医疗辅助技术（介入治疗）国家临床医学研究中心 ,常青,董丽莉,李伟,刘健,潘文志,魏来,闫炀,张海波,赵丰

• 1:青岛大学附属医院
• 2:复旦大学附属中山医院
• 3:广东省人民医院
• 4:西安交通大学第一附属医院

摘要(Abstract)：

经导管二尖瓣缘对缘修复术（M-TEER）已成为高龄、外科手术高危的重度二尖瓣反流患者的重要治疗选择。除了手术操作及团队配合外，其围手术期管理同样重要，但在国内外尚缺乏围手术期抗血栓管理的规范性文件。本专家共识基于国内外循证证据及我国多中心临床实践，对M-TEER术后抗血栓管理提出规范建议，以期降低缺血及出血事件风险、改善患者生存质量。本共识从M-TEER术后血栓栓塞与出血的危险因素分析、风险分层评估、抗栓方案选择（抗凝与抗血小板治疗的适配场景）、抗栓治疗时程、器械相关血栓及出血并发症的处理等方面展开阐述，以期推动我国M-TEER技术规范安全地开展和推广，促进我国二尖瓣反流患者诊疗水平和生活质量的提升。

关键词(KeyWords)： 经导管二尖瓣缘对缘修复术;抗血栓;抗凝;抗血小板;围手术期管理

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 医疗辅助技术（介入治疗）国家临床医学研究中心 ,常青,董丽莉,李伟,刘健,潘文志,魏来,闫炀,张海波,赵丰

参考文献(References)：

• [1]中华医学会心血管病学分会.经导管二尖瓣缘对缘修复术的中国专家共识[J].中华心血管病杂志,2022,50(9):853-863.DOI:10.3760/cma.j.cn112148-20211212-01067.
• [2]Otto CM,Nishimura RA,Bonow RO,et al.2020 ACC/AHA guideline for the management of patients with valvular heart disease:a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J].Circulation,2021,143(5):e72-e227.DOI:10.1161/CIR.0000000000000923.
• [3]Praz F,Borger MA,Lanz J,et al.2025 ESC/EACTS guidelines for the management of valvular heart disease[J].Eur Heart J,2025,46(44):4635-4736.DOI:10.1093/eurheartj/ehaf194.
• [4]Orban M,Braun D,Sonne C,et al.Dangerous liaison:successful percutaneous edge-to-edge mitral valve repair in patients with endstage systolic heart failure can cause left ventricular thrombus formation[J].Euro Intervention,2014,10(2):253-259.DOI:10.4244/EIJV10I2A41.
• [5]Glatthaar A,Seizer P,Patzelt J,et al.Formation of a left atrial thrombus during percutaneous mitral valve edge-to-edge repair induced by acute reduction of mitral regurgitation[J].J Cardiol Cases,2017,17(1):33-35.DOI:10.1016/j.jccase.2017.09.001.
• [6]Rana A,Xu J,McMunn J,et al.Pulmonary vein thrombus after mitral valve transcatheter edge-to-edge repair[J].Methodist Debakey Cardiovasc J,2024,20(1):65-69.DOI:10.14797/mdcvj.1428.
• [7]Galanti K,Di Marino M,Mansour D,et al.Current antithrombotic treatments for cardiovascular diseases:a comprehensive review[J].Rev Cardiovasc Med,2024,25(8):281.DOI:10.31083/j.rcm2508281.
• [8]Stone GW,Adams DH,Abraham WT,et al.Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement:part 2:endpoint definitions:a consensus document from the Mitral Valve Academic Research Consortium[J].J Am Coll Cardiol,2015,66(3):308-321.DOI:10.1016/j.jacc.2015.05.049.
• [9]Kawashima H,Numasawa Y,Hayakawa N,et al.Review of bleeding and thrombotic risks associated with antithrombotic therapy after transcatheter structural heart interventions[J].JACC Asia,2023,4(1):1-9.DOI:10.1016/j.jacasi.2023.08.004.
• [10]Gheorghe L,Ielasi A,Rensing BJWM,et al.Complications following percutaneous mitral valve repair[J].Front Cardiovasc Med,2019,6:146.DOI:10.3389/fcvm.2019.00146.
• [11]Schnitzler K,Hell M,Geyer M,et al.Complications following MitraClip implantation[J].Curr Cardiol Rep,2021,23(9):131.DOI:10.1007/s11886-021-01553-9.
• [12]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].J Am Coll Cardiol,2017,70(19):2315-2327.DOI:10.1016/j.jacc.2017.09.015.
• [13]Mack M,Carroll JD,Thourani V,et al.Transcatheter mitral valve therapy in the United States:a report from the STS/ACC TVT registry[J].Ann Thorac Surg,2022,113(1):337-365.DOI:10.1016/j.athoracsur.2021.07.030.
• [14]Mitsis A,Kyriakou M,Christodoulou E,et al.Antithrombotic therapy following structural heart disease interventions:current status and future directions[J].Rev Cardiovasc Med,2024,25(2):60.DOI:10.31083/j.rcm2502060.
• [15]Geisler T,Jorbenadze R,Popov AF,et al.Thrombogenicity and antithrombotic strategies in structural heart interventions and nonaortic cardiac device therapy-current evidence and practice[J].Thromb Haemost,2019,119(10):1590-1605.DOI:10.1055/s-0039-1694751.
• [16]CalabròP,Gragnano F,Niccoli G,et al.Antithrombotic therapy in patients undergoing transcatheter interventions for structural heart disease[J].Circulation,2021,144(16):1323-1343.DOI:10.1161/CIRCULATIONAHA.121.054305.
• [17]Maznyczka A,Pilgrim T.Antithrombotic treatment after transcatheter valve interventions:current status and future directions[J].Clin Ther,2024,46(2):122-133.DOI:10.1016/j.clinthera.2023.09.028.
• [18]Giordano A,Ferraro P,Finizio F,et al.Incidence and predictors of cerebrovascular accidents in patients who underwent transcatheter mitral valve repair with MitraClip[J].Am J Cardiol,2024,228:24-33.DOI:10.1016/j.amjcard.2024.07.037.
• [19]Kappetein AP,Head SJ,Généreux P,et al.Updated standardized endpoint definitions for transcatheter aortic valve implantation:the Valve Academic Research Consortium-2 consensus document[J].Eur Heart J,2012,33(19):2403-2418.DOI:10.1093/eurheartj/ehs255.
• [20]Mehran R,Rao SV,Bhatt DL,et al.Standardized bleeding definitions for cardiovascular clinical trials:a consensus report from the Bleeding Academic Research Consortium[J].Circulation,2011,123(23):2736-2747.DOI:10.1161/CIRCULATIONAHA.110.009449.
• [21]Singh N,Cohen DJ,Shah MA,et al.Trends,predictors,and outcomes of bleeding complications after mitral transcatheter edge-toedge repair:TVT registry insights[J].JACC Cardiovasc Interv,2024,17(20):2337-2349.DOI:10.1016/j.jcin.2024.09.035.
• [22]Eggebrecht H,Schelle S,Puls M,et al.Risk and outcomes of complications during and after MitraClip implantation:experience in 828 patients from the German TRAnscatheter mitral valve interventions(TRAMI)registry[J].Catheter Cardiovasc Interv,2015,86(4):728-735.DOI:10.1002/ccd.25838.
• [23]Douketis JD,Spyropoulos AC,Spencer FA,et al.Perioperative management of antithrombotic therapy:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012,141(2 Suppl):e326S-e350S.DOI:10.1378/chest.11-2298.
• [24]Casselman FPA,Lance MD,Ahmed A,et al.2024 EACTS/EACTAIC guidelines on patient blood management in adult cardiac surgery in collaboration with EBCP[J].Eur J Cardiothorac Surg,2025,67(5):ezae352.DOI:10.1093/ejcts/ezae352.
• [25]Nusca A,Bressi E,Colaiori I,et al.Antiplatelet therapy in valvular and structural heart disease interventions[J].Cardiovasc Diagn Ther,2018,8(5):678-693.DOI:10.21037/cdt.2018.06.08.
• [26]Feldman T,Wasserman HS,Herrmann HC,et al.Percutaneous mitral valve repair using the edge-to-edge technique:sixmonth results of the EVEREST PhaseⅠclinical trial[J].J Am Coll Cardiol,2005,46(11):2134-2140.DOI:10.1016/j.jacc.2005.07.065.
• [27]Mauri L,Garg P,Massaro JM,et al.The EVERESTⅡtrial:design and rationale for a randomized study of the evalve mitraclip system compared with mitral valve surgery for mitral regurgitation[J].Am Heart J,2010,160(1):23-29.DOI:10.1016/j.ahj.2010.04.009.
• [28]Feldman T,Foster E,Glower DD,et al.Percutaneous repair or surgery for mitral regurgitation[J].N Engl J Med,2011,364(15):1395-1406.DOI:10.1056/NEJMoa1009355.
• [29]Glower DD,Kar S,Trento A,et al.Percutaneous mitral valve repair for mitral regurgitation in high-risk patients:results of the EVERESTⅡstudy[J].J Am Coll Cardiol,2014,64(2):172-181.DOI:10.1016/j.jacc.2013.12.062.
• [30]Whitlow PL,Feldman T,Pedersen WR,et al.Acute and 12-month results with catheter-based mitral valve leaflet repair:the EVERESTⅡ(Endovascular Valve Edge-to-Edge Repair) high risk study[J].J Am Coll Cardiol,2012,59(2):130-139.DOI:10.1016/j.jacc.2011.08.067.
• [31]Maisano F,Franzen O,Baldus S,et al.Percutaneous mitral valve interventions in the real world:early and 1-year results from the ACCESS-EU,a prospective,multicenter,nonrandomized postapproval study of the MitraClip therapy in Europe[J].J Am Coll Cardiol,2013,62(12):1052-1061.DOI:10.1016/j.jacc.2013.02.094.
• [32]Stone GW,Lindenfeld J,Abraham WT,et al.Transcatheter mitralvalve repair in patients with heart failure[J].N Engl J Med,2018,379(24):2307-2318.DOI:10.1056/NEJMoa1806640.
• [33]Obadia JF,Messika-Zeitoun D,Leurent G,et al.Percutaneous repair or medical treatment for secondary mitral regurgitation[J].N Engl J Med,2018,379(24):2297-2306.DOI:10.1056/NEJMoa1805374.
• [34]中国医师协会心血管内科医师分会结构性心脏病学组,亚太结构性心脏病俱乐部.中国经导管二尖瓣缘对缘修复术临床路径(2022版)精简版[J].中国介入心脏病学杂志,2023,31(3):161-173.DOI:10.3969/j.issn.1004-8812.2023.03.001.
• [35]中国医师协会心血管内科医师分会,中国康复医学会心脏介入治疗和康复专业委员会,中国医院协会心脏康复管理专业委员会.经导管二尖瓣缘对缘修复术患者心脏康复中国专家共识[J].中国介入心脏病学杂志,2023,31(4):252-265.DOI:10.3969/j.issn.1004-8812.2023.04.002.
• [36]Hohmann C,Ludwig M,Walker J,et al.Real-world anticoagulatory treatment after percutaneous mitral valve repair using MitraClip:a retrospective,observational study on 1 300 patients[J].Clin Res Cardiol,2022,111(8):889-899.DOI:10.1007/s00392-022-01988-2.
• [37]Waechter C,Ausbuettel F,Chatzis G,et al.Antithrombotic treatment and its association with outcome in a multicenter cohort of transcatheter edge-to-edge mitral valve repair patients[J].J Cardiovasc Dev Dis,2022,9(11):366.DOI:10.3390/jcdd9110366.
• [38]Jarrar Y,Alomari L,Otabor E,et al.A safer bet for MitraClip:choosing between single antiplatelet therapy and dual antiplatelet therapy[J].Int J Cardiol,2025,437:133476.DOI:10.1016/j.ijcard.2025.133476.
• [39]Muscoli S,Cammalleri V,Marsili G,et al.Antithrombotic strategies after transcatheter edge-to-edge repair:clinical implications from the MitraSafe study[J].J Cardiovasc Med(Hagerstown),2026,27(1):4-12.DOI:10.2459/JCM.0000000000001792.
• [40]van der Wall SJ,Olsthoorn JR,Heuts S,et al.Antithrombotic therapy after mitral valve repair:VKA or aspirin?[J].J Thromb Thrombolysis,2018,46(4):473-481.DOI:10.1007/s11239-018-1724-0.
• [41]Pan W,Long Y,Guo Y,et al.Transapical edge-to-edge repair system in high-risk patients with degenerative mitral regurgitation:a multicenter trial(CLAMP-2)[J].JACC Cardiovasc Interv,2023,16(18):2340-2342.DOI:10.1016/j.jcin.2023.06.035.
• [42]Jin Q,Li W,Fan J,et al.Outcomes of a transapical edge-toedge repair system in secondary mitral regurgitation[J].J Invasive Cardiol,2025,37(5).DOI:10.25270/jic/24.00234.
• [43]Hu C,Ge Z,Li W,et al.2-year results and myocardial impact of transapical mitral valve repair in patients with primary mitral regurgitation:an echocardiographic study[J].J Cardiothorac Surg,2024,19(1):403.DOI:10.1186/s13019-024-02827-3.
• [44]Abaci A,Unlu S,Alsancak Y,et al.Short and long term complications of device closure of atrial septal defect and patent foramen ovale:meta-analysis of 28 142 patients from 203 studies[J].Catheter Cardiovasc Interv,2013,82(7):1123-1138.DOI:10.1002/ccd.24875.
• [45]Gurvitz M,Krieger EV,Fuller S,et al.2025 ACC/AHA/HRS/ISACHD/SCAI guideline for the management of adults with congenital heart disease:a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines[J].Circulation,2026,153(8):e115-e251.DOI:10.1161/CIR.0000000000001402.
• [46]Guedeney P,Rodés-Cabau J,Ten Berg JM,et al.Antithrombotic therapy for transcatheter structural heart intervention[J].Euro Intervention,2024,20(16):972-986.DOI:10.4244/EIJ-D-23-01084.
• [47]国家卫生健康委员会国家结构性心脏病介入质量控制中心,国家心血管病中心结构性心脏病介入质量控制中心,中华医学会心血管病学分会先心病经皮介入治疗指南工作组,等.常见先天性心脏病经皮介入治疗指南(2021版)[J].中华医学杂志,2021,101(38):3054-3076.DOI:10.3760/cma.j.cn112137-20210730-01696.
• [48]Ladich E,Michaels MB,Jones RM,et al.Pathological healing response of explanted MitraClip devices[J].Circulation,2011,123(13):1418-1427.DOI:10.1161/CIRCULATIONAHA.110.978130.
• [49]中国医师协会心血管内科医师分会结构性心脏病学组,亚太结构性心脏病俱乐部.中国经导管主动脉瓣置换术临床路径专家共识(2024版)[J].中国介入心脏病学杂志,2024,32(11):601-617.DOI:10.3969/j.issn.1004-8812.2024.11.001.
• [50]Claeys MJ,Aminian A,Bartunek J,et al.Bleeding and thrombotic risk of different antiplatelet regimens posttranscatheter edge-toedge mitral valve repair in patients with an indication for oral anticoagulation:Results from an all-comers national registry[J].Catheter Cardiovasc Interv,2024,103(2):382-388.DOI:10.1002/ccd.30931.
• [51]Schipper JH,Sommer AS,Nies RJ,et al.Direct oral anticoagulants versus vitamin K antagonists after mitral valve transcatheter edge-to-edge repair in patients with atrial fibrillation:a singlecenter observational study[J].J Am Heart Assoc,2025,14(3):e038834 DOI:10.1161/JAHA.124.038834.
• [52]Ahmad S,Albaeni A,Salehin S,et al.Effect of periprocedural anticoagulation on patient outcomes after transcatheter edge to edge repair of mitral valve with MitraClipTM);an insight from nationwide dataset[J].Int J Cardiol Heart Vasc,2025,57:101644.DOI:10.1016/j.ijcha.2025.101644.
• [53]王国轩,常青.经导管二尖瓣缘对缘修复术后抗血栓治疗策略的研究进展[J].中国临床实用医学,2026,17(3):161-166.DOI:10.3760/cma.j.cn115570-20260113-00039.
• [54]中华医学会老年医学分会老年神经病学组,北京神经科学学会血管神经病学专业委员会,心源性卒中治疗中国专家共识组.心源性卒中治疗中国专家共识(2022)[J].中华医学杂志,2022,102(11):760-773.DOI:10.3760/cma.j.cn112137-20210712-01555.
• [55]中华医学会心电生理和起搏分会,中国医师协会心律学专业委员会.中国心房颤动管理指南(2025)[J].中国心脏起搏与心电生理杂志,2025,39(4):273-343.DOI:10.13333/j.cnki.cjcpe.2025.04.001.
• [56]中华医学会胸心血管外科分会瓣膜病外科学组.心脏瓣膜外科抗凝治疗中国专家共识[J].中华胸心血管外科杂志,2022,38(3):164-174.DOI:10.3760/cma.j.cn112434-20220126-00028.
• [57]刘晓辉,宋景春,张进华,等.中国抗血栓药物相关出血诊疗规范专家共识[J].解放军医学杂志,2022,47(12):1169-1179.DOI:10.11855/j.issn.0577-7402.2022.12.1169.
• [58]Wang C,Liu Z,Li Z,et al.Strategies for antithrombotic tRreatment following transcatheter edge-to-edge repair in patients with severe mitral regurgitation:rationale and design of STAR-TEER trial[J].Am Heart J,2026,296:107362.DOI:10.1016/j.ahj.2026.107362.