International Journal of Cardiology ( IF 3.2 ) Pub Date : 2021-11-23 , DOI: 10.1016/j.ijcard.2021.11.027 Antonio Popolo Rubbio 1 , Luca Testa 1 , Carmelo Grasso 2 , Antonio Sisinni 1 , Maurizio Tusa 1 , Eustachio Agricola 3 , Federico De Marco 1 , Anna Sonia Petronio 4 , Matteo Montorfano 3 , Rodolfo Citro 5 , Marianna Adamo 6 , Antonio Mangieri 7 , Matteo Casenghi 1 , Anna Lisa Milici 2 , Laura Stazzoni 4 , Antonio Colombo 7 , Corrado Tamburino 2 , Francesco Bedogni 1
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Background
A-FMR is considered a specific sub-type of secondary MR in patients with atrial fibrillation (AF) and preserved left ventricle ejection fraction (LVEF). Aim of the study was to investigate the acute and mid-term outcomes of transcatheter edge-to-edge mitral valve repair (TMVr) with the MitraClip in atrial functional mitral regurgitation (A-FMR).
Methods
The study included patients with A-FMR and concomitant AF who underwent to the MitraClip at 7 Italian Centers. Aim of the study was to assess the safety, efficacy and mid-term cardiovascular outcomes.
Results
After reviewing 1153 patients with FMR treated with TMVr from 2009 to 2021, 87 patients (median age 81 years, 61% female) with A-FMR were identified. Technical success was achieved in 97%, 30-day device success in 83% and 30-day procedural success in 80%. All-cause death at 30-day was 5%. Estimated two-year freedom from all-cause death and cardiac death was 60% and 77%, respectively, whereas freedom from all-cause death/heart failure hospitalization was 55%. Residual MR ≤ 2+ was encountered in 89% (n = 47/53) and improvement in NYHA class I/II in 79% (n = 48/61). Post-procedural MR ≥ 2+ (HR 5.400, CI 1.371–21.268) and inter-commissural annular diameter ≥ 35 mm (HR 4.159, CI 1.057–16.363) were independent predictors of all-cause death/heart failure hospitalization during the follow-up. Positive reverse remodeling of left atrium and mitral annular dimensions occurred after TMVr during the follow-up.
Conclusions
MitraClip resulted to be a safe and effective option to treat A-FMR in elderly patients.
中文翻译：
心房功能性二尖瓣反流中的经导管边缘到边缘二尖瓣修复：来自多中心 MITRA-TUNE 登记的见解
背景
A-FMR 被认为是心房颤动 (AF) 和保留左心室射血分数 (LVEF) 患者的继发性 MR 的特定亚型。该研究的目的是研究使用 MitraClip 进行经导管边缘对边缘二尖瓣修复 (TMVr) 在心房功能性二尖瓣关闭不全 (A-FMR) 中的急性和中期结果。
方法
该研究包括在 7 个意大利中心接受 MitraClip 的 A-FMR 和伴随 AF 的患者。该研究的目的是评估安全性、有效性和中期心血管结局。
结果
在回顾了 2009 年至 2021 年接受 TMVr 治疗的 1153 名 FMR 患者后，确定了 87 名 A-FMR 患者（中位年龄 81 岁，61% 女性）。技术成功率为 97%，30 天设备成功率为 83%，30 天程序成功率为 80%。30 天时的全因死亡率为 5%。预计两年内免于全因死亡和心源性死亡的比例分别为 60% 和 77%，而免于全因死亡/心力衰竭住院的比例为 55%。89% (n = 47/53) 的残留 MR ≤ 2+ 和 79% (n = 48/61) 的 NYHA I/II 级改善。术后 MR ≥ 2+ (HR 5.400, CI 1.371–21.268) 和连合环直径≥ 35 mm (HR 4.159, CI 1.057–16.363) 是随访期间全因死亡/心力衰竭住院的独立预测因子向上。
结论
MitraClip 成为治疗老年患者 A-FMR 的安全有效的选择。
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