Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Interventional Cardiology Laboratory, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
J Am Soc Echocardiogr. 2021 Jun;34(6):604-613. doi: 10.1016/j.echo.2021.01.010. Epub 2021 Jan 13.
Whether fluoroscopic-echocardiographic fusion imaging (FI) might offer added value for intraprocedural guidance during transcatheter edge-to-edge mitral valve repair is yet unknown, and few data exist regarding the safety and feasibility of this novel technology.
The aim of this single-center study was to test and validate a FI protocol for intraprocedural monitoring of transcatheter edge-to-edge mitral valve repair and assess its clinical usefulness. Eighty patients underwent MitraClip implantation using FI guidance (FI+) for either degenerative (35%) or functional (65%) mitral regurgitation and were compared with the last 80 patients before FI introduction, treated using conventional echocardiography and fluoroscopic monitoring (FI-).
The number of patients treated for functional and degenerative mitral regurgitation was similar between the FI+ and FI- groups, as well as the number of devices implanted (1.51 ± 0.5 vs 1.58 ± 0.6, P = .46). The prevalence of complex mitral anatomy for percutaneous repair was high (32.5%, up to 39.2% in the hybrid arm). Fluoroscopy time was significantly lower in FI+ patients (37.3 ± 14.6 vs 48.3 ± 28.3 min, P = .003), but not kerma area product (91.5 ± 74.1 vs 108.8 ± 105.0 Gy · cm, P = .23) or procedural time (92.2 ± 36.1 vs 103.1 ± 42.7 min, P = .086). After adjusting for confounding factors (MitraClip XT device and complex anatomy), FI reduced fluoroscopy time (coefficient = -10.4 min; 95% CI, -18.03 to -2.82; P = .007) and improved procedural success at the end of the procedure (odds ratio, 2.87; 95% CI, 1.00 to 8.24; P = .049) and discharge (odds ratio, 2.24; 95% CI, 1.04 to 4.80; P = .039). Rates of periprocedural complications were similar in both groups (8.9% vs 13.0%, P = .40).
The authors describe the systematic use of an FI protocol for intraprocedural guidance during transcatheter edge-to-edge mitral valve repair, demonstrating a reduction in fluoroscopy time and an improvement in procedural success in a population with a high prevalence of challenging mitral anatomy for percutaneous repair.
在经导管缘对缘二尖瓣修复术中，荧光透视-超声心动图融合成像（FI）是否能提供额外的术中指导价值尚不清楚，而且关于这项新技术的安全性和可行性的数据很少。
本单中心研究的目的是测试和验证 FI 方案用于经导管缘对缘二尖瓣修复术中的术中监测，并评估其临床实用性。80 例患者因退行性（35%）或功能性（65%）二尖瓣反流接受 MitraClip 植入术，其中 40 例采用 FI 指导（FI+），40 例采用传统超声心动图和荧光透视监测（FI-）。
FI+组和 FI-组功能性和退行性二尖瓣反流的患者治疗数量相似，植入装置的数量也相似（1.51±0.5 比 1.58±0.6，P=0.46）。经皮修复的复杂二尖瓣解剖结构的患病率较高（32.5%，杂交组高达 39.2%）。FI+患者的透视时间明显缩短（37.3±14.6 比 48.3±28.3 分钟，P=0.003），但千伏面积乘积（91.5±74.1 比 108.8±105.0 戈瑞·厘米，P=0.23）或手术时间（92.2±36.1 比 103.1±42.7 分钟，P=0.086）并无差异。在调整混杂因素（MitraClip XT 装置和复杂解剖结构）后，FI 降低了透视时间（系数=-10.4 分钟；95%置信区间，-18.03 至-2.82；P=0.007），并提高了术中即刻手术成功率（比值比，2.87；95%置信区间，1.00 至 8.24；P=0.049）和出院成功率（比值比，2.24；95%置信区间，1.04 至 4.80；P=0.039）。两组围手术期并发症发生率相似（8.9%比 13.0%，P=0.40）。
作者描述了在经导管缘对缘二尖瓣修复术中系统使用 FI 方案进行术中指导，在经皮修复挑战性二尖瓣解剖结构患病率较高的人群中，透视时间减少，手术成功率提高。
