循環器ジャーナル66巻2号

2018年04月発行

特集 Structural Heart Diseaseインターベンション—「新しい」インターベンションのすべて Ⅱ．MitraClip

degenerative MRに対するMitraClipの適応と治療の実際

著者： 天木誠¹

所属機関： ¹国立循環器病研究センター心臓血管内科部門心不全科

ページ範囲：P.238 - P.245

Point
・僧帽弁閉鎖不全症は最も頻度の高い弁膜症疾患であるが，手術適応のある患者の半数近くが手術に至っていない．
・MitraClip治療の位置付けは，手術がハイリスクな器質性MR症例への治療であると確立されつつある．
・MitraClip治療の適応となる患者スクリーニングには，経胸壁心エコー検査が重要である．
・長期成績においては，初期にMR再発を認めなければ術後5年間は手術と同等の効果を得られる．

参考文献

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3) Bach DS, Awais M, Gurm HS, Kohnstamm S:Failure of guideline adherence for intervention in patients with severe mitral regurgitation. J Am Coll Cardiol 54:860-865, 2009

4) Mehta RH, Eagle KA, Coombs LP, et al:Influence of age on outcomes in patients undergoing mitral valve replacement. Ann Thorac Surg 74:1459-1467, 2002

5) Feldman T, Foster E, Glower DD, et al;EVERESTⅡ Investigators:Percutaneous repair or surgery for mitral regurgitation. N Engl J Med 364:1395-1406, 2011

6) Rudolph V, Knap M, Franzen O, et al:Echocardiographic and clinical outcomes of MitraClip therapy in patients not amenable to surgery. J Am Coll Cardiol 58:2190-2195, 2011

7) Whitlow PL, Feldman T, Pedersen WR, et al;EVERESTⅡ Investigators:Acute and 12-Month Results With Catheter-Based Mitral Valve Leaflet Repair The EVERESTⅡ（Endovascular Valve Edge-to-Edge Repair）High Risk Study. J Am Coll Cardiol 59:130-139, 2012

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9) Lim DS, Reynolds MR, Feldman T, et al:Improved functional status and quality of life in prohibitive surgical risk patients with degenerative mitral regurgitation after transcatheter mitral valve repair. J Am Coll Cardiol 64:182-192, 2014

10) Nishimura RA, Otto CM, Bonow RO, et al;ACC/AHA Task Force Members:2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 129:e521-643, 2014

11) Taylor J:ESC/EACTS Guidelines on the management of valvular heart disease. Eur Heart J 33:2371-2372, 2012

12) Mauri L, Foster E, Glower DD, et al;EVERESTⅡ Investigators:4-year results of a randomized controlled trial of percutaneous repair versus surgery for mitral regurgitation. J Am Coll Cardiol 62:317-328, 2013

13) Lubos E, Schlüter M, Vettorazzi E, et al:MitraClip therapy in surgical high-risk patients:identification of echocardiographic variables affecting acute procedural outcome. JACC Cardiovasc Interv 7:394-402, 2014

14) Cockburn J, Fragkou P, Hildick-Smith D:Development of mitral stenosis after single MitraClip insertion for severe mitral regurgitation. Catheter Cardiovasc Interv 83:297-302, 2014

Treatment in a Japanese Cohort. Circ J 81:1116-1122, 2017

16) Boerlage-van Dijk K, van Riel AC, de Bruin-Bon RH, et al:Mitral inflow patterns after MitraClip implantation at rest and during exercise. J Am Soc Echocardiogr 27:24-31. e1, 2014

17) Neuss M, Schau T, Isotani A, et al:Elevated Mitral Valve Pressure Gradient After MitraClip Implantation Deteriorates Long-Term Outcome in Patients With Severe Mitral Regurgitation and Severe Heart Failure. JACC Cardiovasc Interv 10:931-939, 2017

18) Gaemperli O, Biaggi P, Gugelmann R, et al:Real-time left ventricular pressure-volume loops during percutaneous mitral valve repair with the MitraClip system. Circulation 127:1018-1027, 2013

19) Argenziano M, Skipper E, Heimansohn D, et al;EVEREST Investigators:Surgical revision after percutaneous mitral repair with the MitraClip device. Ann Thorac Surg 89:72-80, 2010;discussion p80

20) Feldman T, Kar S, Elmariah S, et al;EVEREST Ⅱ Investigators:Randomized Comparison of Percutaneous Repair and Surgery for Mitral Regurgitation:5-Year Results of EVEREST Ⅱ. J Am Coll Cardiol 66:2844-2854, 2015