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经导管二尖瓣瓣环成形术治疗二尖瓣反流

Transcatheter Mitral Valve Edge-to-Edge Repair with a Novel System.

机构信息

Department of Cardiology, Zhongshan Hospital, Fudan University, Research Unit of Cardiovascular Techniques and Devices, Chinese Academy of Medical Sciences.

National Clinical Research Center for Interventional Medicine.

出版信息

Int Heart J. 2022;63(1):23-29. doi: 10.1536/ihj.21-225.

Abstract

The ValveClamp system is a novel edge-to-edge mitral valve repair system that is designed for ease of operation. We aimed to report the 1-year outcomes of the early feasibility study of this system.Patients with severe degenerative mitral regurgitation (MR) at higher surgical risk and who received transapical ValveClamp implantation were followed for 1 year for clinical and echocardiographic outcomes.Twelve patients (mean age, 76.5 ± 6.3 years; mean Society of Thoracic Surgery score, 6.9 ± 1.9%) were enrolled at three sites in China. At 1 year, no patient died, received reoperation, or had long-term complications. Of the 12 patients with MR of 3+ or 4+ at baseline, 11 patients (91.67%) remained with MR ≤ 2+ at 1 year, and no patient had mitral stenosis. Significant reductions in maximum MR area (from 15.1 ± 6.51 cm to 4.45 ± 1.85 cm, P < 0.001), effective orifice area (from 4.34 ± 0.34 cm to 2.38 ± 0.45 cm, P < 0.001), and vena contracta width (from 8.03 ± 1.11 to 3.38 ± 2.11 mm, P < 0.001) were observed. The left cardiac dimensions were decreased, especially the mitral valve annulus diameter (from 34.79 ± 4.27 mm to 31.42 ± 2.81 mm, P < 0.05). Of the 12 patients with baseline New York Heart Association functional class III/IV, all patients experienced an improvement of at least one class (P < 0.05).Our study provides evidence that transapical ValveClamp implantation in high-risk patients with severe degenerative MR is safe and feasible, with good efficacy in the mid-long term.

摘要

ValveClamp 系统是一种新颖的瓣对瓣二尖瓣修复系统,设计用于操作简便。我们旨在报告该系统早期可行性研究的 1 年结果。在较高手术风险的严重退行性二尖瓣反流(MR)患者中,接受经心尖 ValveClamp 植入的患者接受了 1 年的临床和超声心动图随访,以评估其结果。在中国的三个中心共纳入了 12 名患者(平均年龄 76.5 ± 6.3 岁;平均胸外科医师协会评分 6.9 ± 1.9%)。在 1 年时,没有患者死亡、再次接受手术或发生长期并发症。在基线时 MR 为 3+或 4+的 12 名患者中,有 11 名(91.67%)患者在 1 年时的 MR 为 ≤ 2+,且没有患者出现二尖瓣狭窄。最大 MR 面积(从 15.1 ± 6.51 cm 减小至 4.45 ± 1.85 cm,P < 0.001)、有效瓣口面积(从 4.34 ± 0.34 cm 减小至 2.38 ± 0.45 cm,P < 0.001)和收缩期瓣口宽度(从 8.03 ± 1.11 减小至 3.38 ± 2.11 mm,P < 0.001)显著降低。左心腔尺寸减小,特别是二尖瓣瓣环直径(从 34.79 ± 4.27 mm 减小至 31.42 ± 2.81 mm,P < 0.05)。在基线时为纽约心脏病协会心功能分级 III/IV 的 12 名患者中,所有患者的心功能分级至少提高了 1 级(P < 0.05)。我们的研究结果表明,在高风险的严重退行性 MR 患者中,经心尖 ValveClamp 植入是安全且可行的,且在中期到长期疗效较好。

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