Yokoyama Hiroaki, Ruf Tobias Friedrich, Geyer Martin, Tamm Alexander R, Da Rocha E Silva Jaqueline Grace, Gößler Theresa Ann Maria, Zirbs Julia, Schwidtal Ben, Münzel Thomas, von Bardeleben Ralph Stephan
Department of Cardiology and Catheterisation Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan.
Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany.
Front Cardiovasc Med. 2023 Feb 15;10:1029103. doi: 10.3389/fcvm.2023.1029103. eCollection 2023.
For patients with severe mitral valve regurgitation (MR), different kinds of transcatheter mitral valve repair (TMVr) exist, targeting the leaflets, annulus, and chordae. The concomitant combination (COMBO) therapy of TMVrs is rarely used as treatment, and there are very few publications about this therapeutic strategy. We evaluated the effect of COMBO-TMVr on the cardiac left chambers and clinical data, including survival.
We included 35 patients at high risk who underwent concomitant sequential transcatheter mitral valve edge-to-edge repair (M-TEER) and another TMVr for severe MR in our hospital between March 2015 and April 2018. Of these, 13 had adequate follow-up transthoracic echocardiography (TTE) up to around 1 year after the procedure.
Survival for all patients was 83% at 1 year, 71% at 2 years, and 63% at 3 years, respectively. In the 13 patients with adequate TTE follow-up, M-TEER plus either Cardioband ( = 4), Carillon Mitral Contour System ( = 7), or Neochord ( = 2) were used, respectively. Ten patients had secondary, and three patients primary MR. After 1 year, changes [median (Q1, Q3)] of left ventricular (LV) end-systolic diameter of -9.9 cm (-11.1, 0.4), LV end-diastolic diameter of -3.3 cm (-8.5, 0.0), LV end-systolic volume (LVESV) of -17.4 mL (-32.6, -0.4), LV end-diastolic volume (LVEDV) of -13.5 mL (-15.9, -3.2), LV mass of -19.5 g (-24.2, -7.6), and left atrial volume (LAV) index (LAVi) of -16.4 mL (-23.3, -11.3) were observed. A significant reduction was also seen in the change ratios of LVESV, LVEDV, LV mass, and LAVi, respectively.
We found that COMBO therapy of TMVr seems feasible and may support reverse remodeling of left cardiac chambers during 1 year after the procedure in a cohort of patients at high risk.
对于重度二尖瓣反流（MR）患者，存在多种经导管二尖瓣修复术（TMVr），分别针对瓣叶、瓣环和腱索。TMVr的联合（COMBO）治疗很少用作治疗方法，关于这种治疗策略的出版物也非常少。我们评估了COMBO-TMVr对心脏左心室及临床数据（包括生存率）的影响。
我们纳入了2015年3月至2018年4月期间在我院接受序贯经导管二尖瓣缘对缘修复术（M-TEER）及另一种TMVr治疗重度MR的35例高危患者。其中，13例在术后约1年有足够的经胸超声心动图（TTE）随访资料。
所有患者1年生存率为83%，2年生存率为71%，3年生存率为63%。在13例有足够TTE随访资料的患者中，分别使用了M-TEER联合Cardioband（4例）、Carillon二尖瓣轮廓系统（7例）或Neochord（2例）。10例为继发性MR，3例为原发性MR。1年后，左心室（LV）收缩末期直径变化[中位数（Q1，Q3）]为-9.9 cm（-11.1，0.4），舒张末期直径变化为-3.3 cm（-8.5，0.0），收缩末期容积（LVESV）变化为-17.4 mL（-32.6，-0.4），舒张末期容积（LVEDV）变化为-13.5 mL（-15.9，-3.2），左心室质量变化为-19.5 g（-24.2，-7.6），左心房容积（LAV）指数（LAVi）变化为-16.4 mL（-23.3，-11.3）。LVESV、LVEDV、左心室质量和LAVi的变化率也有显著降低。
我们发现，TMVr的COMBO治疗似乎可行，并且在一组高危患者术后1年内可能有助于左心腔的逆向重构。
