牛冠男,宋光远,吴永健

• 1:国家心血管病中心北京协和医学院中国医学科学院阜外医院结构性心脏病中心
• 2:首都医科大学附属北京安贞医院心脏瓣膜病介入治疗中心

摘要(Abstract)：

未经治疗的症状性二尖瓣重度反流患者5年死亡率高达50%,经胸瓣膜置换术是重度二尖瓣反流(MR)的首选治疗方案。由于部分MR患者为高龄或合并症较多,接受传统外科手术死亡率或并发症发生率较高,因而经导管二尖瓣置换术(TMVR)是外科手术高风险患者的新选择。二尖瓣生物瓣假体损毁、二尖瓣成形术失败、二尖瓣环严重钙化的患者由于解剖结构特殊,为介入瓣膜提供了较好的锚定区域,率先进行了TMVR的尝试。TMVR用于治疗二尖瓣生物瓣损毁的效果较好,可显著降低围术期死亡率,远期生存率高。而二尖瓣成形术失败或二尖瓣环严重钙化的患者,TMVR并发症较多,患者死亡风险增加,只适合用于特定的患者。TMVR术后左心室流出道梗阻及残余中度以上的MR可显著增加患者死亡风险并降低手术成功率,术前细致的评估对预防并发症的出现及降低远期死亡率有重要意义。

关键词(KeyWords)： 二尖瓣反流;经导管二尖瓣置换术;生物瓣损毁;二尖瓣环钙化;二尖瓣成形术失败

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 牛冠男,宋光远,吴永健

参考文献(References)：

• [1] Mirabel M, Iung B, Baron G, et al. What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? Eur Heart J, 2007, 28(11):1358-1365.
• [2] Goel SS, Bajaj N, Aggarwal B, et al. Prevalence and outcomes of unoperated patients with severe symptomatic mitral regurgitation and heart failure:comprehensive analysis to determine the potential role of Mitra Clip for this unmet need. J Am Coll Cardiol, 2014, 63(2):185-186.
• [3] Eleid MF. Mitral valve-in-valve/ring and other percutaneous treatments of surgical failures. Prog Cardiovasc Dis, 2017, 60(3):415-421.
• [4] Stone GW, Lindenfeld J, Abraham WT, et al. Transcatheter mitralvalve repair in patients with heart failure. N Engl J Med, 2018, 379(24):2307-2318.
• [5] Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis:first human case description. Circulation, 2002, 106(24):3006-3008.
• [6] Dvir D, Webb JG, Bleiziff er S, et al. Transcatheter aortic valve implantation in failed bioprosthetic surgical valves. JAMA, 2014,312(2):162-170.
• [7] Massera D, Kizer JR, Dweck MR. Mechanisms of mitral annular calcifi cation. Trends Cardiovasc Med, 2020, 30(5):289-295.
• [8] Cheung A, Webb JG, Wong DR, et al. Transapical transcatheter mitral valve-in-valve implantation in a human. Annals Thorac Surg,2009, 87(3):e18-e20.
• [9] Ye J, Cheung A, Yamashita M, et al. Transcatheter aortic and mitral valve-in-valve implantation for failed surgical bioprosthetic valves:an 8-year single-center experience. JACC Cardiovasc Interv, 2015, 8(13):1735-1744.
• [10] Codner P, Assali A, Vaknin-Assa H, et al. Treatment of aortic,mitral and tricuspid structural bioprosthetic valve deterioration using the valve-in-valve technique. J Heart Valve Dis, 2015, 24(3):345-352.
• [11] D’Onofrio A, Tarja E, Besola L, et al. Early and midterm clinical and hemodynamic outcomes of transcatheter valve-in-valve implantation:results from a multicenter experience. Ann Thorac Surg, 2016, 102(6):1966-1973.
• [12] Mukherjee C, Holzhey D, Mende M, et al. Initial experience with a percutaneous approach to redo mitral valve surgery:management and procedural success. J Cardiothorac Vasc Anesth, 2015, 29(4):889-897.
• [13] Conradi L, Silaschi M, Seiff ert M, et al. Transcatheter valvein-valve therapy using 6 diff erent devices in 4 anatomic positions:Clinical outcomes and technical considerations. J Thorac Cardiovasc Surg, 2015, 150(6):1557-1565, 1567.e1-e3, discussion 1565-1567.
• [14] Eleid MF, Whisenant BK, Cabalka AK, et al. Early outcomes of percutaneous transvenous transseptal transcatheter valve implantation in failed bioprosthetic mitral valves, ring annuloplasty, and severe mitral annular calcifi cation. JACC Cardiovasc Interv, 2017, 10(19):1932-1942.
• [15] Murzi M, Berti S, Gasbarri T, et al. Transapical transcatheter mitral valve-in-valve implantation versus minimally invasive surgery for failed mitral bioprostheses. Interact Cardiovasc Thorac Sur, 2017, 25(1):57-61.
• [16] Gaia DF, Braz AM, Simonato M, et al. Mitral implant of the Inovare transcatheter heart valve in failed surgical bioprostheses:a novel alternative for valve-in-valve procedures. Interac Cardiovasc Thorac Surg, 2017, 24(4):514-520.
• [17] Urena M, Brochet E, Lecomte M, et al. Clinical and haemodynamic outcomes of balloon-expandable transcatheter mitral valve implantation:a 7-year experience. Eur Heart J, 2018, 39(28):2679-2689.
• [18] Yoon SH, Whisenant BK, Bleiziffer S, et al. Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses,failed annuloplasty rings, and mitral annular calcifi cation. Eur Heart J, 2019, 40(5):441-451.
• [19] Takagi H, Hari Y, Kawai N, et al. A meta-analysis of valvein-valve and valve-in-ring transcatheter mitral valve implantation. J Interv Cardiol, 2018, 31(6):899-906.
• [20] de Weger A, Ewe SH, Delgado V, et al. First-in-man implantation of a trans-catheter aortic valve in a mitral annuloplasty ring:novel treatment modality for failed mitral valve repair. Eur J Cardiothorac Surg, 2011, 39(6):1054-1056.
• [21] Descoutures F, Himbert D, Maisano F, et al. Transcatheter valvein-ring implantation after failure of surgical mitral repair. Eur J Cardiothorac Surg, 2013, 44(1):e8-e15.
• [22] Hasan R, Mahadevan VS, Schneider H, et al. First in human transapical implantation of an inverted transcatheter aortic valve prosthesis to treat native mitral valve stenosis. Circulation, 2013, 128(6):e74-e76.
• [23] Guerrero M, Dvir D, Himbert D, et al. Transcatheter mitral valve replacement in native mitral valve disease with severe mitral annular calcifi cation:results from the fi rst multicenter global registry. JACC Cardiovasc Interv, 2016, 9(13):1361-1371.
• [24] Guerrero M, Urena M, Himbert D, et al. 1-Year outcomes of transcatheter mitral valve replacement in patients with severe mitral annular calcifi cation. J Am Coll Cardiol, 2018, 71(17):1841-1853.
• [25] Sorajja P, Gossl M, Babaliaros V, et al. Novel transcatheter mitral valve prosthesis for patients with severe mitral annular calcifi cation. J Am Coll Cardiol, 2019, 74(11):1431-1440.
• [26] Wang DD, Eng MH, Greenbaum AB, et al. Validating a prediction modeling tool for left ventricular outfl ow tract(LVOT)obstruction after transcatheter mitral valve replacement(TMVR). Catheter Cardiovasc Interv, 2018, 92(2):379-387.
• [27] Yoon SH, Bleiziff er S, Latib A, et al. Predictors of left ventricular outfl ow tract obstruction after transcatheter mitral valve replacement.JACC Cardiovasc Interv, 2019, 12(2):182-193.
• [28] Guerrero M, Wang DD, Himbert D, et al. Short-term results of alcohol septal ablation as a bail-out strategy to treat severe left ventricular outfl ow tract obstruction after transcatheter mitral valve replacement in patients with severe mitral annular calcification.Catheter Cardiovasc Interv, 2017, 90(7):1220-1226.
• [29] Babaliaros VC, Greenbaum AB, Khan JM, et al. Intentional percutaneous laceration of the anterior mitral leafl et to prevent outfl ow obstruction during transcatheter mitral valve replacement:first-inhuman experience. JACC Cardiovasc Interv, 2017, 10(8):798-809.
• [30] Sorajja P, Vemulapalli S, Feldman T, et al. Outcomes with transcatheter mitral valve repair in the United States:an STS/ACC TVT registry report. J Am Coll Cardiol, 2017, 70(19):2315-2327.