经导管二尖瓣修复术治疗多发性瓣膜性心脏病：关于合并主动脉瓣关闭不全和二尖瓣反流的疗效和见解。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2024-10-09 DOI:10.1016/j.amjcard.2024.09.032

Craig Basman MD, Ahmad Mustafa MD, Arber Kodra MD, Denny Wang BS, Priyanka Singh BS, Ethan Paliwoda BS, Christopher Gasparis BS, Ythan Goldberg MD, Shangyi Liu MS, Chapman Wei MD, Michael Cinelli MD, Efstathia Mihelis PA-C, MBA, Caroline Ong MD, Biana Trost MD, Bruce Rutkin MD, Elana Koss MD, Gregory Maniatis MD, Sean Wilson MD, Jacob Scheinerman MD, Chad Kliger MD

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引用次数: 0

摘要

主动脉瓣关闭不全（AI）和二尖瓣反流（MR）并存的情况很常见，可能会进一步加速心脏功能障碍。然而，美国监管机构尚未批准用于治疗主动脉瓣关闭不全的经导管设备。因此，我们旨在评估合并有 AI 和 MR 的患者接受二尖瓣经导管边缘到边缘修补术（m-TEER）的疗效，并与接受二尖瓣经导管边缘到边缘修补术（m-TEER）的单纯 MR 患者进行比较。我们从诺斯韦尔 m-TEER 登记处获得了回顾性数据。诺斯韦尔医疗系统的四个高容量 TAVR/TEER 中心共纳入了 587 名接受 m-TEER 的患者。所有患者均有严重的 MR，并被分为两组：AI≥ 3+ (AI+)的第 1 组和 AI≥ 3+ (AI+)的第 2 组。

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Transcatheter Mitral Valve Repair for Multiple Valvular Heart Disease: Outcomes and Insights on Combined Aortic Insufficiency and Mitral Regurgitation

The presence of concomitant aortic insufficiency (AI) and mitral regurgitation (MR) is common and may further accelerate cardiac dysfunction. However, there exists no US regulatory–approved transcatheter device for the treatment of AI. The effectiveness of isolated transcatheter mitral therapy in this population is not well-understood; thus, we aimed to evaluate outcomes for patients with combined AI and MR compared with isolated MR who underwent mitral transcatheter edge-to-edge repair (m-TEER). Retrospective data were obtained from the Northwell m-TEER registry. A total of 587 patients who underwent m-TEER at 4 high-volume transcatheter aortic valve replacement/transcatheter edge-to-edge repair centers within the Northwell Health system were included. All patients had severe MR and were divided into 2 groups: group 1 with ≥3+ AI (AI+) and the group 2 with <3+ AI (AI−). Echocardiographic outcomes were evaluated at 1 month. Clinical outcomes were evaluated at 1 month and 1 year. The primary end point was death or rehospitalization at 1 year. A total of 587 patients were included in the study, with 92 in the AI+ group. Baseline characteristics were similar in both groups. Approximately 2/3 of patients in the AI+ group demonstrated an improvement in AI severity after isolated mitral therapy. There was no difference in the primary outcome at 1 month or 1 year. There was also no significant difference in New York Heart Association functional class at 1 month between the groups. In conclusion, patients who underwent m-TEER with combined MR and AI (AI+ group) fared well compared with those with isolated mitral valve dysfunction (AI− group), with no discernible differences in survival, New York Heart Association class, or rehospitalization rates at 1 month or 1 year. Hence, isolated m-TEER is a reasonable treatment approach in patients with a high surgical risk with combined AI and MR.

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来源期刊

American Journal of Cardiology 医学-心血管系统

CiteScore

4.00

自引率

3.60%

发文量

698

审稿时长

33 days

期刊介绍： Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.