トランスキャセターミトラルバルブ修復 退行性ミトラル吐
Raj R Makkar1, Joanna Chikwe1, Tarun Chakravarty1
1Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
JAMA
|May 23, 2023
まとめ
退行性ミトラル反発 (MR) に対するトランスキャテーターミトラル弁の修復は安全で有効で,成功率は88. 9%です. わずかな残留MRと低いミトラルグラデントで死亡率を下げるなど,最適な結果が見られた.
科学分野:
- 心血管医学
- 介入心臓科
- 医療機器
背景:
- 退行性ミトラル嘔吐 (MR) は患者の生活の質と死亡率に大きな影響を及ぼします.
- 変性 MR のトランスキャセター端から端までのミトラル弁修復 (TEER) に関する実際のデータは限られています.
- トランスキャテーターによるミトラル弁の修復は,一部の患者にとって外科的な修復に代わるより侵襲的な治療法です.
研究 の 目的:
- 変性性 MR のトランスキャセター弁修復の現実的な結果を評価する.
- 大量の患者でTEERの安全性と有効性を評価する.
- TEERによる成功の予測要因を特定する.
主な方法:
- Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry (2014-2022) のデータを用いてコホート研究が行われました.
- MitraClip装置でエッジツーエッジのトランスキャテーテル弁修復を施した連続した患者を退行性MRのために分析した.
- MRの成功は,平均ミトラグラデント<10mmHgの中等またはより少ない残留MRと定義された. 臨床結果は,残留MRの重症度とミトラル弁のグラデーションに基づいて評価された.
主要な成果:
- 中度重症または重症退行性MR患者の合計は19088人 (平均年齢82歳; 48%が女性) であった.
- 30日間の死亡率 (2. 7%),脳卒中 (1. 2%) および再介入率 (0. 97%) が低かった.
- 1年の死亡率 (14. 0% 対 26. 7%) と心不全再入院率 (8. 4% 対 16. 9%) が著しく低下した. 軽度または少量の残留MRと5mmHgのグラデーションを有する患者は死亡率が最も低い (11. 4%) であった.
結論:
- 退行性MRに対する トランスキャテーターミトラル弁の修復は,現実の世界での安全で効果的な手順です.
- 改善された臨床結果と相関する高いMR成功率を達成しました.
- 軽度またはより少ない残留MRと低ミトラグラデント (< 5 mm Hg) の達成は,最良の生存率と関連しています.
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