Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Departamento de Cardiología, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico.
Catheter Cardiovasc Interv. 2024 Oct;104(4):837-852. doi: 10.1002/ccd.31166. Epub 2024 Jul 30.
We aimed to evaluate transcatheter mitral valve implantation (TMVI) using predominantly balloon-expandable transcatheter heart valves (THV) in patients with a landing zone for a percutaneously delivered prosthesis.
Patients with a degenerated mitral valve bioprosthesis, annuloplasty ring, and mitral annulus calcification (MAC) considered at high surgical risk currently represent a treatment challenge. TMVI is an alternative treatment option.
Retrospective analysis of patients with symptomatic degenerated mitral valve bioprosthesis, or annuloplasty ring, and MAC treated with TMVI between November 2011 and April 2021. Endpoints were defined according to Mitral Valve Academic Research Consortium (MVARC) criteria and included device and procedure success at 30 days as well as mortality at 30 days and 1 year after the procedure.
A total of 77 patients underwent TMVI (valve in valve [ViV = 56], valve in ring [ViR = 11], and valve in MAC [ViMAC = 10]). There was a trend toward higher technical success (all = 93.5%, ViV = 96.4%, ViR = 90.9%, ViMAC = 80%, p = 0.06) and lower 30-day (all = 11.7%, ViV = 10.7%, ViR = 9.1%, ViMAC = 20%, p = 0.49) and 1-year mortality (all = 26%, ViV = 23.2%, ViR = 27.3%, ViMAC= 40%, p = 0.36) after ViV and ViR compared to ViMAC.
TMVI represents a reasonable treatment option in selected patients with MAC or who are poor candidates for redo mitral valve surgery. Technical success and survival up to 1 year were not significantly dependent on the subgroup in which TMVI was performed.
我们旨在评估在具有可经皮递送假体的着陆区的患者中使用主要为球囊扩张经导管心脏瓣膜（THV）进行经导管二尖瓣置换术（TMVI）。
目前，患有退行性二尖瓣生物瓣、瓣环成形环和二尖瓣环钙化（MAC）且手术风险较高的患者代表了一种治疗挑战。TMVI 是一种替代治疗选择。
回顾性分析 2011 年 11 月至 2021 年 4 月期间接受 TMVI 治疗的有症状退行性二尖瓣生物瓣或瓣环成形环和 MAC 的患者。根据二尖瓣瓣膜学术研究联盟（MVARC）标准定义终点，包括 30 天的器械和程序成功以及 30 天和 1 年的死亡率。
共有 77 例患者接受了 TMVI（瓣中瓣 [ViV=56]、瓣中环 [ViR=11] 和瓣中环钙化 [ViMAC=10]）。技术成功率有升高趋势（均为 93.5%，ViV 为 96.4%，ViR 为 90.9%，ViMAC 为 80%，p=0.06），30 天（均为 11.7%，ViV 为 10.7%，ViR 为 9.1%，ViMAC 为 20%，p=0.49）和 1 年死亡率（均为 26%，ViV 为 23.2%，ViR 为 27.3%，ViMAC 为 40%，p=0.36）均低于 ViMAC。
在 MAC 患者或再次二尖瓣手术的候选者中，TMVI 是一种合理的治疗选择。技术成功率和 1 年生存率与 TMVI 进行的亚组之间没有显著相关性。
