Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria.
Department of Cardiac, Vascular, and Thoracic Surgery, Kepler University Hospital, Linz, Austria.
EuroIntervention. 2024 Nov 18;20(22):1419-1429. doi: 10.4244/EIJ-D-24-00490.
The MitraCut procedure employs beating heart transapical (TA) cannulation and endoscopic scissors for dividing the anterior mitral leaflet (AML) to prevent left ventricular outflow tract (LVOT) obstruction in transapical transcatheter mitral valve replacement (TA-TMVR).
We present the first multicentre experience of the MitraCut procedure prior to TA-TMVR to prevent LVOT obstruction.
In 6 European centres, the clinical outcomes of all 13 high-risk patients who had undergone the MitraCut procedure during TA-TMVR procedures were retrospectively reviewed regarding technical success, procedural details and outcome.
The MitraCut procedure was successfully completed in 11 patients with 1 cutting attempt, while 2 patients had 2 cutting attempts, with an average procedure duration of 9.0±5.4 min. No patient demonstrated postoperative LVOT obstruction, and all mitral valve (MV) prostheses were competent throughout the follow-up period. However, 1 patient developed a MitraCut-related paravalvular leak (PVL; technical success rate: 12/13). The mean LVOT gradient was 3.9±4.4 mmHg directly after valve expansion and 3.6±3.1 mmHg at follow-up. In-hospital and 30-day mortality were 0%. One patient experiencing MitraCut-related PVL was successfully treated by interventional PVL closure (reintervention rate: n=1). One patient died at 47 days due to cardiac arrhythmia, unrelated to the AML-directed procedure. The mean follow-up at the time of data analysis was 52±34 days.
The MitraCut procedure was effective and reproducible for preventing potential LVOT obstruction in TA-TMVR patients during its initial exploration in 6 European hospitals. Considerations regarding the scissors' characteristics, their handling and cut length are mandatory for safe performance of the procedure.
MitraCut 手术采用跳动心脏经心尖（TA）插管和内镜剪刀来分割前二尖瓣叶（AML），以防止经心尖经导管二尖瓣置换术（TA-TMVR）中的左心室流出道（LVOT）阻塞。
我们介绍了在 TA-TMVR 之前进行 MitraCut 手术以预防 LVOT 阻塞的首例多中心经验。
在 6 个欧洲中心，回顾性分析了 13 例高危患者在 TA-TMVR 过程中进行 MitraCut 手术的所有临床结果，评估技术成功率、手术细节和结果。
MitraCut 手术在 11 例患者中成功完成，其中 1 例尝试 1 次，2 例尝试 2 次，平均手术时间为 9.0±5.4 分钟。无患者术后出现 LVOT 阻塞，所有二尖瓣（MV）假体在整个随访期间均功能正常。然而，1 例患者出现与 MitraCut 相关的瓣周漏（PVL；技术成功率：12/13）。瓣膜扩张后直接测量的 LVOT 梯度为 3.9±4.4mmHg，随访时为 3.6±3.1mmHg。住院期间和 30 天死亡率均为 0%。1 例因 MitraCut 相关 PVL 而行介入性 PVL 封堵术（再干预率：n=1）。1 例患者因心律失常在 47 天时死亡，与 AML 定向手术无关。数据分析时的平均随访时间为 52±34 天。
在 6 家欧洲医院对 MitraCut 手术进行初步探索时，该手术对于预防 TA-TMVR 患者潜在的 LVOT 阻塞是有效且可重复的。必须考虑剪刀的特点、操作和切割长度，以确保手术的安全进行。
