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经导管二尖瓣置换术。

Transcatheter mitral valve replacement.

机构信息

Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.

Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.

出版信息

J Cardiol. 2021 Jun;77(6):555-564. doi: 10.1016/j.jjcc.2020.10.020. Epub 2020 Nov 25.

Abstract

Transcatheter mitral valve (MV) repair, specifically the edge-to-edge leaflet repair, is a less invasive treatment of symptomatic mitral regurgitation (MR) in patients with high or prohibitive surgical risk. In cases with severe leaflet calcification, small mitral orifice area, and/or extremely wide regurgitation across the entire MV commissure, transcatheter MV repair may rather cause suboptimal or potentially hazardous outcomes. In these cases, MV replacement can be a more suitable option. Recently, percutaneous transcatheter MV replacement has emerged as an acceptable therapeutic option for the treatment of degenerated surgical bioprosthetic disease. Moreover, several transcatheter devices for native MV replacement are under evaluation with a hope to provide more complete and reproducible restoration of MV function. In this article, we will review current status, applications, clinical outcomes, and limitations that need to be overcome for transcatheter MV replacement for both degenerated surgical bioprosthetic disease and native MV disorders.

摘要

经导管二尖瓣(MV)修复术,特别是瓣叶对合修复术,是一种治疗高风险或禁忌手术的症状性二尖瓣反流(MR)的微创方法。在瓣叶严重钙化、二尖瓣口面积小和/或整个 MV 交界区广泛反流的情况下,经导管 MV 修复术可能导致效果不理想或潜在危险的结果。在这些情况下,二尖瓣置换术可能是一个更合适的选择。最近,经皮经导管二尖瓣置换术已成为治疗退行性外科生物瓣病变的一种可接受的治疗选择。此外,正在评估几种用于治疗原生 MV 置换的经导管装置,希望能更完整、更可重复地恢复 MV 功能。本文将综述退行性外科生物瓣病变和原生 MV 病变的经导管 MV 置换的现状、应用、临床结果和需要克服的局限性。

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