Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, 46 Henri Huchard, Paris, France.
Department of Anesthesiology, Bichat Claude Bernard Hospital-Paris VII University, 46 rue Henri Huchard, Paris, France.
Eur Heart J. 2018 Jul 21;39(28):2679-2689. doi: 10.1093/eurheartj/ehy271.
We analysed the early and long-term clinical and haemodynamic outcomes of balloon-expandable transcatheter mitral valve implantation (TMVI) in an experienced centre.
All patients undergoing TMVI from July 2010 to July 2017 in our centre were prospectively included. Indication for TMVI relied on the judgement of the local heart team. Patients were followed at 1 month, 1 year, and yearly thereafter. A total of 91 patients underwent TMVI. The median age was 73 (57-81) years and 70% of patients were women. Patients were at high risk for surgery with a median EuroSCORE II of 9.6 (4.0-14.6) %. Indication for TMVI was bioprosthesis failure (valve-in-valve) in 37.3%, annuloplasty failure (valve-in-ring) in 33.0%, and severe mitral annulus calcification (MAC) in 29.7%. The transseptal approach was used in 92.3% of patients and balloon-expandable valves were used in all patients. Technical success was achieved in 84.6% of patients, one patient died during the procedure and haemodynamically significant left ventricular outflow tract obstruction occurred in three patients (3.3%). At 30 days, 7.7% of patients had died, without significant differences between groups, and a major stroke occurred in 2.2% of patients. The cumulative rates of all-cause mortality at 1-year and 2-year follow-up were 21.0% [95% confidence interval (CI) 9.9-38.8] and 35.7% (95% CI 19.2-56.5), respectively, with a higher late mortality in patients with MAC. The 2-year rates of re-intervention and valve thrombosis were 8.8% and 14.4%, respectively. At 6 months to 1 year, 68.9% of patients were in New York Heart Association Class I or II, and 90.7% of patients had mild or less mitral regurgitation. The mean transmitral gradient decreased from 9.3 ± 3.9 mmHg at baseline to 6.0 ± 2.3 mmHg at discharge (P < 0.001) without changes at 6-month to 1-year follow-up.
Transcatheter mitral valve implantation using balloon-expandable valves in selected patients with bioprosthesis or annuloplasty failure or severe MAC was associated with a low rate of peri-procedural complications and acceptable long-term outcomes.
我们分析了在经验丰富的中心进行球囊扩张经导管二尖瓣置换术（TMVI）的早期和长期临床及血流动力学结果。
我们前瞻性纳入了 2010 年 7 月至 2017 年 7 月期间在我院接受 TMVI 的所有患者。TMVI 的适应证取决于当地心脏团队的判断。患者在术后 1 个月、1 年及此后每年进行随访。共有 91 例患者接受了 TMVI。患者的中位年龄为 73（57-81）岁，70%为女性。患者因手术风险高而接受 TMVI，中位 EuroSCORE II 为 9.6（4.0-14.6）%。TMVI 的适应证为生物瓣衰败（瓣中瓣）37.3%、瓣环成形术失败（瓣中环）33.0%和严重二尖瓣环钙化（MAC）29.7%。92.3%的患者采用了经房间隔途径，所有患者均采用球囊扩张瓣。84.6%的患者技术成功，1 例患者术中死亡，3 例（3.3%）出现有临床意义的左心室流出道梗阻。30 天时，7.7%的患者死亡，各组间无显著差异，2.2%的患者发生主要卒中。1 年和 2 年随访的全因死亡率累积率分别为 21.0%（95%置信区间 9.9-38.8）和 35.7%（95%置信区间 19.2-56.5），MAC 患者的晚期死亡率较高。2 年再介入和瓣膜血栓形成率分别为 8.8%和 14.4%。6 个月至 1 年时，68.9%的患者纽约心功能分级为 I 级或 II 级，90.7%的患者二尖瓣反流为轻度或以下。跨二尖瓣梯度从基线时的 9.3±3.9mmHg 降低至出院时的 6.0±2.3mmHg（P<0.001），6 个月至 1 年随访时无变化。
在生物瓣或瓣环成形术失败或严重 MAC 的患者中，采用球囊扩张瓣进行经导管二尖瓣置换术与围手术期并发症发生率低和可接受的长期结果相关。
