Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA.
Division of Cardiology, Montiefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
Catheter Cardiovasc Interv. 2021 Nov 15;98(6):1193-1203. doi: 10.1002/ccd.29783. Epub 2021 Jun 9.
Due to elevated surgical risk, transcatheter mitral valve replacement (TMVR) is used as an alternative for treating failed bioprosthetic valves, annuloplasty repairs and mitral annular calcification (MAC). We report the procedural and longitudinal outcomes for each subtype: Mitral valve-in-valve (MVIV), mitral valve-in-ring (MViR), and valve-in-MAC (ViMAC).
Consecutive patients undergoing TMVR from October 2013 to December 2019 were assessed. Patients at high risk for left ventricular outflow tract obstruction had either alcohol septal ablation or intentional laceration of the anterior leaflet (LAMPOON).
Eight-eight patients underwent TMVR; 38 MViV, 31 MViR, and 19 ViMAC procedures were performed. The median Society of Thoracic Surgery 30-day predicted risk of mortality was 8.2% (IQR 5.2, 19.9) for all. Sapien 3 (78%) and transseptal access (98%) were utilized in most cases. All-cause in-hospital mortality, technical, and procedural success were 8%, 83%, and 66% respectively. Median follow up was 1.4 years (IQR 0.5-2.9 years) and overall survival was 40% at 4 years. Differential survival rates were observed with MViV doing the best, followed by MViR and ViMAC having a <20% survival at 4 years. After adjusting for co-variates, MViV procedure was the strongest predictor of survival (HR 0.24 [95% CI 0.079-0.7]).
TMVR is performed in at high-risk patients with attenuated long-term survival. MViV has the best success and survival rate, but long-term survival in MViR and ViMAC is guarded.
由于手术风险较高，经导管二尖瓣置换术（TMVR）被用作治疗生物瓣失败、瓣环成形术修复和二尖瓣环钙化（MAC）的替代方法。我们报告了每种亚型的程序和纵向结果：二尖瓣瓣中瓣（MVIV）、二尖瓣瓣环内（MViR）和瓣环内 MAC（ViMAC）。
评估了 2013 年 10 月至 2019 年 12 月期间接受 TMVR 的连续患者。有左心室流出道梗阻高风险的患者接受了酒精室间隔消融术或前叶（LAMPOON）的有意撕裂。
88 例患者接受 TMVR；38 例 MVIV、31 例 MViR 和 19 例 ViMAC 手术。所有患者的 30 天预测死亡率为 8.2%（IQR5.2，19.9）。大多数情况下使用了 Sapien3（78%）和经间隔通道（98%）。全因住院死亡率、技术和程序成功率分别为 8%、83%和 66%。中位随访时间为 1.4 年（IQR0.5-2.9 年），4 年总生存率为 40%。观察到不同的生存率，MVIV 效果最好，其次是 MViR 和 ViMAC，4 年后生存率<20%。在调整协变量后，MVIV 手术是生存的最强预测因素（HR0.24[95%CI0.079-0.7]）。
TMVR 是在高危患者中进行的，这些患者的长期生存率降低。MVIV 具有最佳的成功率和生存率，但 MViR 和 ViMAC 的长期生存率不容乐观。
