在5000名患有次次性心肌吐的患者中进行过导管边缘到边缘修复:COAPT批准后研究
Kashish Goel1, JoAnn Lindenfeld1, Raj Makkar2
1Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Journal of the American College of Cardiology
|September 20, 2023
概括
COAPT-PAS研究表明,MitraClip设备对于治疗现实世界心力衰竭患者的二次心肌吐是安全有效的. 结局是积极的,即使是不包括在先前试验中的患者.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 心脏衰竭管理的管理
背景情况:
- 在COAPT和MITRA-FR随机对照试验 (RCT) 之后,MitraClip设备对功能性 mitrale regurgitation 的实际有效性仍在争论中.
- 随机试验中的患者选择可能会限制对心力衰竭和二次心肌吐 (SMR) 的更广泛患者群体的概括性.
研究的目的:
- 评估MitraClip设备在SMR患者的大型现实世界队列中的安全性和有效性.
- 在更广泛的观察性研究中,评估子组的结果,反映COAPT和MITRA-FR RCT标准.
主要方法:
- COAPT-PAS (COAPT后审批研究) 是一项前性,单臂的观察性研究,涉及5000名用MitraClip治疗的SMR患者.
- 在2019年至2020年期间,从通管治疗 (TVT) 注册表中的406个美国中心收集了数据.
- 分析了整个队列和COAPT类和MITRA-FR类子组的一年结果.
主要成果:
- 在所有组中,高的MitraClip植入成功率 (97.7%),在1年内将 mitra regurgitation 持续减少到 ≤2+ .
- 与RCT相比,生活质量显著改善 (堪萨斯市心肌病问卷得分为+29至+33) 和心力衰竭住院减少.
- 与RCT参与者相比,COAPT-PAS患者的并发症和严重心力衰竭比RCT参与者更多,但却显示出可比或更好的临床事件率.
结论:
- 米特拉克利普系统在一个大规模的,当代的,现实世界的SMR人口中展示了强大的安全性和有效性.
- 结果支持在符合先前RCT标准的患者和通常被排除在此类试验之外的患者中使用MitraClip.
- 这项研究加强了通过导管对心膜修复在SMR心力衰竭患者中所具有的价值.
相关概念视频
Mitral Regurgitation III: Medical Management
18
Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
18
Mitral Stenosis III: Medical Management
12
Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
12
Mitral Stenosis II: Clinical features and Diagnostic Tests
22
Mitral stenosis is a heart condition in which the mitral valve, which allows blood to flow from the left atrium to the left ventricle, becomes narrowed or stenotic. This narrowing hinders blood flow and leads to clinical symptoms requiring specific medical evaluations and management strategies. The following overview outlines the clinical symptoms, assessments, diagnostic findings, prevention methods, and treatments for mitral stenosis.Clinical ManifestationsDyspnea (shortness of breath): This...
22
Mitral Regurgitation I: Introduction
15
Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
15
Mitral Regurgitation II: Clinical Features and Diagnostic Tests
22
Mitral regurgitation (MR) is a valvular heart disorder in which the mitral valve fails to close tightly, allowing blood to leak backward into the heart. Understanding the clinical manifestations, assessment, diagnostic findings, and medical management of MR is crucial to effectively managing affected patients.Clinical Manifestations of Mitral RegurgitationMitral regurgitation can be acute or chronic, each presenting differently and requiring different approaches:1. Acute Mitral...
22
Mitral Regurgitation IV: Nursing Management
41
Mitral regurgitation (MR) is a condition where the mitral valve does not close properly, leading to the backward flow of blood from the left ventricle into the left atrium during systole. This condition can arise from various causes, including rheumatic fever, infective endocarditis, or degenerative valve disease. Effective nursing management is crucial to optimizing patient outcomes and involves comprehensive assessment and targeted interventions.Comprehensive Patient AssessmentA detailed...
41


