经导管缘对缘修复技术初步实践:MitraClip治疗二尖瓣反流多中心早期结果

Primary practice of transcatheter edge-to-edge repair for mitral regurgitation:Early results of MitraClip in multiple centers

目的探讨MitraClip系统中国上市后在国内患者中的早期临床应用结果。方法回顾性分析2021年1—6月在中国医学科学院阜外医院、阜外医院深圳医院、云南省阜外心血管病医院,应用MitraClip系统完成经导管缘对缘手术的36例患者的临床资料,其中男24例、女12例,中位年龄70(47~86)岁,术前二尖瓣反流程度为3+级患者10例(27.8%),4+级患者26例(72.2%)。结果全组患者手术顺利,术毕即刻二尖瓣反流程度较前至少下降2+级,术后3 d二尖瓣反流程度≤2+级患者占91.7%。术后患者左心室射血分数无明显变化,术后二尖瓣前向流速、峰值压差均较术前增快,术后3 d二尖瓣跨瓣平均压差较术毕即刻有所增加(P<0.001)。术中2例患者出现急性心包积液,穿刺引流后好转。结论MitraClip系统在中国患者中应用效果良好,能明显改善二尖瓣反流,与国外研究具有良好的一致性,早期结果令人满意。

Objective To investigate the early clinical results of MitraClip system in domestic patients.Methods We retrospectively analyzed the clinical data of 36 patients who underwent transcatheter edge-to-edge repair procedure using MitraClip system in Beijing Fuwai Hospital,Shenzhen Fuwai Hospital and Fuwai Yunnan Cardiovascular Hospital between January and June 2021.There were 24 males and 12 females,with a median age of 70(47-86)years.Ten(27.8%)patients had 3+mitral regurgitation(MR)and 26(72.2%)patients had 4+MR preoperatively.Results All procedures were successfully performed.The reduction in MR was 2+at least immediately after surgery,and 91.7%of patients had MR≤2+at 3 days postoperatively.There was no statistical difference in left ventricular ejection fraction change postoperatively.Forward velocity and peak gradient of mitral valve were increased after the procedure.Mean gradient of mitral valve were increased at 3 days postoperatively than immediately after surgery(P<0.001).Two patients had acute pericardial effusion intraoperatively,and received pericardial puncture and drainage immediately.Conclusion MitraClip system has been applied well in domestic patients and can significantly improve MR.This sutdy has a good consistency with foreign studies,and the early results are satisfactory.