Khatib Diana, Neuburger Peter J, Pan Sabrina, Rong Lisa Q
Department of Anesthesiology, Weill Cornell Medicine, New York, NY.
Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY.
J Cardiothorac Vasc Anesth. 2022 Oct;36(10):3887-3903. doi: 10.1053/j.jvca.2022.05.005. Epub 2022 May 8.
Significant mitral regurgitation (MR) is the most common valvular disease in the United States in patients older than 75. However, many patients with severe MR are at a high risk for surgical repair due to other significant comorbidities. Over the past decade, many transcatheter mitral valve devices have been studied that address the different mechanisms of MR, but only a few have received a Conformité Européene (CE) mark or United States Food and Drug Administration (FDA) approval. The Carillon, Cardioband, and Mitralign all received CE marking for percutaneous mitral annuloplasty, while the Tendyne and SAPIEN 3 received a CE mark and FDA approval, respectively, for transcatheter mitral valve replacement. Finally, the NeoChord DS 1000 received a CE mark for transcatheter chordal repair. Each of these devices is reviewed in detail, including device indications, performance in clinical trials, anesthetic management, intraprocedural imaging guidance, and postprocedural complications. Although percutaneous devices will appear and disappear from use, understanding the procedural considerations remains highly relevant, as these key principles will apply to the next generation of transcatheter valve interventions.
重度二尖瓣反流（MR）是美国75岁以上患者中最常见的瓣膜疾病。然而，许多重度MR患者由于其他严重的合并症而面临手术修复的高风险。在过去十年中，人们研究了许多经导管二尖瓣装置，这些装置针对MR的不同机制，但只有少数获得了欧洲合格认证（CE）标志或美国食品药品监督管理局（FDA）的批准。Carillon、Cardioband和Mitralign均获得了经皮二尖瓣环成形术的CE标志，而Tendyne和SAPIEN 3分别获得了经导管二尖瓣置换术的CE标志和FDA批准。最后，NeoChord DS 1000获得了经导管腱索修复的CE标志。本文将对这些装置进行详细综述，包括装置适应症、临床试验表现、麻醉管理、术中成像引导以及术后并发症。尽管经皮装置在使用中会出现和消失，但了解手术注意事项仍然非常重要，因为这些关键原则将适用于下一代经导管瓣膜干预。
