Key result
MitraClip implantation reduces mortality and heart failure hospitalizations in selected patients with severe secondary mitral regurgitation, particularly those with disproportionate mitral regurgitation.
Why the study?
Convincing evidence of improved survival after mitral valve surgery for secondary mitral regurgitation has been lacking, prompting evaluation of less invasive transcatheter techniques like MitraClip.
Does MitraClip improve clinical outcomes and quality of life in patients with significant mitral regurgitation and heart failure?
Does MitraClip improve clinical outcomes and quality of life in patients with significant mitral regurgitation and heart failure?
MitraClip is an effective treatment option that improves symptoms and quality of life in highly selected patients with significant secondary mitral regurgitation and heart failure, particularly those with disproportionate mitral regurgitation.
LĂŠÄba symptomatickĂŠ primĂĄrnĂ mitrĂĄlnĂ regurgitace zohledĹuje symptomy, dilataci a funkci levĂŠ komory, fibrilacĂ sĂnĂ, zĂĄvaĹžnost plicnĂ hypertenze a velikost levĂŠ sĂnÄ, s preferencĂ zĂĄchovnĂŠ plastiky mitrĂĄlnĂ chlopnÄ, pĹĂpadnÄ nĂĄhrady mitrĂĄlnĂ chlopnÄ u nepĹĂznivĂŠ morfologie. U sekundĂĄrnĂ mitrĂĄlnĂ regurgitace nemĂĄme pĹesvÄdÄivĂŠ dĹŻkazy o zlepĹĄenĂ pĹeĹžitĂ po operaci mitrĂĄlnĂ chlopnÄ. V poslednĂch letech byla klinicky zkouĹĄena Ĺada mĂŠnÄ invazivnĂch katetrizaÄnĂch technik (jejichĹž pĹehled je struÄnÄ uveden), ale pouze implantace MitraClipu (metoda, kterĂĄ vytvĂĄĹĂ spojenĂ mezi pĹednĂm a zadnĂm cĂpem mitrĂĄlnĂ chlopnÄ) zĂskala dostateÄnou klinickou evidenci. DvÄ randomizovanĂŠ klinickĂŠ studie u pacientĹŻ se srdeÄnĂm selhĂĄnĂm a vĂ˝znamnou sekundĂĄrnĂ mitrĂĄlnĂ regurgitacĂ srovnĂĄvaly katetrizaÄnĂ intervenci na mitrĂĄlnĂ chlopni pomocĂ MitraClipu s optimĂĄlnĂ medikamentĂłznĂ lĂŠÄbou. Ve studii MITRA-FR se primĂĄrnĂ sledovanĂ˝ ukazatel neliĹĄil (ĂşmrtĂ na vĹĄechny pĹĂÄiny nebo hospitalizace spojenĂĄ se srdeÄnĂm selhĂĄnĂm v 1 roce: 54,6 % oproti 51,3 %, p =, 53). Naopak ve studii COAPT bylo dosaĹženo vĂ˝znamnĂŠho snĂĹženĂ jak mortality (29,1 % vs. 46,1%, p < 0,001), tak hospitalizacĂ pro srdeÄnĂ selhĂĄnĂ (35,8 % vs. 67,9 % na pacientskĂ˝ rok, p < 0,001) ve skupinÄ MitraClip. StupeĹ mitrĂĄlnĂ regurgitace v kontextu dilatace levĂŠ komory rozliĹĄuje tzv. „proporcionĂĄlnĂ“ a „disproporcionĂĄlnĂ“ mitrĂĄlnĂ regurgitaci a mĹŻĹže pomoci pĹi vĂ˝bÄru optimĂĄlnĂ lĂŠÄby.
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Želı́zko et al. (2019) conducted a review in Mitral regurgitation. MitraClip vs. Optimal medical therapy or surgery was evaluated. MitraClip implantation reduces mortality and heart failure hospitalizations in selected patients with severe secondary mitral regurgitation, particularly those with disproportionate mitral regurgitation.
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