二尖瓣关闭不全最佳经导管治疗的选择）多中心登记的计算机断层扫描数据的连续性症状性MR患者进行分层：在279名符合条件的患者中（中位年龄=76.0岁[Q1-Q3：71.0-81.0岁]，EuroSCORE II=6.2%[Q1-Q3：3.9%-12.1%]），222人（79.6%）患有二尖瓣环钙化（MACnone/mild），57人（20.4%）患有二尖瓣环钙化（MACmod/sev）。MACmod/sev患者的心外动脉病变（P = 0.011）和原发性MR（P < 0.001）发生率较高。虽然技术成功率和 MR 消除程度没有差异，但 MACmod/sev 患者的 TMVR 治疗与较高的术后出血并发症发生率（P = 0.02）和肾功能衰竭发生率（P < 0.001）相关。1年和2年随访时的功能改善情况在各组之间没有差异。随访 2 年时，MACmod/sev 和 MACnone/mild 患者在全因死亡率（38.5% vs 37.7%；P = 0.76）、心血管死亡率（21.3% vs 24.9%；P = 0.97）、全因死亡率或心衰住院率（52.4% vs 46.7%；P = 0.28）方面没有差异：与 MACnone/mild 相比，MACmod/sev 患者的 TMVR 术后并发症发生率较高，但存活率、MR 解除率和功能改善率相似。有必要开展进一步研究，以确定专用 TMVR 设备在这一人群中的作用。(二尖瓣关闭不全最佳经导管治疗的选择注册[CHOICE-MI]；NCT04688190）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Outcomes Following Transcatheter Mitral Valve Replacement Using Dedicated Devices in Patients With Mitral Annular Calcification

Background

Patients with mitral regurgitation (MR) and morphologic presence of relevant mitral annular calcification (MAC) represent a challenging phenotypic subset with limited treatment options.

Objectives

The aim of this study was to assess the feasibility of transcatheter mitral valve replacement (TMVR) using dedicated devices for the treatment of MAC patients.

Methods

Consecutive patients with symptomatic MR receiving TMVR and with available computed tomography data from the CHOICE-MI (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency) multicenter registry were stratified by the presence of none or mild mitral annular calcification (MAC_none/mild) vs moderate or severe mitral annular calcification (MAC_mod/sev).

Results

Among 279 eligible patients (median age = 76.0 years [Q1-Q3: 71.0-81.0 years], EuroSCORE II = 6.2% [Q1-Q3: 3.9%-12.1%]), 222 (79.6%) presented with MAC_none/mild and 57 (20.4%) with MAC_mod/sev. Patients with MAC_mod/sev had a higher prevalence of extracardiac arteriopathy (P = 0.011) and primary MR (P < 0.001). Although the technical success rate and the extent of MR elimination did not differ, TMVR treatment in MAC_mod/sev patients was associated with higher rates of postprocedural bleeding complications (P = 0.02) and renal failure (P < 0.001). Functional improvement at the 1- and 2-year follow-up did not differ between groups. At the 2-year follow-up, there were no differences between patients with MAC_mod/sev and MAC_none/mild regarding all-cause mortality (38.5% vs 37.7%; P = 0.76), cardiovascular mortality (21.3% vs 24.9%; P = 0.97), and all-cause mortality or heart failure hospitalization (52.4% vs 46.7%; P = 0.28)

Conclusions

TMVR in patients with MAC_mod/sev is associated with higher rates of postprocedural complications but similar rates of survival, MR resolution, and functional improvement compared to MAC_none/mild. Further studies are necessary to define the role of dedicated TMVR devices in this population. (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency Registry [CHOICE-MI]; NCT04688190)

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.