经导管二尖瓣缘对缘修复:当前认识与策略原则

Mitral transcatheter edge-to-edge repair:A state of art and strategic principles

治疗二尖瓣反流(mitral regurgitation,MR)的经导管缘对缘修复技术(transcatheter edge-to-edge repair,TEER)称为M-TEER。其具有靶点精确、植入物少;原理简单,容易经导管实现;医学原理可靠,以不变应万变的优势;并且TEER相对于外科缘对缘修复(surgical edge-to-edge repair,SEER)更有术中实时评估疗效和血流动力学的优势。对于退行性二尖瓣反流患者,M-TEER应该追求更完美的手术效果,使M-TEER术后即刻MR 0~1+,而对于功能性二尖瓣反流,M-TEER允许中度残余分流或者轻度压差,不影响患者预后并且降低并发症几率。

Transcatheter edge-to-edge repair(TEER)for mitral regurgitation(MR)is known as M-TEER.Its strengths include:precise targets and fewer implants;simple and clear principles for catheterization;originating from dependable medical concepts and broad applicability.Furthermore,TEER offers advantages in real-time hemodynamic and effectiveness measurement throughout the procedure over surgical edge-to-edge repair(SEER).When it comes to patients with degenerative mitral regurgitation,M-TEER should aim to deliver more optimum procedural outcomes.In functional mitral regurgitation,a modest transvalvular gradients or moderate residual shunt can be tolerated with M-TEER,which reduces the risk of problems and has no bearing on the patient's prognosis.