Role of real-time three-dimensional transesophageal echocardiography in mitral valve repair

Background and objective Pre-operative assessment of mitral valve (MV) anatomy is essential to surgical design in patients undergoing MV repair.Although 2-dimensional (2D) echocardiography provides precise information regarding MV anatomy,RT-3D TEE could increase the understanding of MV apparatus and individual scallop identification.We aimed to investigate the value of RT- 3DTEE in MV repair.Methods RT-3DTEE was performed in six patients with mitral valve prolapse (MVP) by using Philips 1E33 with X7-2t probe.Preoperative RT-3DTEE studies were compared with surgical findings in patients undergoing surgical mitral valve repair,and quantitative evaluation was performed by QLab 6.0 software before and after surgical mitral valve repair.Results RT- 3DTEE could display dynamic morphology of MV,the location of prolapse,and spatial relation to the surrounding tissue.It could provide surgical views of the valves and the valvular apparatus.These results were consistent with surgical findings.The quantitative evaluation before and after surgical MV repair indicated that anterolateral to posteromedial diameter of annulus,anterior to posterior diameter of annulus,perimeter of annulus,and area of annulus in projection plane were significantly smaller after operation compared with those before operation (P【0.05).The length of posterior leaflet,the area of anterior and posterior leaflet,the maximal prolapse height,the volume of leaflet prolapse and the length of coaptation in projection plane were significantly reduced after operation (P【0. 05).Conclusion RT-3DTEE is a unique new modality for rapid and accurate evaluation ofmitral valve prolapse and mitral valve repair.

The first two cases of transcatheter mitral valve repair with ARTO system in Asia

BACKGROUND:MAVERIC(Mitral Valve Repair Clinical Trial)validates the safety and effi cacy of the ARTO system.We here report the fi rst two successful cases of utilizing the ARTO system in patients with symptomatic heart failure(HF)with functional mitral regurgitation(FMR)in Asia.METHODS:Two patients,aged 70 and 63,had severe HF with FMR.Transesophageal echocardiography confirmed that the left ventricular ejection fractions were less than 50%with severe mitral regurgitation(MR)in both patients.Optimizing drug treatment could not mitigate their symptoms.Therefore,we used the ARTO system to repair the mitral valve for these patients on March 5 and 6,2019,respectively.RESULTS:Mitral valve repairs using the ARTO system were successfully performed under general anaesthesia for these two patients.MR was decreased immediately after the procedures in both patients.The 30-day and 3-month transthoracic echocardiography(TTE)revealed a moderate to severe MR in both patients,and the New York Heart Association(NYHA)scales were also partially improved.CONCLUSION:The first two cases in Asia indicate that the ARTO system is feasible for patients with heart failure with FMR,and the patient selection appears to be crucial.

One-year outcome of percutaneous mitral valve repair in patients with severe symptomatic mitral valve regurgitation

AIM To investigate one-year outcomes after percutaneous mitral valve repair with Mitra Clip~? in patients with severe mitral regurgitation(MR). METHODS Our study investigated consecutive patients with symptomatic severe MR who underwent Mitra Clip~?implantation at the University Hospital Bergmannsheil from 2012 to 2014. The primary study end-point was all-cause mortality. Secondary end-points were degree of MR and functional status after percutaneous mitral valve repair.RESULTS The study population consisted of 46 consecutive patients(mean logistic Euro SCORE 32% ± 21%). The degree of MR decreased significantly(severe MR before Mitra Clip~? 100% vs after Mitra Clip~? 13%; P < 0.001),and the NYHA functional classes improved(NYHA III/IV before Mitra Clip~? 98% vs after Mitra Clip~? 35%; P < 0.001). The mortality rates 30 d and one year after percutaneous mitral valve repair were 4.3% and 19.5%,respectively. During the follow-up of 473 ± 274 d,11 patients died(90% due to cardiovascular death). A preprocedural plasma B-type natriuretic peptide level > 817 pg/m L was associated with all-cause mortality(hazard ratio,6.074; 95%CI: 1.257-29.239; P = 0.012).CONCLUSION Percutaneous mitral valve repair with Mitra Clip~? has positive effects on hemodynamics and symptoms. Despite the study patients' multiple comorbidities and extremely high operative risk,one-year outcomes after Mitra Clip~? are favorable. Elevated B-type natriuretic peptide levels indicate poorer mid-term survival.

Midterm Results of Leaflet Augmentation in Mitral Valve Repairin Rheumatic Valves Experience in One Center

Patients with severe mitral regurgitation (MR) should undergo surgery when they present symptoms or if asymptomatic when there is objective evidence of left ventricular dysfunction. In this work, we analyze the midterm results of leaflet augmentation in mitral valve repair of rheumatic valves with gluteraldehyde preserved autologous pericardium. Patients and Methods: In our department 48 patients were exposed to mitral valve repair by leaflet augmentation either anterior or posterior beside other technique and all patients supported by flexible annuloplasty ring and followed for five years clinically and by echocardiography. Results: Age of the patients ranging from 12 to 47 years, mean age 25.9 ± 8.9 and there were 12 males (25%) and 36 females (75%) with male to female ratio of 1:3. All patients presented with shortness of breath (100%);with 14 patients were in NYHA class III (29.17%) and 34 patients were in NYHA class IV (70.83%). During follow-up period 5 patients needed reoperation by valve replacement, causes of reoperation were restrictive valve motion in one patient, left atrial thrombus in 1 patient and sever mitral regurgitation in 3 patients. Freedom from reoperation was 87.5%. At 5 years, (92.9%) were in New York Heart Association functional class I, three patients (7.1%) were in class II. Echocardiography at follow-up showed satisfactory mitral valve function. Conclusion: leaflet augmentation is a simple and reproducible method of valve repair for rheumatic MR with good midterm result.

Impact of Mitral Valve Repair in Patients with End-Stage Congestive Heart Failure

Objective: The utility of mitral valve repair in patients with Mitral Regurgitation (MR) and advanced CHF remains controversial. Methods: 37 patients with MR and Left Ventricular Ejection Fraction (LVEF) 25% as well as patients with LVIDd Results: Operative mortality was 0% for the group. There were significant reductions in NYHA Class (p = 0.0004), mitral regurgitation (p 25%. There were no significant differences in cardiac outcome changes between patients with LVIDd 25%, and between patients with LVIDd Conclusions: MV repair in patients with low LVEF and MR can be performed safely, with significant improvement in LVEF and symptom profile. No survival difference were noted between those patients with severely depressed LVEF or those with elevated ventricular dimensions (LVIDd) when compared to those with less severe but still significant cardiac impairment. Consideration should be given to these patients as an option prior to transplantation.

“A Prospective Randomized Case-Control Study To Evaluate Mini Right Thoracotomy versus Conventional Sternotomy For Mitral Valve Repair In Rheumatic Heart Disease.”

Purpose: Right mini thoracotomy has been evaluated in many studies for mitral valve repair mainly in degenerative valvular disease but not in rheumatic heart disease. Mitral valve repair is more challenging in rheumatic etiology due to complexity of lesions. This prospective randomized case control study was designed to evaluate repair through mini right thoracotomy and to compare the clinical and echocardiographic outcomes with sternotomy in rheumatic patients. Methods: 25 patients of rheumatic heart disease underwent mitral valve repair through mini right thoracotomy (group I). Various clinical and functional parameters were compared with 25 patients of mitral valve repair through sternotomy (group II). On follow up the results were compared in both groups for clinical and echocardiographic parameters. Results: The various pre-operative demographic parameters were comparable in two groups. Equal rate of mitral valve repair (group I-21/25, 84% and group II-21/25, 84%) was achieved in both groups. The various intra-operative and post-operative clinical parameters were better in group I .There were equivalent functional and valve related outcomes in both groups in term of NYHA class (1.28 ± 0.613 vs 1.08 ± 0.276, P = 0.144), post-operative mitral valve area (2.43 ± 0.891 vs 2.82 ± 0.662, P = 0.090), incidence of more than mild mitral regurgitation (0) and mean pressure gradient across mitral valve (4.98 ± 3.33 vs 4.23 ± 1.5, P = 0.309). Conclusion: Mitral valve repair through mini right thoracotomy approach in rheumatic etiology is feasible and safe with equivalent rate of successful repair as compared to median sternotomy. It is associated with lesser morbidity, cosmetic advantage and lesser resource utilization.

Mitral Valve Repair with Artificial Chordae for Posterior Leaflet Disease

Background: Recently, the concept of “Respect rather than resect” has been proposed in an attempt to restore mitral valve function. We investigated the results of mitral valve repair for posterior leaflet disease. Methods: Between April 2008 and July 2017, mitral valve repair was performed in 78 cases at our facility. Among them, 37 cases were analyzed. We divided patients into three groups according to the repair techniques used: artificial chordae technique, which uses the anchoring-technique and measured tube technique (Group A, 23 cases), resection and suture technique (Group R, 10 cases), and artificial chordae together with resection and suture technique (Group AR, 4 cases), and compared their postoperative outcomes. Results: Residual postoperative mitral regurgitation (MR) grade in groups A, R and AR at discharge were 0.3 ± 0.4, 0.8 ± 0.9 and 0.0 ± 0.0 (p = 0.07), respectively. Mitral valve areas (cm2) in groups A, R and AR were 3.2 ± 0.6, 2.9 ± 0.6 and 3.0 ± 0.6 (p = 0.47), respectively. Freedom from severe MR at 5 years postoperatively was seen in 91.7%, 90% and 100% (p = 0.92) in groups A, R and AR, respectively. Conclusions: There was no significant difference in postoperative outcomes, as assessed echocardiographically, between the artificial chordae technique and resection and suture technique. The results of all repair techniques were satisfactory.

Mitral Valve Repair for Mitral Valve Regurgitation with Papillary Muscle Displacement and Posterior Leaflet Prolapse

A case of abnormal chordae of the mitral valve (MV) associated with systolic anterior motion (SAM) is not commonly encountered in clinical practice. Here we report MV repair via the edge-to-edge technique in a 56-year-old male with MV regurgitation associated with papillary muscle displacement and posterior leaflet prolapse. Echocardiography revealed obstruction of the left ventricular outflow tract caused by SAM because of papillary muscle displacement and mitral regurgitation associated with posterior leaflet prolapse due to chordae rupture. MV repair was successfully performed by reconstruction with an Alfieri stitch. The outcome of this case demonstrated that this surgical technique is preferable for MV abnormalities with no complex malformations.

Application of real-time 3d echocardiography in mitral valve repair for replacement of chordae tendineae

Objective To investigate the surgical technique and outcomes of replacement of chordae tendineae in mitral valve repair,and evaluate the value of real-time three-di-mensional transesophageal echocardiography in the perioperative period. Methods Thirty-one patients with mitral valve prolapse underwent mitral valve repair using chordae tendineae replacement concomitant with implantation

右心室功能障碍预测原发性二尖瓣反流经导管二尖瓣修复术后疗效的临床价值

目的:探讨右心室功能障碍(right ventricular dysfunction,RVD)预测原发性二尖瓣反流(mitral regurgitation,MR)经导管二尖瓣修复术(transcatheter mitral valve repair,TMVR)后疗效的临床价值。方法:选取2019年3月至2021年5月在我院就诊的60例症状性MR患者作为研究对象,根据CMR中右心室射血分数(right ventricular ejection fraction,RVEF)是否低于45%,分为MR+RVD组(n=25)及单纯MR组(n=35)。探讨RVD对预测MR患者术后死亡和再入院的价值。结果:16例患者(26.7%)显示右心室扩张。随访期间,14例患者全因死亡(23.3%),20例(33.3%)患者因心力衰竭等原因再次入院。根据受试者工作特征曲线,RVEF预测死亡和再入院的最佳截断值分别为34.6%和44.9%。MR患者中左右心室舒收缩期容积指数、左右心室每搏量指数、LVEF与REVF均呈正相关性(r=0.420、0.490、0.447,P<0.05)。RVEF与肺动脉收缩压呈负相关(r=-0.292,P=0.028)。Cox模型结果显示调整左心室参数后,RVD也可预测再入院风险和全因死亡风险(P<0.05)。与单纯MR组患者相比,MR+RVD组患者的再入院时间和全因死亡时间缩短(P<0.05)。结论:即使在有效的TMVR之后,术前RVD也与不良预后相关。同时出现RVD、右心室扩张和肺动脉高压的患者队列显示出更高的全因死亡率。

经导管缘对缘修复二尖瓣的体外流体力学性能评价

目的建立一套适用于离体二尖瓣体外测试的方法,定量评价国产经导管缘对缘修复术(TEER)对功能性二尖瓣反流(FMR;非A2-P2反流)的修复效果。方法本研究通过对离体猪二尖瓣瓣环扩张和乳头肌非对称移位建立模拟真实解剖结构的FMR病理模型(非A2-P2反流)。使用离体二尖瓣脉动流测试系统,测试6个FMR病理瓣膜经国产TEER器械修复前、后,不同生理和病理条件下的流体力学特征。结果病理瓣膜由修复前的中-重度及重度反流下降到修复后的轻度及轻-中度反流[反流分数(60.2±17.5)%比(34.7±12.0)%,P<0.001],差异有统计学意义。表征瓣膜正向流性能的EOA[(3.8±1.6)cm^(2)比(2.2±0.5)cm^(2),P<0.001]和正向跨瓣压差[(1.8±1.3)mmHg比(3.8±1.8)mmHg,P<0.001]修复前、后比较,差异均有统计学意义。修复带来一定程度上的瓣膜狭窄,有效孔口面积降低约40%,正向跨瓣压差升高约110%,但瓣膜正向流性能仍处于正常生理范围内,未造成医源性狭窄。结论证实国产TEER器械对于治疗FMR(非A2-P2反流)具有良好的修复效果。本研究为TEER器械的设计、优化及可靠性和有效性的验证、评价提供了全面的数据和有效的测试方法,同时也为该类产品测试相关标准的制订提供了可参考的资料。

二尖瓣后叶折叠修复技术10年临床效果总结

目的评价二尖瓣后叶折叠修复技术在治疗退行性二尖瓣关不全时的远期效果。方法回顾2010年1月至2019年12月于我中心由单一术者进行退行性二尖瓣修复的患者共1537例。经纳排标准筛选终入组207例。回顾患者术前超声资料,术中二尖瓣修复技术随访观察患者远期治疗效果。终点事件包括患者死亡情况,二尖瓣反流复查中度以上和再手术情况。结果207例患者均修复成功。出院时超声心动提示二尖瓣反流202例为轻度以下,5例为轻度。住院期间1例患者因原发性脑梗塞伴脑出血死亡。平均随访5.3年,随访过程中5例(2.43%)患者死亡,心脏相关死亡3例。12例中度以上反流,其中8例中度,4例重度,再手术患者3例。10年累计免于终点事件发生率为(84.99±3.83)%;10年生存率为(94.33±2.73)%;10年免于中度以上反流复发及再手术率为(90.4±2.9)%。结论二尖瓣后叶折叠是一种简单、可反复操作且治疗有效的修复技术,能够提供良好的远期效果。

三步标准化儿童二尖瓣成形手术在儿童容量负荷型二尖瓣反流中的应用

目的:探索儿童容量负荷型二尖瓣反流的最佳外科成形策略。方法:回顾2020年4月至2022年3月期间在中国医学科学院阜外医院接受初次二尖瓣成形术的110例容量负荷型二尖瓣反流患者,平均年龄(14.5±15.1)个月,男性42例(38.2%)。其中69例患者接受三步标准化儿童二尖瓣成形手术(标准化组),41例患者接受单纯瓣环环缩术(单纯环缩组)。倾向性评分匹配后,共纳入38对患者。比较两组主要终点事件(二尖瓣功能衰竭和术后心力衰竭)发生率。结果:在26.3(19.8,32.9)个月的电话随访及11.9(7.5,14.8)个月的超声心动图随访期间未发生全因死亡,共有1例(0.8%)患者发生院内计划外的二次成形手术,7例患者(单纯环缩组:标准化组=3:4)在术后6个月及以后的超声心动图随访提示中到大量二尖瓣反流复发,9例患者(单纯环缩组:标准化组=5:4)出院1个月后超声心动图提示心力衰竭,两组间差异无统计学意义。倾向性评分匹配后,标准化组体外循环时间[113(90,132)min vs.90(77,114)min]和主动脉阻断时间[80(61,92)min vs.62(49,83)min]均显著长于单纯环缩组(P均<0.05),其余结果差异均无统计学意义。基于年龄进行亚组分析,<1岁患者标准化组主要终点事件发生率(8.2%vs.26.9%P=0.041)和术后心力衰竭发生率(4.1%vs.19.2%,P=0.045)均显著低于单纯环缩组,且单纯环缩组术后末次超声心动图随访提示平均左心室舒张末期内径标准分数(LVEDD Z值)仍>2。结论:三步标准化儿童二尖瓣成形手术患者围术期恢复和术后转归并不劣于单纯瓣环环缩术患者;而对于<1岁的容量负荷型二尖瓣反流患者,该术式术后心力衰竭和主要终点发生率更低,更具推广意义。

不同病因二尖瓣反流经导管缘对缘修复术后心脏逆重构分析和超声心动图应用经验

目的:评估二尖瓣经导管缘对缘修复术(TEER)对功能性和退行性中重度二尖瓣反流患者术后6个月的瓣膜功能、心脏逆重构和心功能变化情况,并总结超声心动图应用经验。方法:回顾性分析2022年7月至2023年2月在云南省阜外心血管病医院接受二尖瓣TEER且完成6个月随访的93例中重度二尖瓣反流患者的超声心动图资料。根据病因将患者分为功能性二尖瓣反流(FMR)组和退行性二尖瓣反流(DMR)组。比较两组患者的瓣膜特征参数、术前和术后6个月的瓣膜功能、心腔容积和心功能指标。评估手术疗效,并总结超声心动图应用经验。结果:93例患者中,FMR患者71例,DMR患者22例。与FMR组比,DMR组患者二尖瓣前叶长度较短,对合缘高度较低,对合深度较浅,瓣叶栓系比例较低,瓣环内外径较短,左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)较小,左心室射血分数(LVEF)较高、左心室整体纵向应变(GLS)绝对值较高(P均<0.05)。所有患者术后6个月二尖瓣反流分级、NYHA心功能分级较术前均显著改善(P均<0.05),二尖瓣平均跨瓣压差较术前有所升高(P<0.05)。其中,FMR组术后LVEDV、LVESV、左心房容积指数(LAVI)较术前均显著降低(P均<0.05),而DMR组术后左心室和左心房容积较术前差异均无统计学意义(P均>0.05),观察期间两组患者LVEF和左心室GLS差异均无统计学意义(P均>0.05)。与FMR组相比,DMR组患者手术前后ΔLVEDV、ΔLVESV的绝对值均较小(P均<0.05)。结论:对于不同病因的中重度二尖瓣反流患者,二尖瓣TEER均可有效降低患者术后早期反流程度并改善心功能。FMR与DMR患者在术前瓣膜结构和术后心脏逆重构方面存在差异。在二尖瓣TEER的全流程中,超声心动图是重要的影像学评估及监测手段。

重度主动脉瓣狭窄合并二尖瓣反流的诊治现状

重度主动脉瓣狭窄(AS)合并二尖瓣反流(MR)并不少见。目前经导管主动脉瓣置换术已成为重度AS的主要治疗方式,经导管二尖瓣置换/修复用于治疗MR的技术也日趋成熟。重度AS合并MR这一群体逐渐受到关注,了解这类患者的病理生理改变、AS解除后MR的变化及其对预后的影响,有助于合理地选择治疗方案。

Mitral Valve Surgery for Functional Regurgitation: Insights into Heart Failure and Readmission

Background: Functional mitral regurgitation (FMR) is an increasing burden as population ages. Mitral valve repair (MVr) is the preferred surgical treatment of FMR despite limited evidence supporting its efficacy. Mitral valve replacement (MVR) is the alternative procedure typically reserved for patients who are at higher risk or refractory to MVr. The present study aims to determine which of the two procedures is more effective in the surgical treatment of FMR. Methods: 344 charts of FMR patients who received either MVr (n = 263) or MVR (n = 81) from 2004-2016 at our institution were reviewed. Treatment efficacy was assessed based on heart failure (HF)-readmission and survival rates within 5 years from discharge. Propensity score approach with inverse probability weighting and Cox regression models were employed to evaluate procedural impact on survival and rehospitalizations, respectively. Follow-up echocardiographic data from the original cohort was assessed for differences in metrics between procedural groups at >6 months (MVr: n = 75;MVR: n = 23) and 1 year (MVr: n = 75;MVR: n = 18) post-op. Results: MVR patients had a lower risk of being readmitted for HF within 5 years compared to the MVr group (HR-adj (95% CI): 0.60 (0.41 - 0.88), p = 0.008). MVR patients also had a higher overall risk of death (HR-adj (95% CI): 1.82 (1.05 - 3.16), p = 0.034) but this was borderline significantly different at 5 years cut-off (p = 0.057). Conclusions: Higher HF readmission in MVr patients than in sicker, higher surgical-risk MVR patients reflects the inadequacy of MVr to treat FMR. Novel approaches to MVR may be necessary to adequately manage FMR.

Indications and Results of Repair of the Rhumatismal Valve in Children in Senegal concerning 63 Cases

In Africa, acute rheumatic fever is endemic. Cardiac involvement is one of the most common complications in the form of valvular heart disease representing all damages to the heart valves. It is in this perspective that we realized this study whose general objective was to evaluate the results of mitral repair surgery in children in Senegal and the specific objective was to state the indications for mitral repair surgery and assess the results in terms of morbidity and mortality. This is a retrospective and analytical monocentric study, in the thoracic and cardiovascular surgery department of FANN National University Hospital Center in Dakar. It took place over a period of 30 months. All the patients who underwent mitral surgery, aged less than 18 years were included. The total number of patients was 63, including 39 girls and 24 boys, a sex ratio of 0.62. The average age at the time of the surgery was 12 years old [5 - 17]. The functional symptomatology was dominated by the dyspnea found in all the patients. Cardiac ultrasound was diagnosed with mitral regurgitation in all patients. For all surgical procedures, the approach was a vertical midline sternotomy. The mitral valve was approached by left atriotomy in 40 patients (63.5%) and by transseptal way in 23 patients. All patients had undergone mitral valve repair associated or not with either aortic valve repair in 9 patients (14.2%), aortic valve replacement in 3 patients (4.8%), or one tricuspid valve repair in 31 patients (49%). The average duration of intubation was 6 hours [2 - 52]. The average length of stay in intensive care was 2 days. Postoperative complications have been observed. Surgery was performed in 10 patients with 3 mitral valve replacements, 2 aortic valve replacements, a double mitral and an aortic valve replacement associated with a tricuspid repair and in 4 cases a perfection of their mitral repair. Early and late surgical mortality was zero. The average follow-up time for our patients was 9 months [1 - 26]. During their follow-up, the evolution was favorable in 89% of patients who no longer had any functional symptoms.

冠状动脉旁路移植术治疗冠心病合并中度缺血性二尖瓣反流的近远期疗效分析

目的:评估单纯冠状动脉旁路移植术(CABG)治疗冠心病合并中度缺血性二尖瓣反流的近远期效果,以探讨最佳的治疗方案。方法:2009年1月至2018年12月,共有822例冠心病合并中度缺血性二尖瓣反流的患者在首都医科大学附属北京安贞医院接受治疗,其中750例行单纯冠状动脉旁路移植术(CABG组),72例同期行二尖瓣修复(MVP)或二尖瓣置换术(MVR)(CABG+MV组),通过倾向性评分匹配后(5:1匹配),共有384例患者纳入分析,其中CABG组320例,CABG+MV组64例。通过对比,评估两组患者外科治疗术后的效果。结果:两组患者均成功接受了手术治疗。围术期患者死亡19例,其中CABG组17例(5.3%),CABG+MV组2例(3.1%),两组间比较差异无统计学意义(P=0.461)。围术期发生MACCE事件21例,其中CABG组18例(5.6%),CABG+MV组3例(4.7%),两组间比较差异无统计学意义(P=0.763)。患者术后随访时间为(51.48±21.59)个月,期间死亡59例,其中CABG组50例(15.6%),CABG+MV组9例(14.1%),两组间比较差异无统计学意义(P=0.752)。随访期间发生MACCE事件80例,其中CABG组67例(20.9%),CABG+MV组13例(20.3%),两组间比较差异无统计学意义(P=0.911)。累积生存率(P=0.88)及MACCE事件免除率(P=0.77)两组间比较差异也无统计学意义。结论:对于冠心病合并中度缺血性二尖瓣反流的患者,单纯行CABG术与CABG+MV术相比,近远期疗效相当。

中国经导管二尖瓣缘对缘修复术临床路径(2022版)精简版

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。

经导管二尖瓣缘对缘修复系统治疗器质性二尖瓣反流的早期效果

目的 探讨经导管二尖瓣缘对缘修复系统治疗器质性二尖瓣反流的早期临床效果。方法 纳入2021年10月至2022年9月在郑州大学第一附属医院应用国产经导管二尖瓣缘对缘修复系统行介入治疗的12例重度器质性二尖瓣反流患者。收集患者住院期间临床特征及超声心动图指标,3个月时随访收集患者的心功能状态及超声心动图指标变化。结果 全组共12例患者,其中女6例,男6例,年龄(69.2±5.76)岁,术前二尖瓣反流程度4+患者11例,3+患者1例。全组共10例患者成功完成手术且术后即刻反流程度≤1+。2例手术失败,术后即刻二尖瓣反流程度≥3+;术后即刻左房径、舒张末期左心室内径较前好转。术后3个月时10例患者二尖瓣反流程度均≤2+,左房径、舒张末期左心室内径、肺动脉收缩压较前好转(P<0.05)。术后患者左室射血分数、二尖瓣前向峰值流速、二尖瓣平均跨瓣压差差异无统计学意义(P>0.05)。1例患者术中出现急性心包积液,穿刺引流后好转。结论 新一代国产二尖瓣缘对缘修复系统治疗严重的器质性二尖瓣反流具有较好的安全性和有效性,早期结果令人满意。