二尖瓣环钙化患者的经导管边缘到边缘修复：系统回顾和荟萃分析。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

American Journal of the Medical Sciences Pub Date : 2025-07-15 DOI:10.1016/j.amjms.2025.07.008

Abiodun Idowu MD , Olayinka Adebolu MD , Bakhtawer Siraj MD , Phuuwadith Wattanachayakul MD , Omotola Balogun MD , Kevin Bryan Lo MD , Christian Witzke MD , Emmanuel Akintoye MD , Behnam Bozorgnia MD , Gregg Pressman MD

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引用次数: 0

摘要

背景：二尖瓣环钙化（MAC）在功能性二尖瓣反流接受经导管边缘到边缘二尖瓣修复（TEER）的患者中很常见。然而，TEER系统在MAC患者中的安全性和有效性尚不清楚。方法：我们系统地回顾了多个在线数据库，以确定报告TEER中潜在中度/重度MAC患者与无/轻度MAC患者预后的研究。通过Cochrane Review Manager 5.4进行95%置信区间的随机效应模型荟萃分析。结果：共纳入6项研究，共纳入2808例患者（无/轻度MAC: 84.5% vs中/重度MAC: 15.5%）。与无/轻度MAC患者相比，接受TEER治疗的中度/重度MAC患者的即时手术成功率较低（OR: 0.62, 95% CI: 0.37 - 1.04, p=0.07）。TEER治疗一年后，两组重复二尖瓣介入或手术的比率相似（or: 1.67, 95%CI: 0.92 - 3.05, p=0.09），持续临床改善（NYHA≤2）（or: 0.86, 95%CI: 0.64 - 1.15, p=0.30），心力衰竭再入院（or: 0.84, 95%CI: 0.52 - 1.36, p=0.48）。然而，中/重度MAC患者的全因死亡率更高（OR: 1.82, 95%CI: 1.15 - 2.86, p = 0.01）。结论：在精心挑选的MAC显著患者中，TEER是安全有效的。需要一种标准化的选择算法来确定从TEER中获益最多的MAC患者。

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Transcatheter edge-to-edge repair in patients with mitral annular calcification: A systematic review and meta-analysis

Background

Mitral annular calcification (MAC) is common in patients with functional mitral regurgitation undergoing transcatheter edge-to-edge mitral valve repair (TEER). However, the safety and effectiveness of TEER systems in patients with MAC is poorly understood.

Methods

We systematically reviewed multiple online databases to identify studies that reported outcomes in patients undergoing TEER with underlying moderate/severe MAC versus those with no/mild MAC. Random-effect model meta-analysis at a 95 % confidence interval was done via Cochrane Review Manager 5.4.

Results

A total of 6 studies with a pooled 2808 patients (no/mild MAC: 84.5 % vs moderate/severe MAC: 15.5 %) were included. Compared to those with no/mild MAC, patients undergoing TEER with moderate/severe MAC have an insignificant trend towards a lower immediate procedural success (OR: 0.62, 95 % CI: 0.37 – 1.04, p = 0.07). After one year of TEER, the two groups had similar rates of repeat mitral valve intervention or surgery (OR: 1.67, 95 %CI: 0.92 – 3.05, p = 0.09), sustained clinical improvement (NYHA ≤ 2) (OR: 0.86, 95 %CI: 0.64 - 1.15, p = 0.30), and heart failure re-admission (OR: 0.84, 95 %CI: 0.52 - 1.36, p = 0.48). All-cause mortality was, however, higher in the moderate/severe MAC patients (OR: 1.82, 95 %CI: 1.15 – 2.86, p = 0.01).

Conclusions

TEER appears safe and effective in carefully selected patients with significant MAC. A standardized selection algorithm is needed to identify MAC patients that would benefit most from TEER.

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来源期刊

American Journal of the Medical Sciences 医学-医学：内科

CiteScore

4.40

自引率

0.00%

发文量

303

审稿时长

1.5 months

期刊介绍： The American Journal of The Medical Sciences (AJMS), founded in 1820, is the 2nd oldest medical journal in the United States. The AJMS is the official journal of the Southern Society for Clinical Investigation (SSCI). The SSCI is dedicated to the advancement of medical research and the exchange of knowledge, information and ideas. Its members are committed to mentoring future generations of medical investigators and promoting careers in academic medicine. The AJMS publishes, on a monthly basis, peer-reviewed articles in the field of internal medicine and its subspecialties, which include: Original clinical and basic science investigations Review articles Online Images in the Medical Sciences Special Features Include: Patient-Centered Focused Reviews History of Medicine The Science of Medical Education.