当代经导管二尖瓣置换术治疗二尖瓣环钙化或瓣环
Contemporary Transcatheter Mitral Valve Replacement for Mitral Annular Calcification or Ring.
机构信息
Division of Cardiology, University of Washington, Seattle, Washington.
Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
出版信息
JACC Cardiovasc Interv. 2020 Oct 26;13(20):2388-2398. doi: 10.1016/j.jcin.2020.07.007. Epub 2020 Sep 30.
OBJECTIVES
The aim of this study was to evaluate outcomes of commercial transcatheter mitral valve replacement (TMVR) for annular rings and calcification using contemporary techniques.
BACKGROUND
TMVR is evolving in the absence of other viable treatment options for severe mitral annular calcification and failing ring repairs. The concomitant use of laceration of the anterior mitral valve leaflet to prevent left ventricular outflow tract obstruction and pre-emptive alcohol septal ablation is not well studied in clinical practice.
METHODS
A single-center study was conducted of valve-in-mitral annular calcification (ViMAC) and valve-in-ring (ViRing) TMVR from September 2015 to April 2020. In-hospital and 30-day outcomes were assessed.
RESULTS
Forty patients underwent TMVR (28 ViMAC and 12 ViRing). Sixteen ViMAC (57%) and 5 ViRing (42%) patients underwent attempted laceration of the anterior mitral valve leaflet to prevent left ventricular outflow tract obstruction. Three patients underwent pre-emptive alcohol septal ablation. The median index hospitalization was 7 days. Six patients died within 30 days of the procedure, 6 (21%) in the ViMAC group and none in the ViRing group. Five patients (13%) had left ventricular outflow tract obstruction: 4 (14%) in the ViMAC cohort and 1 (8%) in the ViRing cohort. Five patients (13%) had either intraprocedural valve embolization or late migration (4 ViMAC and 1 ViRing). Technical success defined according to Mitral Valve Academic Research Consortium criteria was present in 25 patients (63%): 9 (75%) in the ViRing cohort and 16 (57%) in the ViMAC cohort. At 30 days, the mitral valve gradient was significantly reduced (5.5 ± 2.1 vs. 10.6 ± 4.8; p < 0.01). Three patients (8%) had at least moderate residual mitral regurgitation.
CONCLUSIONS
Transcatheter ViMAC and ViRing can be successfully performed but frequently require the use of contemporary adjunctive techniques.
目的
本研究旨在评估使用当代技术对环形环和钙化进行商业经导管二尖瓣置换术（TMVR）的结果。
背景
在没有其他可行的重度二尖瓣环形钙化和环修复失败治疗选择的情况下，TMVR 正在发展。在临床实践中，前二尖瓣叶裂伤以预防左心室流出道梗阻和预防性酒精室间隔消融的同时使用并未得到很好的研究。
方法
对 2015 年 9 月至 2020 年 4 月期间进行的瓣膜内环形钙化（ViMAC）和瓣膜内环（ViRing）TMVR 进行了单中心研究。评估了住院期间和 30 天的结果。
结果
40 例患者接受了 TMVR（28 例 ViMAC 和 12 例 ViRing）。16 例 ViMAC（57％）和 5 例 ViRing（42％）患者尝试了前二尖瓣叶裂伤以预防左心室流出道梗阻。3 例患者接受了预防性酒精室间隔消融。中位住院指数为 7 天。6 例患者在手术后 30 天内死亡，ViMAC 组 6 例（21％），ViRing 组无死亡。5 例（13％）患者出现左心室流出道梗阻：ViMAC 队列中有 4 例（14％），ViRing 队列中有 1 例（8％）。5 例（13％）患者发生术中瓣膜栓塞或晚期迁移（4 例 ViMAC 和 1 例 ViRing）。根据二尖瓣学术研究联盟标准定义的技术成功率为 25 例（63％）：ViRing 队列中有 9 例（75％），ViMAC 队列中有 16 例（57％）。30 天时，二尖瓣梯度明显降低（5.5 ± 2.1 对 10.6 ± 4.8；p < 0.01）。3 例（8％）患者至少存在中度残余二尖瓣反流。
结论
经导管 ViMAC 和 ViRing 可以成功进行，但通常需要使用当代辅助技术。
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