Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, MN (M.G., M.E., A.K.C., G.S., D.H., C.R.).
Duke Clinical Research Institute, Durham, NC (S.V., Q.X.).
Circ Cardiovasc Interv. 2020 Mar;13(3):e008425. doi: 10.1161/CIRCINTERVENTIONS.119.008425. Epub 2020 Mar 6.
Transcatheter mitral valve replacement using aortic transcatheter heart valves has recently become an alternative for patients with degenerated mitral bioprostheses, failed surgical repairs with annuloplasty rings or severe mitral annular calcification who are poor surgical candidates. Outcomes of these procedures are collected in the Society of Thoracic Surgeons/American College of Cardiology/Transcatheter Valve Therapy Registry. A comprehensive analysis of mitral valve-in-valve (MViV), mitral valve-in-ring (MViR), and valve-in-mitral annular calcification (ViMAC) outcomes has not been performed. We sought to evaluate short-term outcomes of early experience with MViV, MViR, and ViMAC in the United States.
Retrospective analysis of data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.
Nine hundred three high-risk patients (median Society of Thoracic Surgeons score 10%) underwent MViV (n=680), MViR (n=123), or ViMAC (n=100) between March 2013 and June 2017 at 172 hospitals. Median age was 75 years, 59.2% female. Technical and procedural success were higher in MViV. Left ventricular outflow tract obstruction occurred more frequently with ViMAC (ViMAC=10%, MViR=4.9%, MViV=0.7%; <0.001). In-hospital mortality (MViV=6.3%, MViR=9%, ViMAC=18%; =0.004) and 30-day mortality (MViV=8.1%, MViR=11.5%, ViMAC=21.8%; =0.003) were higher in ViMAC. At 30-day follow-up, median mean mitral valve gradient was 7 mm Hg, most patients (96.7%) had mitral regurgitation grade ≤1 (+) and were in New York Heart Association class I to II (81.7%).
MViV using aortic balloon-expandable transcatheter heart valves is associated with a low complication rate, a 30-day mortality lower than predicted by the Society of Thoracic Surgeons score, and superior short-term outcomes than MViR and ViMAC. At 30 days, patients in all groups experienced improvement of symptoms, and valve performance remained stable. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02245763.
使用经导管主动脉瓣置换治疗退行性二尖瓣生物瓣、瓣环成形环修复失败伴严重二尖瓣瓣环钙化且手术风险高的患者，已成为一种替代方法。这些手术的结果被收集在胸外科医师协会/美国心脏病学会/经导管瓣膜治疗注册中心。尚未对二尖瓣瓣中瓣（MViV）、二尖瓣瓣环内瓣（MViR）和瓣环内钙化（ViMAC）的结果进行综合分析。我们旨在评估美国早期经导管二尖瓣瓣中瓣、瓣环内瓣和瓣环内钙化治疗的短期结果。
回顾性分析胸外科医师协会/美国心脏病学会经导管瓣膜治疗注册中心的数据。
2013 年 3 月至 2017 年 6 月，172 家医院的 903 名高危患者（中位胸外科医师协会评分 10%）接受了 MViV（n=680）、MViR（n=123）或 ViMAC（n=100）治疗。中位年龄为 75 岁，59.2%为女性。MViV 组的技术和手术成功率更高。ViMAC 组更常发生左心室流出道梗阻（ViMAC=10%，MViR=4.9%，MViV=0.7%；<0.001）。住院死亡率（MViV=6.3%，MViR=9%，ViMAC=18%；=0.004）和 30 天死亡率（MViV=8.1%，MViR=11.5%，ViMAC=21.8%；=0.003）在 ViMAC 组更高。30 天随访时，中位平均二尖瓣瓣间梯度为 7mmHg，大多数患者（96.7%）二尖瓣反流程度≤1（+），纽约心脏协会心功能分级为 I 至 II 级（81.7%）。
使用主动脉球囊扩张经导管心脏瓣膜进行 MViV 治疗的并发症发生率低，30 天死亡率低于胸外科医师协会评分预测值，短期结果优于 MViR 和 ViMAC。30 天时，所有组的患者症状均有改善，瓣膜功能稳定。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT02245763。
