Russo Giulio, Maisano Francesco, Massaro Gianluca, Terlizzese Giuseppe, Mariano Enrica, Bonanni Michela, Matteucci Andrea, Bezzeccheri Andrea, Benedetto Daniela, Chiricolo Gaetano, Martuscelli Eugenio, Sangiorgi Giuseppe Massimo
Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome, Italy.
Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy.
Front Cardiovasc Med. 2022 Feb 9;8:738756. doi: 10.3389/fcvm.2021.738756. eCollection 2021.
According to the European and American guidelines, surgery represents the treatment of choice for mitral valve (MV) disease. However, a number of patients are deemed unsuitable for surgery due to a prohibitive/high operative risk. In such cases, transcatheter therapies aiming at MV repair have been proven to be a valuable alternative and have been recently introduced in the latest American guidelines on valvular heart disease. Indeed, percutaneous repair techniques, particularly transcatheter edge-to-edge, have gained a broad experience and demonstrated to be safe and effective. However, given the complexity and heterogeneity of MV anatomy and pathology, transcatheter MV implantation (TMVI) has grown as a possible alternative to percutaneous MV repair. Current data about TMVI are still limited and come from different settings: valve-in-native MV, valve-in-valve (ViV), valve-in-ring (ViR), and valve-in-mitral annular calcification. Preliminary data are promising although several open issues still need to be addressed. This paper provides a comprehensive review of the available devices in the different clinical settings, to discuss potentialities, limitations, and future directions for TMVI.
根据欧美指南，手术是二尖瓣疾病的首选治疗方法。然而，由于手术风险过高，一些患者被认为不适合手术。在这种情况下，旨在修复二尖瓣的经导管治疗已被证明是一种有价值的替代方法，并且最近已被纳入最新的美国瓣膜性心脏病指南。事实上，经皮修复技术，特别是经导管缘对缘修复，已经积累了丰富的经验，并被证明是安全有效的。然而，鉴于二尖瓣解剖结构和病理的复杂性和异质性，经导管二尖瓣植入术（TMVI）已发展成为经皮二尖瓣修复的一种可能替代方法。目前关于TMVI的数据仍然有限，并且来自不同的情况：原生二尖瓣内瓣膜、瓣中瓣（ViV）、瓣环内瓣膜（ViR）和二尖瓣环钙化内瓣膜。尽管仍有几个未解决的问题需要解决，但初步数据很有前景。本文对不同临床情况下可用的设备进行了全面综述，以讨论TMVI的潜力、局限性和未来方向。
