Blackman Daniel J, Schlosshan Dominik, Dawkins Sam, Smith Robert, Byrne Jonathan, MacCarthy Philip A
Professor of Interventional Cardiology.
Consultant Cardiologist Department of Cardiology, Leeds General Infirmary, Leeds, LS1 3EX.
Br J Cardiol. 2023 Oct 10;30(4):34. doi: 10.5837/bjc.2023.034. eCollection 2023.
Transcatheter edge-to-edge repair (TEER) was first performed in 2003, and is now established across the developed world as an effective, minimally invasive treatment option for patients with mitral regurgitation (MR). Multiple large registries have established the efficacy of mitral TEER in patients with primary or degenerative MR in whom surgery is considered prohibitive or high risk, while ongoing randomised-controlled trials will determine its role in younger and lower- risk patients. In patients with secondary or functional MR, in whom mitral valve surgery is not routinely recommended, the pivotal COAPT trial showed a profound reduction in both mortality and heart failure hospitalisation in carefully selected patients. NHS England approved the routine commissioning of mitral TEER in 2019, and following a substantial delay, due in large part to the COVID pandemic, the procedure is now widely available across the UK. This review article describes the TEER procedure, currently available devices, the underlying evidence base, and the key facts needed for clinicians to understand who, how, and where to refer patients for consideration of mitral TEER. The emerging role of TEER in patients with severe symptomatic tricuspid regurgitation is also considered.
经导管缘对缘修复术（TEER）于2003年首次实施，目前在发达国家已成为二尖瓣反流（MR）患者一种有效的微创治疗选择。多个大型登记研究证实，二尖瓣TEER对于那些被认为手术禁忌或手术风险高的原发性或退行性MR患者有效，而正在进行的随机对照试验将确定其在年轻和低风险患者中的作用。对于不常规推荐二尖瓣手术的继发性或功能性MR患者，关键的COAPT试验表明，在精心挑选的患者中，死亡率和心力衰竭住院率均大幅降低。英国国家医疗服务体系（NHS）英格兰分部于2019年批准了二尖瓣TEER的常规委托治疗，由于新冠疫情导致了相当长的延迟，目前该手术在英国已广泛开展。这篇综述文章描述了TEER手术、目前可用的设备、基础证据基础，以及临床医生了解哪些患者、如何以及在何处转诊患者以考虑二尖瓣TEER所需的关键事实。还讨论了TEER在严重症状性三尖瓣反流患者中的新兴作用。
