Fiocco Alessandro, Nadali Matteo, Speziali Giovanni, Colli Andrea
Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
Division of Cardiac Surgery, St. Louis University, Saint Louis, MO, United States.
Front Cardiovasc Med. 2019 Sep 4;6:128. doi: 10.3389/fcvm.2019.00128. eCollection 2019.
Transcatheter Mitral Valve Repair (TMVRe) technologies constitute a rapidly expanding field, and have the potential of being adopted as a valuable alternative to surgery in selected patients. TMVRe devices can be distinguished depending on the targeted part of the Mitral Valve (MV) apparatus. Standard classification includes leaflet repair, direct/indirect annuloplasty, chordal repair, and ventricular/chamber remodeling devices. We present the current device situation on chordal repair technologies. Nowadays, transapical off-pump beating heart chordal implantation procedure has become a safe and reproducible option for Degenerative Mitral Regurgitation (DMR). Besides the truly minimally-invasiveness of the procedure, another unique advantage offered by a beating-heart chordal implantation is the real-time assessment of chordal length adjustment during heart cycle with a normally filled left ventricle. Currently, one system is commercially available in Europe, the NeoChord DS 1000 (NeoChord, Inc., St. Louis Park, MN) and the Harpoon TDS-5 (Edwards Lifesciences, Irvine, CA) should become available soon. There is also a diffuse and strong interest to move from a transapical procedure toward a fully transcatheter (transfemoral and transeptal) procedure as shown by the increased number of preclinical programs under development. Interestingly, to achieve outcomes that equate to those of open surgery in DMR, transcatheter therapies will need to follow rigid indications due to strict patient selection criteria for each device, or adopt multiple techniques in a single repair procedure for complex MV disease. Continuous analysis of current clinical results together with future dedicated trial will be of extreme importance to foster the new and upcoming field of transcatheter MV therapy technology development.
经导管二尖瓣修复术（TMVRe）技术构成了一个迅速发展的领域，并且有潜力在特定患者中作为手术的一种有价值替代方法被采用。TMVRe设备可根据二尖瓣（MV）装置的目标部位进行区分。标准分类包括瓣叶修复、直接/间接瓣环成形术、腱索修复以及心室/腔室重塑装置。我们介绍腱索修复技术的当前设备情况。如今，经心尖非体外循环心脏跳动下腱索植入术已成为退行性二尖瓣反流（DMR）的一种安全且可重复的选择。除了该手术真正的微创性之外，心脏跳动下腱索植入术的另一个独特优势是在左心室正常充盈的心动周期中实时评估腱索长度调整。目前，欧洲有一种系统已商业化，即NeoChord DS 1000（NeoChord公司，明尼苏达州圣路易斯公园），而Harpoon TDS - 5（爱德华兹生命科学公司，加利福尼亚州欧文）也将很快上市。从经心尖手术转向完全经导管（经股动脉和经房间隔）手术也存在广泛且浓厚的兴趣，这从正在开展的临床前项目数量增加可以看出。有趣的是，为了在DMR中实现等同于开放手术的结果，由于每种设备都有严格的患者选择标准，经导管治疗将需要遵循严格的适应症，或者在单一修复手术中采用多种技术来治疗复杂的MV疾病。持续分析当前临床结果以及未来专门的试验对于推动经导管MV治疗技术发展这个新的且即将兴起的领域极为重要。
