Giustino Gennaro, Asselin Chantal Y, Naguib Mostafa, Jabri Ahmad, Lok Lai Leo Kar, Kipperman Robert, Koulogiannis Kostantinos P, Marcoff Leo, Abbas Amr, Villablanca Pedro, Généreux Philippe
Gagnon Cardiovascular Institute, Atlantic Health System, Morristown, New Jersey, United States.
Department of Cardiovascular Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, United States.
Struct Heart. 2025 Jun 24;9(8):100683. doi: 10.1016/j.shj.2025.100683. eCollection 2025 Aug.
Severe calcific mitral stenosis is common and therapeutically challenging. Intravascular lithotripsy (IVL) can facilitate percutaneous balloon mitral valvuloplasty in patients not amenable to conventional therapies. We describe a modified technique using larger IVL balloons to ensure maximal annular contact and delivery of ultrasonic shockwaves to restore mitral leaflet pliability and reduce transvalvular gradients without the need for noncompliant valvuloplasty balloons.
Seven patients underwent the Mitral Annulo-TRIpsy in eXtreme risk patients (MATRIX) procedure at 3 tertiary structural heart disease centers in the United States. Transcatheter mitral valve replacement was contraindicated due to prohibitive risk of left ventricular outflow tract obstruction or insufficient annular calcification for anchoring of a balloon-expandable valve. IVL balloons were delivered using a large-bore transseptal sheath over three 0.014 wires. Runs of delivery of IVL therapy were repeated until satisfactory results in terms of mean mitral gradient (mMG) reduction were achieved.
Median age was 78 years, and 14.3% were female. All patients presented with progressive New York Heart Association class III-IV symptoms and functional limitations. Pre-MATRIX mMG was 9.0 mmHg. The final mMG was 3.0 mmHg (absolute difference 6.3 mmHg; 95% CI 2.6-10.1 mmHg; <0.01). No conventional valvuloplasty balloons were used after IVL. All patients successfully underwent MATRIX. No major periprocedural complications were observed including death, stroke, major bleeding, or reintervention. No patients experienced worsening mitral regurgitation. All patients were discharged alive.
This small multicenter series demonstrates that IVL of calcified mitral stenosis using the MATRIX technique is feasible and safe and associated with effective reductions in mMG.
重度钙化性二尖瓣狭窄很常见，治疗具有挑战性。血管内碎石术（IVL）可促进对传统治疗不适用的患者进行经皮球囊二尖瓣成形术。我们描述了一种改良技术，使用更大的IVL球囊以确保最大程度的瓣环接触并传递超声波冲击波，从而恢复二尖瓣叶的柔韧性并降低跨瓣压差，而无需使用非顺应性瓣膜成形球囊。
7例患者在美国3家三级结构性心脏病中心接受了极高风险患者二尖瓣环碎石术（MATRIX）。由于左心室流出道梗阻风险过高或瓣环钙化不足无法锚定球囊扩张瓣膜，经导管二尖瓣置换术被视为禁忌。通过一根大口径经房间隔鞘管，在三根0.014导丝上输送IVL球囊。重复进行IVL治疗，直到平均二尖瓣压差（mMG）降低取得满意结果。
患者中位年龄为78岁，女性占14.3%。所有患者均表现为纽约心脏协会心功能Ⅲ - Ⅳ级的进行性症状和功能受限。MATRIX术前mMG为9.0 mmHg。最终mMG为3.0 mmHg（绝对差值6.3 mmHg；95%置信区间2.6 - 10.1 mmHg；P<0.01）。IVL术后未使用传统瓣膜成形球囊。所有患者均成功完成MATRIX。未观察到主要的围手术期并发症，包括死亡、中风、大出血或再次干预。无患者出现二尖瓣反流加重。所有患者均存活出院。
这个小型多中心系列研究表明，使用MATRIX技术对钙化性二尖瓣狭窄进行IVL是可行且安全的，并能有效降低mMG。
