CHU Lille, Heart Valve Clinic, Lille, France.
EuroIntervention. 2019 Dec 6;15(11):e983-e989. doi: 10.4244/EIJ-D-19-00444.
Transcatheter mitral valve replacement (TMVR) is a promising therapeutic solution to treat high-risk patients with severe mitral regurgitation (MR) contraindicated to surgery. Optimal selection of patients who will benefit from the procedure is of paramount importance. We aimed to investigate factors associated with TMVR screening.
From November 2016 to July 2018, we examined conditions associated with TMVR screening success in patients referred to the two French heart valve clinics with the greatest TMVR experience. Among a total of 40 consecutively screened patients, 16 (40%) were selected for TMVR (8 Twelve Intrepid, 7 Tendyne and 1 HighLife), while 24 patients (60%) were refused for TMVR mainly because of a too large mitral annulus (MA) (n=15, 62% of those refused), or too small anatomy and risk of neo-left ventricular outflow tract (LVOT) obstruction (n=6, 25% of those refused). Patients with suitable anatomy for TMVR were more often male and more frequently suffered from secondary MR (p=0.01) associated with previous myocardial infarction and presented a commissure-to-commissure diameter less than 39 mm (AUC=0.72, p=0.0085) and LVESD greater than 32 mm (AUC=0.83, p<0.0001) on transthoracic echocardiography, and an MA area less than 17.6 cm² (AUC=0.95, p<0.0001) and anteroposterior diameter greater than 41.6 mm (AUC=0.87, p<0.001) on CT scan.
Despite several prostheses being available, most patients referred to heart valve clinics who are good candidates with regard to their clinical profile cannot have TMVR because of mismatch between their anatomy and prosthesis characteristics. Our findings suggest the need to develop new prostheses adapted to larger mitral annuli but with a lower impact on the LVOT.
经导管二尖瓣置换术（TMVR）是一种有前途的治疗方法，可用于治疗手术禁忌的高危重度二尖瓣反流（MR）患者。选择将从该手术中获益的患者至关重要。本研究旨在探讨与 TMVR 筛查相关的因素。
2016 年 11 月至 2018 年 7 月，我们检查了法国两家具有丰富 TMVR 经验的心脏瓣膜诊所转诊患者的 TMVR 筛查成功相关条件。在总共 40 例连续筛查的患者中，有 16 例（40%）被选中进行 TMVR（8 例 Twelve Intrepid，7 例 Tendyne 和 1 例 HighLife），而 24 例（60%）因二尖瓣环（MA）过大（拒绝 TMVR 的患者中有 15 例，占 62%）或解剖结构过小且存在新左心室流出道（LVOT）梗阻风险（拒绝 TMVR 的患者中有 6 例，占 25%）而被拒绝。适合 TMVR 解剖结构的患者更常为男性，并且更常患有继发性 MR（p=0.01），与既往心肌梗死相关，其瓣环交界对交界直径小于 39mm（AUC=0.72，p=0.0085），LVESD 大于 32mm（AUC=0.83，p<0.0001），经胸超声心动图检查 MA 面积小于 17.6cm²（AUC=0.95，p<0.0001），CT 扫描的前后直径大于 41.6mm（AUC=0.87，p<0.001）。
尽管有几种假体可供选择，但大多数因解剖结构与假体特征不匹配而被认为是合适的患者无法进行 TMVR。我们的研究结果表明需要开发新的假体，以适应更大的 MA，但对 LVOT 的影响较低。
