潘文志,龙愉良,周达新,葛均波

• 1:复旦大学附属中山医院心内科上海市心血管病研究所国家放射与治疗临床医学研究中心

摘要(Abstract)：

经导管缘对缘修复（TEER）是目前应用最广泛、证据最多的二尖瓣反流（MR）介入治疗技术，并得到最新版指南的肯定。笔者目前将TEER定义为一项基于外科二尖瓣缘对缘修复术的经导管介入技术，其采用二尖瓣夹合装置，经股静脉或心尖路径置入，在超声及X线引导下夹住MR区的前、后瓣叶并使之接合，使心脏收缩期时瓣叶之间间歇减少或消失，而舒张期时瓣口变成双孔或多孔，从而达到减少或消除MR的效果。TEER的器械可根据夹合装置的锁定原理分为机械锁定、自锁定和闭环锁定三类，代表器械分别为MitraClip、PASCAL以及ValveClamp系统。MitraClip G4是最新一代TEER器械，夹臂增宽至6mm，操作更便捷，可实现瓣膜分别捕获，心房压力检测。EXPANDG4研究结果显示，急性手术的成功率为97.4%。30d随访时，95.9%患者MR≤2+，平均压差4.4 mmHg(1 mmHg=0.133 kPa),30 d全因死亡率为1.5%，其效果已经接近外科手术效果。PASCAL Ace系统的基本形态及工作原理同PASCAL，但其夹臂更窄、中央的隔离球更小。German CLASP研究结果显示，急性手术的成功率为96.4%,30d随访时，器械成功率为81.9%，临床成功率为86.9%。CLASP研究2年超声心动图随访结果示，78%的患者MR≤1+,97%患者MR≤2+。TEER技术未来发展方向包括治疗非中心性MR、向中低危人群扩展、应用于三尖瓣反流的介入治疗、TEER失效后再次介入治疗以及现有器械进一步迭代升级，全新器械的设计研发等。

关键词(KeyWords)： 二尖瓣反流;经导管缘对缘修复;夹合

Abstract:

Keywords:

基金项目(Foundation): 国家重点研发计划资助项目（2020YFC2008100）;; 上海市放射与治疗（介入治疗）临床医学研究中心基金项目（19MC1910300）

作者(Author): 潘文志,龙愉良,周达新,葛均波

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