经导管二尖瓣修复治疗二尖瓣反流所致心力衰竭的进展与展望

Progress and prospect in transcatheter mitral valve repair treatment of heart failure caused by mitral valve regurgitation

二尖瓣关闭不全主要是由于瓣膜的异常所导致的原发性或退化性的二尖瓣反流(mitral valve regurgitation,MR),也可由继发性心肌病变引起功能性、继发性MR。药物治疗可以缓解相应症状,但却无法阻止病程进展。目前,尽管有明确的指南建议对伴有左心功能不全症状和体征的中至重度(NYHA分级超过Ⅲ级)MR患者进行手术,但由于种种客观与主观的原因大多数严重MR患者仍没有接受手术。随着经导管二尖瓣介入手术修复治疗的蓬勃发展,目前的经导管二尖瓣修复治疗的理念主要来源于外科修复技术,分别以缘对缘、人工腱索修复、人工瓣环成形等方式为代表,有不同种类的器械进入临床,取得了良好的效果。经导管介入治疗MR为二尖瓣手术高危患者提供了新的选择。本文将综述手术治疗MR所致心力衰竭的新进展。

Mitral valve insufficiency is mainly caused by valve abnormality which gives rise to degenerative mitral regurgitation(MR)/primary MR and it also can be caused by secondary cardiomyopathy,which gives rise to functional MR/secondary MR.Though medical management can alleviate homologous symptoms,it cannot inhibit progression of the disease.Current guidelines recommend surgical treatment for moderate-to-severe(Grade>3)MR in patients with symptoms or evidence of left ventricular dysfunction.However,related to many subjective and objective reasons,the majority of patients with severe MR are reluctant to choose surgery.Transcatheter mitral valve repair treatments have been developed and transcatheter mitral valve repair treatment mainly comes from a surgical repair technology.It is represented by means of edge to edge,artificial chords repair,and annuloplasty.Clinical applications of different kinds of instruments have achieved good results.Recently,the emergence of percutaneous interventional approaches in treating MR has offered new options for patients who are at high risk for conventional mitral valve(MV)surgery.In this article,we review the new advances of surgical treatments of heart failure caused from mitral regurgitation.