循環器ジャーナル68巻1号

2020年01月発行

特集 U40世代が描く心不全診療の現状と未来—基礎研究を識り，臨床を素心深考する Ⅰ．心筋症

弁膜症性心筋症：MR→MitraClip後の予後規定因子はありますか？—MitraClipの適応と予後規定因子

著者： 金子英弘¹

所属機関： ¹東京大学医学部附属病院循環器内科

ページ範囲：P.48 - P.55

Point
・経皮的僧帽弁形成術デバイスであるMitraClipは外科治療が困難な僧帽弁閉鎖不全治療としてだけでなく，僧帽弁閉鎖不全症を合併した心不全治療としても期待される．
・MitraClip治療の成功のカギはMtiraClipに適しているかを経食道心エコーを用いて僧帽弁複合体の解剖学的評価を行うことである．
・COAPT試験によってMitraClipは機能性僧帽弁閉鎖不全症合併心不全に対して初めてpositiveな結果が証明された治療となった．

参考文献

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

2) Feldman T, Kar S, Rinaldi M, et al:Percutaneous mitral repair with the MitraClip system:safety and midterm durability in the initial EVEREST（Endovascular Valve Edge-to-Edge REpair Study）cohort. J Am Coll Cardiol 54:686-694, 2009

3) Boekstegers P, Hausleiter J, Baldus S, et al:Percutaneous interventional mitral regurgitation treatment using the Mitra-Clip system. Clin Res Cardiol 103:85-96, 2014

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

5) Maisano F, Franzen O, Baldus S, et al:Percutaneous mitral valve interventions in the real world:early and 1-year results from the ACCESS-EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe. J Am Coll Cardiol 62:1052-1061, 2013

6) Eggebrecht H, Schelle S, Puls M, et al:Risk and outcomes of complications during and after MitraClip implantation:Experience in 828 patients from the German TRAnscatheter mitral valve interventions（TRAMI）registry. Catheter Cardiovasc Interv 86:728-735, 2015

7) Obadia JF, Messika-Zeitoun D, Leurent G, et al:Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation. N Engl J Med 379:2297-2306, 2018

8) Stone GW, Lindenfeld J, Abraham WT, et al:Transcatheter Mitral-Valve Repair in Patients with Heart Failure. N Engl J Med 379:2307-2318, 2018

9) Kaneko H, Kitamura M, Neuss M, et al:MitraClip in Patients With Mitral Regurgitation and Left Ventricular Ejection Fraction ＜30%-Potential Implications for the Treatment of Patients in Japan. Circ J 82:2672-2675, 2018

10) Kaneko H, Neuss M, Schau T, et al:Impact of left ventricular systolic dysfunction on the outcomes of percutaneous edge-to-edge mitral valve repair using MitraClip. Heart Vessels 31:1988-1996, 2016

11) Lesevic H, Sonne C, Braun D, et al:Acute and Midterm Outcome After MitraClip Therapy in Patients With Severe Mitral Regurgitation and Left Ventricular Dysfunction. Am J Cardiol 116:749-756, 2015

12) Kaneko H, Neuss M, Weissenborn J, et al:Impact of residual mitral regurgitation after MitraClip implantation. Int J Cardiol 227:813-819, 2017

13) 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

14) Neuss M, Schau T, Schoepp M, et al:Patient selection criteria and midterm clinical outcome for MitraClip therapy in patients with severe mitral regurgitation and severe congestive heart failure. Eur J Heart Fail 15:786-795, 2013

15) Kaneko H, Neuss M, Schau T, et al:Interaction between renal function and percutaneous edge-to-edge mitral valve repair using MitraClip. J Cardiol 69:476-482, 2017

16) Kaneko H, Neuss M, Okamoto M, et al:Impact of Preprocedural Anemia on Outcomes of Patients With Mitral Regurgitation Who Underwent MitraClip Implantation. Am J Cardiol 122:859-865, 2018

17) Matsumoto T, Nakamura M, Yeow WL, et al:Impact of pulmonary hypertension on outcomes in patients with functional mitral regurgitation undergoing percutaneous edge-to-edge repair. Am J Cardiol 114:1735-1739, 2014

18) Ohno Y, Attizzani GF, Capodanno D, et al:Association of tricuspid regurgitation with clinical and echocardiographic outcomes after percutaneous mitral valve repair with the MitraClip System:30-day and 12-month follow-up from the GRASP Registry. Eur Heart J Cardiovasc Imaging 15:1246-1255, 2014

19) Kaneko H, Neuss M, Weissenborn J, et al:Prognostic Significance of Right Ventricular Dysfunction in Patients With Functional Mitral Regurgitation Undergoing MitraClip. Am J Cardiol 118:1717-1722, 2016

20) Auricchio A, Schillinger W, Meyer S, et al:Correction of mitral regurgitation in nonresponders to cardiac resynchronization therapy by MitraClip improves symptoms and promotes reverse remodeling. J Am Coll Cardiol 58:2183-2189, 2011

therapy in patients with end-stage systolic heart failure. Eur J Heart Fail 13:569-576, 2011

22) Rudolph V, Huntgeburth M, von Bardeleben RS, et al:Clinical outcome of critically ill, not fully recompensated, patients undergoing MitraClip therapy. Eur J Heart Fail 16:1223-1239, 2014