PDF(Pubmed)
Abstract：
Background: Minimally invasive mitral valve surgery (MIC-MVS) has been established as preferred treatment of mitral regurgitation (MR), but mitral transcatheter edge-to-edge valve repair (M-TEER) is routinely performed in patients at high surgical risk and is increasingly performed in intermediate risk patients. Methods: From 2010 to 2021, we performed 723 M-TEER and 123 isolated MIC-MVS procedures. We applied a sensitivity analysis by matching age, left ventricular ejection fraction (LVEF), EuroSCORE II and etiology of MR. Results: Baseline characteristics showed significant differences in the overall cohort (p < 0.01): age 78.3 years vs. 61.5 years, EuroSCORE II 5.5% vs. 1.3% and LVEF 48.4% vs. 60.4% in M-TEER vs. MIC-MVS patients. Grade of MR at discharge was moderate/severe in 24.5% (171/697) in M-TEER vs. 6.5% (8/123) in MIC-MVS (p < 0.01). One-year survival was 91.5% (552/723) in M-TEER vs. 97.6% (95/123) in MIC-MVS (p = 0.04). A matching with 49 pairs (n = 98) showed comparable survival during follow-up, but a numerically higher mean mitral valve gradient of 4.1 mmHg (95% CI: 3.6-4.6) vs. 3.4 mmHg (95% CI: 3.0-3.8) in M-TEER (p = 0.04). Conclusions: Patients undergoing M-TEER had lower one-year survival than MIC-MVS, but differences disappeared after matching. Reduction in MR was less effective in M-TEER patients and postprocedural mitral valve gradients were higher.
摘要：
背景：微创二尖瓣手术（MIC-MVS）已被确定为二尖瓣返流（MR）的首选治疗方法。但二尖瓣经导管边缘-边缘瓣膜修复术(M-TEER)通常在手术风险高的患者中进行,并且在中危患者中的应用越来越多.方法：从2010年到2021年，我们进行了723个M-TEER和123个分离的MIC-MVS程序。我们通过匹配年龄应用了敏感性分析，左心室射血分数(LVEF),EuroSCOREII和MR的病因。结果：基线特征在总体队列中显示出显着差异（p<0.01）：年龄78.3岁与61.5年，EuroSCOREII5.5%与1.3%和LVEF48.4%与60.4%的M-TEER与MIC-MVS患者。M-TEER患者出院时的MR分级为中度/重度，占24.5%(171/697)，与MIC-MVS中6.5%(8/123)(p<0.01)。M-TEER的一年生存率为91.5%（552/723）。MIC-MVS为97.6%(95/123)(p=0.04)。与49对（n=98）的匹配显示随访期间具有可比性的生存率，但数值上更高的平均二尖瓣梯度为4.1mmHg（95％CI：3.6-4.6）M-TEER中3.4mmHg（95%CI：3.0-3.8）（p=0.04）。结论：接受M-TEER的患者一年生存率低于MIC-MVS，但匹配后差异消失。M-TEER患者的MR减少效果较差，术后二尖瓣梯度较高。
