Service Médico-Chirurgical: Valvulopathies- Chirurgie Cardiaque - Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU-Bordeaux, Bordeaux, France.
Structural Valve Program, Montreal Heart Institute, Montréal, Canada.
Curr Cardiol Rep. 2021 Mar 9;23(4):37. doi: 10.1007/s11886-021-01466-7.
This systematic review was performed to evaluate the results of transcatheter mitral valve implantation (TMVI) in the native mitral valve.
Medline, EMBASE, and the Cochrane Central register were systematically searched for studies that reported results of TMVI in mitral valve regurgitation and/or stenosis and mitral annular calcification. To improve the sensitivity of the literature search, we performed citation chasing in Google Scholar, Scopus, and Web of Science.
Twelve studies reporting results of TMVI in mitral regurgitation were retrieved and included 347 patients. The transseptal approach represented 28% of cases. Secondary mitral regurgitation was the predominant indication in 63% of cases. Thirty-day mortality was 11% and was lowered with the transseptal approach (7%). Technical success was 92%. Surgical conversion was needed in 5% of patients. Only one patient presented moderate to severe mitral regurgitation. These hemodynamic results were sustainable up to one year of follow-up. Three series focused on results of TMVI in mitral annulus calcification including 167 patients. Only nine patients were treated with TMVI dedicated prosthesis. Eighty-seven patients had their prosthesis delivered through a transseptal approach. Mitral stenosis was present in 63% of cases. Thirty-day mortality was 24%, and none with TMVI prosthesis. Technical success was achieved in 71% of cases and was improved by using TMVI prosthesis (89%). The main complication was left ventricular outflow tract obstruction (20%). Post procedural moderate to severe mitral regurgitation was observed in 4% of cases.
TMVI seems to be feasible, achieving good technical success and predictable and durable MR reduction.
本系统评价旨在评估经导管二尖瓣置换术（TMVI）在原生二尖瓣中的应用效果。
系统检索了 Medline、EMBASE 和 Cochrane 中心注册数据库，以寻找报告 TMVI 治疗二尖瓣反流和/或狭窄以及二尖瓣环钙化的研究结果。为了提高文献检索的敏感性，我们在 Google Scholar、Scopus 和 Web of Science 中进行了引文追踪。
共检索到 12 项报告 TMVI 治疗二尖瓣反流的研究，共纳入 347 例患者。经房间隔入路占 28%。继发性二尖瓣反流是主要适应证，占 63%。30 天死亡率为 11%，经房间隔入路可降低死亡率（7%）。技术成功率为 92%。5%的患者需要进行外科转换。仅有 1 例患者出现中度至重度二尖瓣反流。这些血流动力学结果在一年的随访中是可持续的。有 3 个系列专注于 TMVI 治疗二尖瓣环钙化的结果，共纳入 167 例患者。仅 9 例患者使用 TMVI 专用假体进行治疗。87 例患者通过经房间隔入路输送假体。63%的病例存在二尖瓣狭窄。30 天死亡率为 24%，无 TMVI 假体相关死亡率。71%的病例获得技术成功，使用 TMVI 假体可提高成功率（89%）。主要并发症为左心室流出道梗阻（20%）。术后中度至重度二尖瓣反流发生率为 4%。
TMVI 似乎是可行的，可实现良好的技术成功率和可预测且持久的 MR 减轻。
