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Impact of the Leaflet-to-Annulus Index on Residual Mitral Regurgitation in Patients Undergoing Edge-to-Edge Mitral Repair.
JACC: Cardiovascular Interventions ( IF 11.7 ) Pub Date : 2019-12-23 , DOI: 10.1016/j.jcin.2019.09.014 Noriaki Tabata 1 , Marcel Weber 2 , Atsushi Sugiura 2 , Can Öztürk 2 , Masanobu Ishii 3 , Kenichi Tsujita 3 , Georg Nickenig 2 , Jan-Malte Sinning 2
JACC: Cardiovascular Interventions ( IF 11.7 ) Pub Date : 2019-12-23 , DOI: 10.1016/j.jcin.2019.09.014 Noriaki Tabata 1 , Marcel Weber 2 , Atsushi Sugiura 2 , Can Öztürk 2 , Masanobu Ishii 3 , Kenichi Tsujita 3 , Georg Nickenig 2 , Jan-Malte Sinning 2
Affiliation
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OBJECTIVES
This study sought to investigate the clinical impact of leaflet-to-annulus mismatch on residual mitral regurgitation (MR) after percutaneous edge-to-edge mitral repair.
BACKGROUND
Annular dilation is a common feature of secondary MR, which requires concomitant annuloplasty in surgical mitral valve repair.
METHODS
Consecutive MR patients undergoing MitraClip (Abbott Vascular, Santa Clara, California) implantation in the Heart Center Bonn were enrolled. Residual MR was defined as a post-procedural MR ≥2+ and patients were stratified into 2 groups according to the residual MR. The study calculated the leaflet-to-annulus index (LAI) using pre-procedural 2- and 3-dimensional transesophageal echocardiography. All-cause death within a 1-year follow-up was examined.
RESULTS
Of 420 consecutive patients, 117 (27.9%) patients had residual MR (≥2+). Patients with residual MR had a significantly lower pre-procedural LAI than did those with MR <2+ (median 1.14 [interquartile range (IQR): 1.07 to 1.20] vs. 1.18 [IQR: 1.12 to 1.29]; p < 0.001). A multivariable analysis revealed that the LAI value was significantly associated with residual MR (odds ratio: 0.95; p < 0.001). After 1-year follow-up, patients with residual MR had a significantly worse prognosis than did patients with MR <2+ (estimated mortality rate 17.4% vs. 7.3%; log-rank p = 0.002), and the presence of residual MR was independently correlated with 1-year mortality (hazard ratio: 2.74; p = 0.004).
CONCLUSIONS
The LAI value is associated with residual MR after MitraClip implantation, which is independently correlated with 1-year mortality. This index might be a useful tool to identify patients with the need for concomitant annuloplasty before edge-to-edge repair.
中文翻译：
瓣环到瓣环指数对接受边缘对边缘二尖瓣修复的患者残余二尖瓣反流的影响。
目的本研究旨在探讨经皮边缘对边缘二尖瓣修复后小叶-瓣环不匹配对残余二尖瓣关闭不全（MR）的临床影响。背景技术环形扩张是继发性MR的共同特征，其在外科二尖瓣修复中需要伴随瓣环成形术。方法招募了连续的MR患者，该患者在波恩心脏中心接受了MitraClip（美国加利福尼亚州圣克拉拉市的Abbott Vascular公司）植入手术。残余MR被定义为术后MR≥2+，并且根据残余MR将患者分为两组。该研究使用术前2维和3维经食道超声心动图计算了小叶与瓣环指数（LAI）。在1年的随访中检查了全因死亡。结果连续420例患者中有117例（27。9％的患者残留MR（≥2+）。残留MR的患者术前LAI明显低于MR <2+的患者（中位数1.14 [四分位间距（IQR）：1.07至1.20]与1.18 [IQR：1.12至1.29]； p <0.001）。多变量分析显示，LAI值与残留MR显着相关（比值：0.95； p <0.001）。一年的随访后，残留MR患者的预后显着低于MR <2+的患者（估计死亡率为17.4％vs. 7.3％；对数秩p = 0.002），并且存在残留MR分别与1年死亡率相关（危险比：2.74； p = 0.004）。结论LAI值与MitraClip植入后的残留MR有关，这与1年死亡率独立相关。
更新日期：2019-12-16
中文翻译：
瓣环到瓣环指数对接受边缘对边缘二尖瓣修复的患者残余二尖瓣反流的影响。
目的本研究旨在探讨经皮边缘对边缘二尖瓣修复后小叶-瓣环不匹配对残余二尖瓣关闭不全（MR）的临床影响。背景技术环形扩张是继发性MR的共同特征，其在外科二尖瓣修复中需要伴随瓣环成形术。方法招募了连续的MR患者，该患者在波恩心脏中心接受了MitraClip（美国加利福尼亚州圣克拉拉市的Abbott Vascular公司）植入手术。残余MR被定义为术后MR≥2+，并且根据残余MR将患者分为两组。该研究使用术前2维和3维经食道超声心动图计算了小叶与瓣环指数（LAI）。在1年的随访中检查了全因死亡。结果连续420例患者中有117例（27。9％的患者残留MR（≥2+）。残留MR的患者术前LAI明显低于MR <2+的患者（中位数1.14 [四分位间距（IQR）：1.07至1.20]与1.18 [IQR：1.12至1.29]； p <0.001）。多变量分析显示，LAI值与残留MR显着相关（比值：0.95； p <0.001）。一年的随访后，残留MR患者的预后显着低于MR <2+的患者（估计死亡率为17.4％vs. 7.3％；对数秩p = 0.002），并且存在残留MR分别与1年死亡率相关（危险比：2.74； p = 0.004）。结论LAI值与MitraClip植入后的残留MR有关，这与1年死亡率独立相关。
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