Frazzetto Marco, Sanfilippo Claudio, Briguglio Francesco, Giacalone Chiara, Contrafatto Claudia, Munafò Andrea, Bonanni Michela, Oreglia Jacopo, Costa Giuliano, Attizzani Guilherme, Capodanno Davide, Grasso Carmelo
Harrington Heart & Vascular Institute, University Hospitals, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA.
De Gasperis Cardio Center, Interventional Cardiology Unit, Niguarda Hospital, 20162 Milan, Italy.
Rev Cardiovasc Med. 2025 Apr 21;26(4):33396. doi: 10.31083/RCM33396. eCollection 2025 Apr.
Acute ischemic mitral regurgitation is a rare but potentially catastrophic complication following acute myocardial infarction (AMI), characterized by severe clinical presentation and high mortality. Meanwhile, advancements in primary percutaneous coronary intervention (PCI) have reduced the incidence of acute mitral regurgitation (AMR). The surgical approach remains the standard treatment but is associated with high rates of complications and in-hospital mortality, particularly in patients with cardiogenic shock or mechanical complications, such as papillary muscle rupture. Mitral transcatheter edge-to-edge repair (M-TEER) has emerged as a minimally invasive treatment. Current evidence demonstrates the feasibility and safety of M-TEER in reducing mitral regurgitation, stabilizing hemodynamics, and improving in-hospital and short-term survival. The procedural success rate is high, with notable symptoms and functional status improvements. Mortality rates remain significant, reflecting the severity of AMR, but are lower compared to medical management alone. Challenges remain regarding the optimal timing of M-TEER, long-term device durability, and patient selection criteria. Ongoing iterations in device technology and procedural techniques are expected to enhance outcomes. This review highlights the role of M-TEER in AMR management, emphasizing the need for multidisciplinary decision-making and further research to refine M-TEER application and improve outcomes in this high-risk AMR population.
急性缺血性二尖瓣反流是急性心肌梗死（AMI）后一种罕见但可能具有灾难性的并发症，其特点是临床表现严重且死亡率高。同时，原发性经皮冠状动脉介入治疗（PCI）的进展降低了急性二尖瓣反流（AMR）的发生率。手术方法仍然是标准治疗，但并发症发生率和院内死亡率较高，特别是在有心源性休克或机械并发症（如乳头肌破裂）的患者中。二尖瓣经导管缘对缘修复术（M-TEER）已成为一种微创治疗方法。目前的证据表明M-TEER在减少二尖瓣反流、稳定血流动力学以及改善院内和短期生存率方面具有可行性和安全性。手术成功率高，症状和功能状态有显著改善。死亡率仍然较高，反映了AMR的严重性，但与单纯药物治疗相比有所降低。关于M-TEER的最佳时机、长期器械耐用性和患者选择标准仍存在挑战。器械技术和手术技术的不断迭代有望改善治疗结果。本综述强调了M-TEER在AMR管理中的作用，强调了多学科决策的必要性以及进一步研究以完善M-TEER的应用并改善这一高风险AMR人群的治疗结果。
