前瓣顺行切开术预防左心室流出道梗阻：从实验台到临床的简化技术。
Antegrade Intentional Laceration of the Anterior Mitral Leaflet to Prevent Left Ventricular Outflow Tract Obstruction: A Simplified Technique From Bench to Bedside.
机构信息
Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, GA (J.C.L., A.B.G., N.K., P.T.G., I.B., J.F.C., A.J., G.P., K.J.G., V.C.B.).
Cadiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland (J.M.K., T.R., R.J.L.).
出版信息
Circ Cardiovasc Interv. 2020 Jun;13(6):e008903. doi: 10.1161/CIRCINTERVENTIONS.119.008903. Epub 2020 Jun 9.
BACKGROUND
Intentional laceration of the anterior mitral leaflet (LAMPOON) is an effective adjunct to transcatheter mitral valve replacement that prevents left ventricular outflow tract (LVOT) obstruction. To date, LAMPOON has been performed in over 150 patients using a retrograde approach that can be technically challenging. A modified antegrade transseptal technique may simplify the procedure.
METHODS
Antegrade LAMPOON was developed and tested in nonsurvival pig experiments. Thereafter, antegrade LAMPOON was performed in patients at prohibitive risk of LVOT obstruction. Clinical, procedural, and angiographic details were abstracted from medical records of their index procedure, and were compared with findings in comparable patients at risk of fixed-LVOT obstruction in the LAMPOON investigational device exemption trial.
RESULTS
Eight patients at risk of fixed LVOT obstruction underwent antegrade LAMPOON. Leaflet traversal and laceration were technically successful in all. There were no cases of clinically significant LVOT obstruction (mean LVOT gradient at discharge: 5.4±1.4 mm Hg). One patient suffered a ventricular wire perforation, unrelated to the antegrade LAMPOON technique, and did not survive to discharge. At the time of discharge, no patients had an increase of >10 mm Hg in LVOT gradient compared with baseline. Procedure times (from traversal to transcatheter mitral valve replacement) were shorter, compared with the retrograde technique in the LAMPOON investigational device exemption trial (39±09 versus 65±35 minutes). All patients survived (8/8, 100%) the procedure, and 7/8 (88%) survived to 30 days, similar to subjects in the LAMPOON investigational device exemption trial.
CONCLUSIONS
Antegrade LAMPOON is an effective, reproducible, and simplified strategy to lacerate the anterior leaflet before transcatheter mitral valve replacement. The authors recommend the technique as the new standard for LAMPOON.
背景
经皮二尖瓣置换术中切开前二尖瓣叶（LAMPOON）是一种有效的辅助手段，可防止左心室流出道（LVOT）阻塞。迄今为止，已有超过 150 名患者采用逆行方法进行了 LAMPOON，该方法技术上具有挑战性。改良的顺行经间隔技术可能会简化该过程。
方法
在非存活猪实验中开发并测试了顺行 LAMPOON。此后，在有 LVOT 阻塞高风险的患者中进行了顺行 LAMPOON。从其指数手术的病历中提取了临床、程序和血管造影细节，并与 LAMPOON 研究性设备豁免试验中固定 LVOT 阻塞风险患者的发现进行了比较。
结果
8 名有固定 LVOT 阻塞风险的患者接受了顺行 LAMPOON。所有患者的叶瓣穿过和切开均在技术上获得成功。无临床显著的 LVOT 阻塞（出院时的平均 LVOT 梯度：5.4±1.4mmHg）。1 名患者发生心室导线穿孔，与顺行 LAMPOON 技术无关，且未存活至出院。出院时，与 LAMPOON 研究性设备豁免试验中的逆行技术相比，无患者的 LVOT 梯度增加超过 10mmHg（从基线增加）。与 LAMPOON 研究性设备豁免试验中的逆行技术相比，手术时间（从穿过到经皮二尖瓣置换）更短（39±09 比 65±35 分钟）。所有患者均成功完成手术（8/8，100%），7/8（88%）存活至 30 天，与 LAMPOON 研究性设备豁免试验中的患者相似。
结论
顺行 LAMPOON 是一种有效、可重复且简化的切开前二尖瓣叶的策略，在经皮二尖瓣置换术前使用。作者建议将该技术作为 LAMPOON 的新标准。
Zotero 插件