D'Ancona G, Paranskaya L, Öner A, Kische S, Ince H
Heart Center, Rostock University Hospital, Rostock, Germany.
Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany.
Neth Heart J. 2017 Nov;25(11):605-608. doi: 10.1007/s12471-017-1028-6. Epub 2017 Aug 2.
Severe aortic valve stenosis (AVS) and mitral valve regurgitation (MVR) often coexist. Although a fully percutaneous treatment for the two conditions, by means of transcatheter aortic valve implantation (TAVI) followed by MitraClip, can be appealing in selected high-risk candidates, critical and strategical reasoning should be applied. In a 3-year period we have developed a single-centre experience of 14 patients who were managed with a staged percutaneous approach to treat severe AVS and MVR. The average interval from TAVI to MitraClip repair was 101 ± 12 days. Success for TAVI was 100% and 92.9% (13/14) for MitraClip. At late follow-up, 3 patients developed MVR 3+. Estimated 1‑year survival was 66.5%. Freedom from 1‑year endpoint (death, stroke, major bleeding, myocardial infarction, and cardiac re-hospitalisation) was 57.9%.In our view, a fully transcatheter approach for mitro-aortic pathology is feasible and should be performed only as a staged procedure in those patients that remain symptomatic, in spite of successful TAVI. It should be emphasised that although the periprocedural success rate is satisfactory, follow-up mortality and re-hospitalisation rates remain high, even at mid-term follow-up. This most probably results from the advanced clinical picture at time of referral for treatment.
严重主动脉瓣狭窄（AVS）和二尖瓣反流（MVR）常并存。尽管对于这两种病症，通过经导管主动脉瓣植入术（TAVI）然后进行二尖瓣夹合术（MitraClip）的完全经皮治疗，对于选定的高风险患者可能具有吸引力，但仍应进行关键和策略性的考量。在3年期间，我们积累了单中心14例患者的经验，这些患者采用分期经皮方法治疗严重AVS和MVR。从TAVI到二尖瓣夹合术修复的平均间隔时间为101±12天。TAVI成功率为100%，二尖瓣夹合术成功率为92.9%（13/14）。在晚期随访中，3例患者出现3+级MVR。估计1年生存率为66.5%。无1年终点事件（死亡、中风、大出血、心肌梗死和心脏再住院）的发生率为57.9%。我们认为，对于二尖瓣-主动脉病变，完全经导管方法是可行的，并且仅应在那些尽管TAVI成功但仍有症状的患者中作为分期手术进行。应该强调的是，尽管围手术期成功率令人满意，但即使在中期随访时，随访死亡率和再住院率仍然很高。这很可能是由于转诊治疗时的晚期临床表现所致。
