Dvir Danny, Cheung Anson, Boone Robert, Leipsic Jonathon, Blanke Philipp, Perlman Gidon, Moss Robert, Toma Mustafa, Stub Dion, Banai Shmuel, Webb John
St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
EuroIntervention. 2016 Jun 12;12(2):e244-9. doi: 10.4244/EIJV12I2A38.
Transcatheter mitral valve implantation (TMVI) is a novel approach that may enable a less invasive effective reduction of mitral regurgitation (MR). A limitation of the MitraClip is that definitive implantation of a clip precludes future therapy with TMVI. The purpose of this paper is to describe contemporary treatment considerations in patients with mitral valve regurgitation.
In this report we describe an attempted MitraClip implantation which resulted in no reduction of MR severity. There was a consensus that additional clips would probably not be effective. MitraClip implantation was therefore abandoned and the clip was removed, allowing subsequent successful TMVI with the Tiara™ system three weeks later. Echocardiography revealed secure seating of the prosthesis with good mitral valve function, trivial paravalvular leakage and transvalvular gradient of 3 mmHg. The patient recovered rapidly and was discharged four days post implant.
The clinical approach towards high-risk patients with significant MR may change in the next few years. In selected patients, in whom an initial attempt with MitraClip implantation results in only limited efficacy, the clip may be retrieved during the index procedure to allow subsequent TMVI.
经导管二尖瓣植入术（TMVI）是一种新方法，可能实现以微创方式有效减轻二尖瓣反流（MR）。MitraClip的一个局限性在于夹子的最终植入会排除未来进行TMVI治疗的可能性。本文旨在描述二尖瓣反流患者当前的治疗考量。
在本报告中，我们描述了一次MitraClip植入尝试，结果并未减轻MR的严重程度。大家一致认为额外的夹子可能也无效。因此放弃了MitraClip植入并移除了夹子，三周后使用Tiara™系统成功进行了TMVI。超声心动图显示人工瓣膜固定良好，二尖瓣功能正常，瓣周微量反流，跨瓣压差为3 mmHg。患者恢复迅速，植入后四天出院。
未来几年，针对有严重MR的高危患者的临床治疗方法可能会改变。在部分患者中，如果首次尝试植入MitraClip仅产生有限疗效，可在初次手术过程中取出夹子，以便后续进行TMVI。
