Transcatheter mitral valve replacement: current status
Transcatheter mitral valve replacement: current status
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DOI：
10.1007/s00059-019-04851-9
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发表时间：
2019-11-01
期刊：
影响因子：
1.7
通讯作者：
Nickenig, G.
中科院分区：
文献类型：
--
作者：
Vogelhuber, J.;Weber, M.;Nickenig, G.
二尖瓣反流（MR）是仅次于主动脉瓣狭窄的第二大常见瓣膜疾病，尤其影响老年患者。在心力衰竭治疗的背景下，最佳药物治疗是继发性mr首选的一线治疗方法。如果尽管进行了最佳药物治疗，症状仍然存在，则需要手术或经导管二尖瓣修复（推荐等级IIb）。相比之下，对于有症状的原发性MR和左室射血分数（LVEF）低于30%且围手术期风险合理的患者，手术治疗是必要的（修复优先于置换，推荐等级I）；对于高危患者，经导管介入二尖瓣修复（特别是“边缘到边缘重建”）是一种可行的选择（推荐等级IIb）。最近，经导管二尖瓣置换术（TMVR）作为另一种有吸引力的治疗方案受到关注，目前正在深入研究中。起初，TMVR用于生物二尖瓣置换术（Bio-MKE）或重建后出现症状性功能不全或狭窄的患者，作为“瓣中瓣”或“瓣中环”手术。因此，我们采用经导管主动脉瓣假体。在过去的几年里，一些专门的TMVR假体被开发出来用于治疗先天性mr，但到目前为止，还没有TMVR假体通过ce认证。以下所有TMVR方法都在关键试验范围内进行临床评估。由经验丰富的心脏病专家和心脏外科医生组成的跨学科心脏团队，考虑到特定的MR病因、先前存在的合并症、年龄、临床症状和状态，制定了针对患者的个性化治疗概念。
After aortic valve stenosis, mitral regurgitation (MR) is the second most common valvular disease, particulary affecting older patients. Optimal medical treatment within the context of heart failure therapy is the favored first-line therapy for secondary MR. If symptoms persist despite optimal medical therapy, surgical or transcatheter mitral valve repair is indicated (recommendation class IIb). In contrast, surgical treatment is essential for patients with symptomatic primary MR and left-ventricular ejection fraction (LVEF) >30% and justifiable perioperative risk (repair preferred over replacement, recommendation class I); for high-risk patients, interventional transcatheter mitral valve repair (especially by "edge-to-edge-reconstruction") is a viable option (recommendation class IIb). Recently, transcatheter mitral valve replacement (TMVR) has come into focus as another attractive treatment option and is currently under intensive research. At first, the TMVR was used both for patients with symptomatic insufficiency or stenosis after biological mitral valve replacement (Bio-MKE) or after reconstruction as a "valve-in-valve" or "valve-in-ring" procedure. Therefore, transcatheter aortic valve prostheses were used. In the past few years several dedicated TMVR prostheses were developed for the treatment of native MR. So far, no TMVR prosthesis is CE-certified. All of the following TMVR methods are under clinical evaluation in the scope of pivotal trials. The interdisciplinary heart team, consisting of experienced cardiologists and heart surgeons develops a patient-specific, individual treatment concept considering the particular MR etiology, pre-existing comorbidities, age, clinical symptoms, and status.