Valvular heart disease 2 Mitral valve disease-current management and future challenges
Valvular heart disease 2 Mitral valve disease-current management and future challenges
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DOI：
10.1016/s0140-6736(16)00558-4
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发表时间：
2016-03-26
期刊：
影响因子：
168.9
通讯作者：
Mack, Michael J.
中科院分区：
文献类型：
--
作者：
Nishimura, Rick A.;Vahanian, Alec;Mack, Michael J.
二尖瓣疾病的诊断和管理领域正在迅速变化。对疾病病理和进展的新理解，以及先进成像方式的改进和增加使用，导致了早期诊断和复杂治疗。在原发性二尖瓣返流中，手术修复是标准治疗。在瓣膜参考中心治疗无症状重度二尖瓣返流患者，其中修复成功率超过95%，手术死亡率低于1%，应是未来5年的预期。在手术风险较高的原发性二尖瓣返流患者中，使用二尖瓣夹系统进行经导管二尖瓣修复术也产生了良好的结局。在中等手术风险患者中进行的MitraClip与外科手术的临床试验结果预计将在未来几年内启动。在继发性二尖瓣返流患者中，主要是左心室疾病，未来5年的视力几乎不清楚。正在进行的临床试验的结果将大大告知这一领域。经导管技术的使用，包括修复和置换，预计将大大扩展。二尖瓣环钙化在老年人中是一个日益严重的问题，导致二尖瓣狭窄和返流，这是难以治疗的。通过基于导管的方法或作为开放手术的混合技术使用经导管瓣膜的轶事经验，正在早期可行性试验中进行研究。
The field of mitral valve disease diagnosis and management is rapidly changing. New understanding of disease pathology and progression, with improvements in and increased use of sophisticated imaging modalities, have led to early diagnosis and complex treatment. In primary mitral regurgitation, surgical repair is the standard of care. Treatment of asymptomatic patients with severe mitral regurgitation in valve reference centres, in which successful repair is more than 95% and surgical mortality is less than 1%, should be the expectation for the next 5 years. Transcatheter mitral valve repair with a MitraClip device is also producing good outcomes in patients with primary mitral regurgitation who are at high surgical risk. Findings from clinical trials of MitraClip versus surgery in patients of intermediate surgical risk are expected to be initiated in the next few years. In patients with secondary mitral regurgitation, mainly a disease of the left ventricle, the vision for the next 5 years is not nearly as clear. Outcomes from ongoing clinical trials will greatly inform this field. Use of transcatheter techniques, both repair and replacement, is expected to substantially expand. Mitral annular calcification is an increasing problem in elderly people, causing both mitral stenosis and regurgitation which are difficult to treat. There is anecdotal experience with use of transcatheter valves by either a catheter-based approach or as a hybrid technique with open surgery, which is being studied in early feasibility trials.