经导管二尖瓣置换治疗原发性二尖瓣反流的研究进展

Transcatheter Mitral Replacement in Primary Mitral Valve Regurgitation

二尖瓣反流(MR)是老龄化社会中最常见的心脏瓣膜疾病,由二尖瓣膜自身结构或功能改变引发的原发性MR是MR的一大类。体外循环下二尖瓣修复或置换是原发性MR的标准临床治疗方案,但其适应证窄、风险高且术后并发症多。经导管二尖瓣置换术(TMVR)很大程度上解决了药物治疗无效性和手术治疗高风险性的问题,成为原发性MR治疗的重要手段。TMVR设备大多处于早期安全性评估和可行性临床试验阶段,二尖瓣结构的复杂性也使TMVR治疗方法面临诸多挑战,人工二尖瓣的密封性、持久性以及左心室流出道阻塞和潜在血栓的形成均为TMVR技术难点。现综述目前用于原发性MR治疗的各类人工二尖瓣装置及相关研究进展。

Mitral regurgitation is the most common valvular heart disease in the elderly.Primary mitral valve regurgitation is a major category of MR caused by the changes of structure or function of mitral valve.Mitral valve repair or replacement under extracorporeal circulation is the standard clinical treatment protocol for primary mitral valve regurgitation,but it has limited indications and high risk postoperative complications.Transcatheter mitral valve regurgitation(TMVR)has become an important therapy for primary mitral valve regurgitation especially for patients with drug refractory or high risk for surgery.Most TMVR devices are in the early stage of safety evaluation and feasibility clinical trials.On account of the complexity of mitral valve structure,TMVR faces many challenges,including the tightness and durability of artificial mitral valve,as well as the formation of left ventricular outflow tract obstruction and potential thrombosis.This review summarizes kinds of artificial mitral valve devices and related research progresses used in primary mitral valve regurgitation therapy currently.