Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California.
J Am Soc Echocardiogr. 2021 Oct;34(10):1025-1037. doi: 10.1016/j.echo.2021.03.240. Epub 2021 Apr 17.
Transcatheter edge-to-edge mitral valve repair has revolutionized the treatment of primary and secondary mitral regurgitation. The landmark EVEREST (Endovascular Valve Edge-to-Edge Repair Study) and COAPT (Clinical Outcomes Assessment of the MitraClip Percutaneous Therapy for High Surgical Risk Patients) trials included only clinically stable patients with favorable mitral valve anatomy for edge-to-edge repair. However, since its initial commercial approval in the United States, growing operator experience, device iterations, and improvements in intraprocedural imaging have led to an expansion in the use of transcatheter edge-to-edge repair to more complex mitral valve pathologies and clinical scenarios, many of which were previously considered contraindications for the procedure. Because patients with prohibitive surgical risk are often older and present with complex mitral valve disease, knowledge of the potential effectiveness, versatility, and technical approach to a broad range of anatomy is clinically relevant. In this review the authors examine the current experience with mitral valve transcatheter edge-to-edge repair in various pathologies and scenarios that go well beyond the EVEREST II trial inclusion criteria.
经导管缘对缘二尖瓣修复术已经彻底改变了原发性和继发性二尖瓣反流的治疗方法。具有里程碑意义的 EVEREST（经血管瓣膜缘对缘修复研究）和 COAPT（经皮二尖瓣夹治疗高危手术患者的临床结果评估）试验仅纳入了临床稳定且具有有利于缘对缘修复的二尖瓣解剖结构的患者。然而，自其在美国最初获得商业批准以来，随着操作人员经验的增加、设备的迭代和术中成像的改进，经导管缘对缘修复的应用范围已经扩大到更复杂的二尖瓣病变和临床情况，其中许多情况在以前被认为是该手术的禁忌症。由于手术风险极高的患者通常年龄较大，且患有复杂的二尖瓣疾病，因此，了解广泛解剖结构的潜在有效性、多功能性和技术方法在临床上具有重要意义。在这篇综述中，作者检查了经导管二尖瓣缘对缘修复在各种超出 EVEREST II 试验纳入标准的病变和情况下的现有经验。
