ミトラクリップの1年後の効果
Gorav Ailawadi1, D Scott Lim2, Michael J Mack3
1Division of Thoracic and Cardiovascular Surgery (G.A., I.L.K.), University of Virginia, Charlottesville.
Circulation
|December 28, 2018
まとめ
MitraClipの処置は,二次性ミトラリゲルチテーション (SMR) の患者に許容可能な安全性と症状の改善を提供します. このトランスキャテーターの修復はSMRの重症性を軽減し,陽性な心室改造を促進し,患者のアウトカムを改善します.
科学分野:
- 心臓病科
- 介入心臓科
- 医療機器
背景:
- 副次性ミトラル反発 (SMR) は,主弁疾患なしに発生し,しばしば左心房の変化や小葉片の結合によるものです.
- SMRの最適な治療法は不明であり,さらなる臨床試験が必要である.
- EVEREST II試験では,SMRに対するトランスキャテーターミトラル弁の修復が評価されました.
研究 の 目的:
- MitraClip 装置で治療された SMR 患者の1年経過を評価する.
- 外科リスク (高リスク対非高リスク) に基づいてアウトカムを階層化します.
主な方法:
- 616人のSMR患者 (高リスクおよび非高リスク) がMitraClipを受けた.
- 臨床,エコーカルディオグラフィ,機能的データは,基値と1年後に収集された.
- 結果はランダム化試験,高リスクレジストリ,継続的なアクセスレジストリで判断されました.
主要な成果:
- 1年後の死亡率は76. 8%で,MR ≤2+は84. 7%で,NYHAクラスI/ IIは83. 0%でした.
- 高リスクの患者は74. 1%の生存率を示し,高リスクでない患者は86. 4%の生存率を示した (P=0. 0175).
- 両群とも,比較可能な MR 減少と左心室容量の改善を達成し,高リスクでない患者はよりよい NYHA クラス改善 (P=0. 008) を示した.
- 高リスクの患者は,手術後の心不全の入院が有意に減少した.
結論:
- MitraClipはSMRに対して安全で有効です.
- 症状の軽減と 心室の改造につながります
- MitraClipは,手術のリスクが高い患者を含むSMR患者にとって有効な治療法です.
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