Eleid Mackram F, Collins Jeremy D, Mahoney Paul, Williamson Eric E, Killu Ammar M, Whisenant Brian K, Rihal Charanjit S, Guerrero Mayra E
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: https://twitter.com/EleidMack.
Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
JACC Cardiovasc Interv. 2023 Apr 24;16(8):885-895. doi: 10.1016/j.jcin.2023.01.357.
An increasing number of patients with mitral valve disease are high risk for surgery and in need of less invasive treatments including transcatheter mitral valve replacement (TMVR). Left ventricular outflow tract (LVOT) obstruction is a predictor of poor outcome after TMVR, and its risk can be accurately predicted using cardiac computed tomography analysis. Novel treatment strategies that have shown efficacy in reducing risk of LVOT obstruction after TMVR include pre-emptive alcohol septal ablation, radiofrequency ablation, and anterior leaflet electrosurgical laceration. This review describes recent advances in the management of LVOT obstruction risk after TMVR, provides a new management algorithm, and explores forthcoming studies that will further advance the field.
越来越多的二尖瓣疾病患者手术风险高，需要包括经导管二尖瓣置换术（TMVR）在内的侵入性较小的治疗方法。左心室流出道（LVOT）梗阻是TMVR术后预后不良的一个预测指标，其风险可通过心脏计算机断层扫描分析准确预测。已显示出在降低TMVR术后LVOT梗阻风险方面有效的新型治疗策略包括预防性酒精间隔消融、射频消融和前叶电外科撕裂术。本综述描述了TMVR术后LVOT梗阻风险管理的最新进展，提供了一种新的管理算法，并探讨了将进一步推动该领域发展的未来研究。
