Individual Patient-specific Planning of Minimally Invasive Transcatheter Intervention for Heart Valve Disease.
Individual Patient-specific Planning of Minimally Invasive Transcatheter Intervention for Heart Valve Disease.
复制标题
针对心脏瓣膜疾病的微创经导管干预的个体患者特定计划。
DOI：
10.1016/j.eclinm.2019.01.002
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发表时间：
2018
影响因子：
15.1
通讯作者：
De Vecchi A
中科院分区：
文献类型：
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作者：
De Vecchi A
在英国，有100万65岁及以上的人受到心脏瓣膜疾病的影响。鉴于人口迅速老龄化，预计到2050年，具有临床意义的瓣膜疾病的患病率将翻一番[1]。这些预测对负责满足这一日益增长的患者群体需求的医疗保健提供者具有严重影响，这些患者大多太老太弱，不适合心脏直视手术。主动脉瓣狭窄和二尖瓣返流是最常见的瓣膜疾病。两者都有不良的预后，而且缺乏有效的药物治疗。作为回应，在微创经导管技术方面取得了突破性的进展，可以将生物假体植入失败的自然瓣膜中。经导管主动脉瓣置入术(TAVI)已经被确定为不能手术和高/中风险患者的传统手术的替代方案，低风险队列的试验目前正在结束。在5年内，TAVI很可能成为大多数主动脉狭窄患者的默认治疗方法。基于这种范式的转变，现在的注意力集中在经导管二尖瓣置换术(TMVR)上。与TAVI不同，TMVR需要复杂的工程解决方案，以应对二尖瓣解剖和生理的异质性和复杂性及其与左心室的相互作用所带来的独特挑战。具体问题包括难以将装置固定在变形的二尖瓣环处(存在瓣膜移位或瓣膜旁渗漏的风险)，以及植入的瓣膜可能导致左室流出道(LVOT)阻塞(存在顽固性心力衰竭和晚期死亡的风险)[2，3]。后者是预测二尖瓣环钙化患者30天和1年死亡率的最重要和独立的预测因子。
One million individuals aged 65 and over are affected by heart valve disease in the UK. Given the rapidly ageing population, the prevalence of clinically significant valve disease is projected to double by 2050 [1]. These forecasts carry serious implications for healthcare providers tasked with addressing the needs of this growing cohort of patients, who are mostly too old and frail for open-heart surgery. Aortic stenosis and mitral regurgitation are the most frequent valve conditions. Both share an adverse prognosis and a lack of effective medical therapies. In response, there have been groundbreaking developments in minimally-invasive transcatheter technology to implant bioprosthetic devices in the failing native valve. Transcatheter aortic valve implantation (TAVI) is already established as an alternative to conventional surgery for inoperable and high/intermediate-risk patients, and trials in low-risk cohorts are currently being concluded. Within 5 years, TAVI is likely to become the default treatment for the majority of patients with aortic stenosis. Based upon this paradigm shift, attention is now firmly focused on transcatheter mitral valve replacement (TMVR). Unlike TAVI, TMVR requires sophisticated engineering solutions to address the unique challenges posed by the heterogeneity and complexity of mitral valve anatomy and physiology, and its interaction with the left ventricle. Specific concerns include difficulty in anchoring the device to the deformed mitral annulus (with risk of valve migration or paravalvular leak), and potential for left ventricular outflow tract (LVOT) obstruction by the implanted valve (with risk of refractory heart failure and late mortality)[2, 3]. The latter is the most important and independent predictor of 30-day and 1-year mortality in patients with mitral annular calcification under-