Rogers Jason H, Bolling Steven F
Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, CA, USA.
Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
Ann Cardiothorac Surg. 2021 Jan;10(1):50-56. doi: 10.21037/acs-2020-mv-10.
Chordal replacement is a fundamental technique used in the surgical repair of primary mitral regurgitation, and can be an effective means of preserving the native valve without leaflet resection. Surgical chordal replacement can be challenging since it is performed on an open, non-beating heart, and choosing the correct chord length to restore the zone of coaptation requires both intuition and skill. Developing transcatheter, transfemoral, and transseptal approaches to mitral valve chordal replacement presents the opportunity for safer and potentially earlier treatment of patients with primary mitral regurgitation. In particular, transcatheter methods will allow adjustment of chordal length and position real-time on a beating heart under echocardiographic guidance. In this manuscript, we review the current transcatheter transseptal technologies in development and discuss the various issues related to device design, efficacy, durability, and clinical trial design.
腱索置换是原发性二尖瓣反流外科修复中使用的一项基本技术，并且可以成为不进行瓣叶切除而保留天然瓣膜的有效方法。外科腱索置换具有挑战性，因为它是在开放的、非跳动的心脏上进行的，选择正确的腱索长度以恢复瓣叶贴合区域既需要直觉又需要技巧。开发经导管、经股动脉和经房间隔途径进行二尖瓣腱索置换为原发性二尖瓣反流患者提供了更安全且可能更早治疗的机会。特别是，经导管方法将允许在超声心动图引导下在跳动的心脏上实时调整腱索长度和位置。在本手稿中，我们回顾了目前正在开发的经导管经房间隔技术，并讨论了与器械设计、疗效、耐久性和临床试验设计相关的各种问题。
