外科经导管二尖瓣修复的研究进展

Research advance of surgical transcatheter mitral valve repair

二尖瓣反流是心脏外科中常见的疾病,病因较多,可大致分为原发性二尖瓣反流和继发性二尖瓣反流两类。随着近年来心脏导管技术的发展,更多的高风险二尖瓣反流患者因不能耐受开胸手术而行导管介入治疗,并取得了令人满意的效果。目前针对二尖瓣反流的导管技术包括瓣叶修复、瓣环环缩以及人工腱索植入。相较于原发性二尖瓣反流,继发性二尖瓣反流病理生理机制复杂,手术效果通常不理想。因此本文将以外科经导管介入二尖瓣成形术为中心,以治疗原发性二尖瓣反流为重点,以外科的角度从手术风险、手术种类、展望三个方面对经导管二尖瓣修复的研究进展综述。

Mitral regurgitation (MR) with multi-pathogenesis is a common disease in cardiac surgery department. MR can be classified into two categories-primary mitral regurgitation and secondary mitral regurgitation. With the development of cardiac intervention, numerous patients who cannot tolerate open heart surgery for the reason of high risk of surgery receive the treatment of intervention and achieve the favorable endpoint. The technique of transcatheter therapy which could be used to treat MR is comprised of leaflet repair, annuloplasty and implantation of artificial chordae. Comparing to primary mitral regurgitation, surgical effect of secondary mitral regurgitation is not desirable for the reasons of complex pathophysiologic mechanism. Hence, based on the perspective of surgeon, we will introduce the research progress of transcatheter interventional mitral valve repair which is focused on the treatment of primary mitral valve regurgitation and reviewed from three aspects of surgical risks, surgical types and outlook.