Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA.
Catheter Cardiovasc Interv. 2021 Oct;98(4):E602-E609. doi: 10.1002/ccd.29515. Epub 2021 Feb 4.
Surgical intervention in patients with native mitral disease due to severe mitral annular calcification (MAC) carries significant risk. Transcatheter mitral valve replacement (TMVR) using balloon-expandable aortic transcatheter heart valve (THV) in MAC had emerged as alternative treatment.
We aim to study the temporal change in clinical outcomes of the procedure at a single center.
We retrospectively studied 23 patients who underwent TMVR in MAC at Mayo Clinic from January, 14, 2014 to March, 15, 2019. Cases were divided into early (n = 11) and late (n = 12) experience. The primary end point was 30-day all-cause mortality. The secondary end points were immediate technical success, 30-day procedural success, and 1-year all-cause mortality.
Mean age of patients was 75.2 ± 8.9 years and 17 (74.0%) were female. Median STS score for 30-day mortality was 8 (Interquartile range 4.3-13.4) for the entire population. Immediate technical success was achieved in 21 out of 23 patients (two failures in the early experience were related to tamponade and procedural death). Thirty-day procedural success was higher in the late experience (10 out of 12 patients) compared to early experience (5 out of 11 patients, p = .06). Four deaths in the first 30-days were observed in the early experience while all patients survived to hospital discharge in the late experience (p = .01).
Procedural success and 30-day survival of transcatheter mitral valve replacement in severe mitral annular calcification procedure using balloon-expandable aortic prosthesis had improved over the years. This is likely attributed to significant advancement in procedural planning, valve design, and techniques.
由于严重二尖瓣环钙化（MAC），对原发性二尖瓣疾病患者进行手术干预存在较大风险。使用球囊扩张式主动脉经导管心脏瓣膜（THV）进行经导管二尖瓣置换术（TMVR）已成为一种替代治疗方法。
我们旨在研究单中心该手术的临床结果的时间变化。
我们回顾性研究了 2014 年 1 月 14 日至 2019 年 3 月 15 日期间，梅奥诊所 23 例 MAC 患者接受 TMVR 的病例。将病例分为早期（n=11）和晚期（n=12）经验。主要终点是 30 天全因死亡率。次要终点为即刻技术成功率、30 天手术成功率和 1 年全因死亡率。
患者的平均年龄为 75.2±8.9 岁，17 例（74.0%）为女性。整个队列 30 天死亡率的 STS 评分中位数为 8（四分位距 4.3-13.4）。23 例患者中有 21 例（早期经验中有 2 例失败与填塞和手术死亡有关）即刻技术成功。晚期经验中的 30 天手术成功率较高（12 例中有 10 例），而早期经验中为 5 例（11 例中有 5 例，p=0.06）。早期经验中前 30 天观察到 4 例死亡，而晚期经验中所有患者均存活至出院（p=0.01）。
使用球囊扩张式主动脉假体进行严重二尖瓣环钙化经导管二尖瓣置换术的手术成功率和 30 天生存率近年来有所提高。这可能归因于手术计划、瓣膜设计和技术的显著进步。
