Key result
MitraClip implantation in patients with advanced heart failure and functional mitral regurgitation significantly reduced mitral regurgitation grade from 3.6 to 2.2 and improved NYHA functional class at 12 months.
Observational (n=30)
No
Absolute Event Rate: 2.2% vs 3.6%
p-value: p=0.001
May inform MitraClip selection in functional MR; leaves open mortality/HF hospitalization effects pending RCTs.
CĂl: ChronickĂŠ srdeÄnĂ selhĂĄnĂ se systolickou dysfunkcĂ levĂŠ komory (LK) je Äasto provĂĄzeno funkÄnĂ mitrĂĄlnĂ regurgitacĂ (MiR). Tu lze pĹi vhodnĂŠ morfologii chlopnÄ zmĂrnit implantacĂ MitraClipu. Z registrĹŻ je znĂĄmo pĹĂznivĂŠ ovlivnÄnĂ symptomĹŻ. SnĂĹženĂ mortality a hospitalizacĂ pro srdeÄnĂ selhĂĄnĂ je tĂŠmatem probĂhajĂcĂch randomizovanĂ˝ch studiĂ. CĂlem prĂĄce je popis naĹĄich zkuĹĄenostĂ s tĂmto zpĹŻsobem lĂŠÄby. Metodika a vĂ˝sledky: Od roku 2014 byl na naĹĄem pracoviĹĄti implantovĂĄn MitraClip celkem 30 pacientĹŻm s vĂ˝znamnou funkÄnĂ MiR a systolickou dysfunkcĂ LK (dilataÄnĂ kardiomyopatie 60 %, ischemickĂĄ choroba srdeÄnĂ 26 %, ejekÄnĂ frakce levĂŠ komory 29 ± 6 %, NYHA ≥ 3 84 %). VĂ˝kon byl technicky ĂşspÄĹĄnĂ˝ v 97 % pĹĂpadĹŻ, periprocedurĂĄlnĂ i 90dennĂ mortalita byla nulovĂĄ a vĂ˝skyt zĂĄvaĹžnĂ˝ch komplikacĂ minimĂĄlnĂ. Po 12 mÄsĂcĂch od implantace byly prokĂĄzĂĄny nĂĄsledujĂcĂ zmÄny (pĂĄrovĂ˝ t-test, p < 0,05): zlepĹĄenĂ ve funkÄnĂ tĹĂdÄ NYHA (2,8 ± 0,3 vs. 2,3 ± 0,2), v kvalitÄ Ĺživota dle KansaskĂŠho a MinnesotskĂŠho dotaznĂku (Kansas City Cardiomyopathy Ques- tionnaire [KCCQ] overall summary 58 ± 27 vs. 69 ± 23, skĂłre Minnesota Living With Heart Failure Questionnaire [MLHFQ] 36 ± 23 vs. 26 ± 13), zvýťenĂ systolickĂŠho (113 ± 15 vs. 119 ± 12 mm Hg) i diastolickĂŠho (68 ± 11 vs. 75 ± 9 mm Hg) krevnĂho tlaku, vzestup hemoglobinu (130 ± 21 vs. 138 ± 17 g/l), redukce MiR (3,6 ± 0,4 vs. 2,2 ± 0,6), pokles hmoty levĂŠ komory (139 ± 35 vs. 129 ± 29 g/m2) a trend ke zlepĹĄenĂ funkce pravĂŠ komory. RoÄnĂ mortalita byla 10 %, hospitalizacĂ pro srdeÄnĂ selhĂĄnĂ 30 % a k srdeÄnĂ transplantaci byli indikovĂĄni dva pacienti. ZĂĄvÄr: NaĹĄe zkuĹĄenosti ukazujĂ, Ĺže implantace MitraClipu zlepĹĄuje u vybranĂ˝ch pacientĹŻ se srdeÄnĂm selhĂĄnĂm se systolickou dysfunkcĂ LK a funkÄnĂ MiR jak symptomy, tak i kvalitu Ĺživota. Tato metoda rozĹĄiĹuje moĹžnosti lĂŠÄby pacientĹŻ, kteĹĂ pro charakter chlopennĂ vady a dysfunkci LK nemohou podstoupit kardiochirurgickou korekci vady.
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Benák et al. (2018) conducted an observational in Functional mitral regurgitation and advanced heart failure (n=30). MitraClip vs. Baseline (pre-implantation) was evaluated on Mitral regurgitation grade at 12 months (p=0.001). MitraClip implantation in patients with advanced heart failure and functional mitral regurgitation significantly reduced mitral regurgitation grade from 3.6 to 2.2 and improved NYHA functional class at 12 months.
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