卢志南,宋光远,潘文志,刘先宝,蒲朝霞,李伟,科雨彤,刘然,李捷,李飞,尚小珂,张晓春,朱政斌,张龙岩,姜正明,弭守玲,方臻飞,徐凯,韩克,张东会,王斌,方军,刘长福,张兆国,喻鹏铭

• 1:中国医师协会心血管内科医师分会结构性心脏病学组
• 2:亚太结构性心脏病俱乐部
• 3:首都医科大学附属北京安贞医院
• 4:复旦大学附属中山医院

摘要(Abstract)：

经导管二尖瓣缘对缘修复术（TEER）已成为外科手术高危的重度二尖瓣反流患者的重要治疗选择，TEER的手术流程复杂，团队协作要求高，在中国尚缺乏规范的临床路径。基于当前循证医学证据，针对TEER团队建设、患者临床评估、影像评估、手术规范流程、复杂病变处理、围术期管理、全生命周期康复和随访等临床关注的关键问题，专家组有针对性撰写了此临床路径，以推动我国TEER安全、规范地开展和普及，进而提高我国二尖瓣反流的诊疗水平以及改善患者预后。

关键词(KeyWords)： 经导管二尖瓣缘对缘修复术;影像;手术流程;围术期管理;康复

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 卢志南,宋光远,潘文志,刘先宝,蒲朝霞,李伟,科雨彤,刘然,李捷,李飞,尚小珂,张晓春,朱政斌,张龙岩,姜正明,弭守玲,方臻飞,徐凯,韩克,张东会,王斌,方军,刘长福,张兆国,喻鹏铭

参考文献(References)：

• [1]潘文志，周达新，葛均波.中国二尖瓣反流患者人群数量的估测[J].中国胸心血管外科临床杂志，2021, 28(5):495-498. DOI:10.7507/1007-4848.202012080.
• [2]聂静雨，王增武，张林峰，等. 35岁及以上人群二尖瓣反流现状及其影响因素研究[J].中国循环杂志，2017, 32(5):475-479. DOI:10.3969/j.issn.1000-3614.2017.05.013.
• [3] Xu H, Liu Q, Cao K, et al. Distribution, characteristics,and management of older patients with valvular heart disease in China:China-DVD study[J]. JACC Asia, 2022, 2(3):354-365. DOI:10.1016/j.jacasi.2021.11.013.
• [4] Condado JA, Acquatella H, Rodriguez L, et al. Percutaneous edge-toedge mitral valve repair:2-year follow-up in the first human case[J].Catheter Cardiovasc Interv, 2006, 67(2):323-325. DOI:10.1002/ccd.20603.
• [5] Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelinesfor the management of valvular heart disease[J]. Eur Heart J, 2022,43(7):561-632. DOI:10.1093/eurheartj/ehab395.
• [6] 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]. J Am Coll Cardiol, 2021, 77(4):e25-e197. DOI:10.1016/j.jacc.2020.11.018.
• [7]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.
• [8]亚太心脏病学会专家组.经导管缘对缘技术（MitraClip）治疗二尖瓣反流——亚太心脏病学会（APSC）专家共识[J].中国循环杂志，2022, 37(1):4-11. DOI:10.3969/j.issn.1000-3614.2022.01.002.
• [9] Packer M, Grayburn PA. New evidence supporting a n o v e l conceptual framework for distinguishing proportionate and disproportionate functional mitral regurgitation[J].JAMA Cardiol,2020, 5(4):469-475. DOI:10.1001/jamacardio.2019.5971.
• [10] Wunderlich NC, Beigel R, Ho SY, et al. Imaging for mitral interventions:methods and efficacy[J]. JACC Cardiovasc Imaging,2018, 11(6):872-901. DOI:10.1016/j.jcmg.2018.02.024.
• [11] Bax JJ, Debonnaire P, Lancellotti P, et al. Transcatheter interventions for mitral regurgitation:multimodality imaging for patient selection and procedural guidance[J]. JACC Cardiovasc Imaging, 2019,12(10):2029-2048. DOI:10.1016/j.jcmg.2019.03.036.
• [12] Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation:a report from the American Society of Echocardiography Developed in collaboration with the Society for Cardiovascular Magnetic Resonance[J]. J Am Soc Echocardiogr, 2017, 30(4):303-371. DOI:10.1016/j.echo.2017.01.007.
• [13]中国医师协会超声分会超声心动图专业委员会，中华医学会超声医学分会超声心动图学组，中华医学会心血管病分会结构性心脏病学组，等.二尖瓣反流介入治疗的超声心动图评价中国专家共识[J].中国介入心脏病学杂志，2019, 27(1):6-12. DOI:10.3969/j.issn.1004-8812.2019.01.003.
• [14] Lim DS, Herrmann HC, Grayburn P, et al. Consensus document on non-suitability for transcatheter mitral valve repair by edgeto-edge therapy[J]. Structural Heart, 2021, 5(3):227-233. DOI:10.1080/24748706.2021.1902595.
• [15] Sato K, Jones PM. Sedation versus general anesthesia for transcatheter aortic valve replacement[J]. J Thorac Dis,2018,10(Suppl 30):S3588-S3594. DOI:10.21037/jtd.2018.08.89.
• [16] Ahmad M, Patel JN, Vipparthy SC, et al. Conscious sedation versus general anesthesia in transcatheter aortic valve replacement:a cost and outcome analysis[J]. Cureus,2019, 11(6):e4812. DOI:10.7759/cureus.4812.
• [17] Butala NM, Chung M, Secemsky EA, et al. Conscious sedation versus general anesthesia for transcatheter aortic valve replacement:variation in practice and outcomes[J]. JACC Cardiovasc Interv,2020, 13(11):1277-1287. DOI:10.1016/j.jcin.2020.03.008.
• [18] Melillo F, Fisicaro A, Stella S, et al. Systematic fluoroscopicechocardiographic fusion imaging protocol for transcatheter edge-to-edge mitral valve repair intraprocedural monitoring[J]. J Am Soc Echocardiogr, 2021, 34(6):604-613. DOI:10.1016/j.echo.2021.01.010.
• [19] Ge Z, Pan C, Li W, et al. Real-time monitoring and stepby-step guidance for transapical mitral valve edge-to-edge repair using transesophageal echocardiography[J]. J Interv Cardiol,2021, 2021:6659261. DOI:10.1155/2021/6659261.
• [20] Patzelt J, Zhang Y, Seizer P, et al. Effects of mechanical ventilation on heart geometry and mitral valve leafl et coaptation during percutaneous edge-to-edge mitral valve repair[J]. JACC Cardiovasc Interv, 2016, 9(2):151-159. DOI:10.1016/j.jcin.2015.09.038.
• [21] Borgia F, Di Mario C, Franzen O. Adenosine-induced asystole to facilitate MitraClip placement in a patient with adverse mitral valve morphology[J]. Heart, 2011, 97(10):864.DOI:10.1136/hrt.2010.208132.
• [22] Gavazzoni M, Taramasso M, Zuber M, et al. Conceiving Mitra Clip as a tool:percutaneous edge-to-edge repair in complex mitral valve anatomies[J]. Eur Heart J Cardiovasc Imaging,2020, 21(10):1059-1067. DOI:10.1093/ehjci/jeaa062.
• [23] Singh GD, Smith TW, Rogers JH. Multi-MitraClip therapy for severe degenerative mitral regurgitation:"anchor"technique for extremely fl ail segments[J]. Catheter Cardiovasc Interv,2015, 86(2):339-346.DOI:10.1002/ccd.25811.
• [24] Ta r a m a s s o M, M a i s a n o F. C h a l l e n g i n g m i t r a l c l e f t s with MitraClip:the convergent clips strategy[J].EuroIntervention, 2016, 12(8):e1071. DOI:10.4244/EIJV12I8A173.
• [25] Cheng R, Kar S, Siegel RJ, et al. Cleft mitral leafl ets and severe mitral regurgitation:testing the limits of percutaneous mitral valve repair[J]. Catheter Cardiovasc Interv, 2019,93(6):1161-1164. DOI:10.1002/ccd.27980.
• [26] Sannino A, Grayburn PA. Mitral regurgitation in patients with severe aortic stenosis:diagnosis and management[J]. Heart,2018, 104(1):16-22. DOI:10.1136/heartjnl-2017-311552.
• [27] 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.
• [28] Guyatt GH, Akl EA, Crowther M, et al. Introduction to the ninth edition:antithrombotic therapy and prevention of thrombosis, 9th ed:American College of Chest Physicians evidence-based clinical practice guidelines[J]. Chest, 2012,141(2 Suppl):48S-52S. DOI:10.1378/chest.11-2286.
• [29] 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.
• [30] 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.
• [31] Praz F, Braun D, Unterhuber M, et al. Edge-to-edge mitral valve repair with extended clip arms:early experience from a multicenter observational study[J]. JACC Cardiovasc Interv, 2019, 12(14):1356-1365. DOI:10.1016/j.jcin.2019.03.023.
• [32] Gheorghe L, Ielasi A, Rensing B, et al. Complications following percutaneous mitral valve repair[J]. Front Cardiovasc Med, 2019, 6:146. DOI:10.3389/fcvm.2019.00146.
• [33] 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.
• [34] Ikenaga H, Hayashi A, Nagaura T, et al. Left atrial pressure is associated with iatrogenic atrial septal defect after mitralvalve clip[J]. Heart, 2019, 105(11):864-872. DOI:10.1136/heartjnl-2018-313839.
• [35] Toyama K, Rader F, Kar S, et al. Iatrogenic atrial septal defect after percutaneous mitral valve repair with the MitraClip system[J]. Am J Cardiol, 2018, 121(4):475-479.DOI:10.1016/j.amjcard.2017.11.006.
• [36] Schueler R, Ozturk C, Wedekind JA, et al. Persistence of iatrogenic atrial septal defect after interventional mitral valve repair with the MitraClip system:a note of caution[J]. JACC Cardiovasc Interv, 2015, 8(3):450-459. DOI:10.1016/j.jcin.2014.10.024.
• [37] Smith T, McGinty P, Bommer W, et al. Prevalence and echocardiographic features of iatrogenic atrial septal defect after catheter-based mitral valve repair with the MitraClip system[J].Catheter Cardiovasc Interv, 2012, 80(4):678-685. DOI:10.1002/ccd.23485.
• [38] Paukovitsch M, Schneider LM, Reichart C, et al. Prevalence of iatrogenic atrial septal defects(iASD)after mitral valve(MV)transcatheter edge-to-edge repair(TEER)in the longterm follow-up[J]. Open Heart, 2021, 8(2):e001732.DOI:10.1136/openhrt-2021-001732.
• [39] Freitas-Ferraz AB, Rodés-Cabau J, Junquera Vega L, et al.Transesophageal echocardiography complications associated with interventional cardiology procedures[J]. Am Heart J, 2020,221:19-28. DOI:10.1016/j.ahj.2019.11.018.
• [40] Steppich B, Stegmüller F, Rumpf PM, et al. Vascular complications after percutaneous mitral valve repair and venous access closure using suture or closure device[J]. J Interv Cardiol, 2018, 31(2):223-229. DOI:10.1111/joic.12459.