수술 고위험군 승모판 폐쇄부전증 치료를 위한 MitraClip: 안전성 유효성에 대한 문헌고찰
MitraClip for Mitral Regurgitation in Patients at High Surgical Risk: Review on Safety and Effectiveness
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Objectives: Mitral regurgitation (MR) is a valvular disorder common in aged society. Treatment option available to patients with moderate to severe MR is surgical management, in the form of mitral valve repair or replacement. However, patients with MR often have both cardiac and non-cardiac comorbidities. Transcatheter mitral valve repair (TMVR) using MitraClip is introduced for these pa- tients. The aim of this study is to review recent evidence of TMVR using the leaflet repair device. Methods: From August 2015 to March 2016, literature search was conducted with terms: MR, mi- tral valve surgery, MitraClip, percutaneous mitral valve repair, TMVR. Of total 422 publications, 26 publications including 2 systematic reviews were finally selected for detailed review. Results: Re- ported outcome for 30-day mortality was ranged from 0 to 8.0%, 1-year mortality range was 11.5 to 23.6%. 4-year outcome was reported with survival, 76.1%. Incidence rate of complications ranged from 12.6 to 22%. Effectiveness outcome was measured with New York Heart Association class and MR level improvement, of which all studies reported improvement post-procedure. Compared to mitral valve surgery, mortality and complications were lower for TMVR, and heart function im- provement was similar in both treatment in indirect comparison reviewed in systematic reviews. Conclusion: Clinical evidence of transcather mitral valve repair using MitraClip shows safe and effective outcome for patients with moderate to severe MR. The novel procedure can provide treat- ment option for patients at high surgical risk.
Abstract
Objectives: Mitral regurgitation (MR) is a valvular disorder common in aged society. Treatment option available to patients with moderate to severe MR is surgical management, in the form of mitral valve repair or replacement. However, patients with MR often have both cardiac and non-cardiac comorbidities. Transcatheter mitral valve repair (TMVR) using MitraClip is introduced for these pa- tients. The aim of this study is to review recent evidence of TMVR using the leaflet repair device. Methods: From August 2015 to March 2016, literature search was conducted with terms: MR, mi- tral valve surgery, MitraClip, percutaneous mitral valve repair, TMVR. Of total 422 publications, 26 publications including 2 systematic reviews were finally selected for detailed review. Results: Re- ported outcome for 30-day mortality was ranged from 0 to 8.0%, 1-year mortality range was 11.5 to 23.6%. 4-year outcome was reported with survival, 76.1%. Incidence rate of complications ranged from 12.6 to 22%. Effectiveness outcome was measured with New York Heart Association class and MR level improvement, of which all studies reported improvement post-procedure. Compared to mitral valve surgery, mortality and complications were lower for TMVR, and heart function im- provement was similar in both treatment in indirect comparison reviewed in systematic reviews. Conclusion: Clinical evidence of transcather mitral valve repair using MitraClip shows safe and effective outcome for patients with moderate to severe MR. The novel procedure can provide treat- ment option for patients at high surgical risk.
참고문헌 (31)
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