Percutaneous mitral valve repair: are they changing the guard?
Percutaneous mitral valve repair: are they changing the guard?
复制标题
经皮二尖瓣修复术：他们正在换岗吗？
DOI：
10.1161/01.cir.0000165266.57397.b2
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发表时间：
2005
期刊：
影响因子：
37.8
通讯作者：
P. Block
中科院分区：
文献类型：
--
作者：
P. Block
二尖瓣返流（MR）患者的治疗策略正在发生变化。目前的指南建议，有症状的患者，房性心律失常，（特别是房颤）、肺动脉高压或左心室（LV）射血分数变化预示的左心室（LV）失代偿应接受二尖瓣手术。1此外，对于可能进行瓣膜修复的患者，该指南还建议，严重二尖瓣返流和左室功能正常的无症状患者可以接受二尖瓣修复术，以防止慢性二尖瓣返流的后遗症。早期和早期治疗和二尖瓣修复术现在是手术规范。从某种意义上说，警卫已经在改变。
参见第2183页
与置换术相比，二尖瓣修复术的晚期生存率至少相当，手术风险可能更低。3，4心内膜炎风险降低，血栓栓塞并发症减少，LV功能保留更好5，6使修复术成为一种有吸引力的策略;然而，成功的二尖瓣手术取决于个体瓣膜病理。在风湿性二尖瓣返流中，扭曲的瓣叶解剖结构、相关的瓣下纤维化和钙化很少允许瓣膜修复。患有缺血性或充血性心脏病、LV重构、瓣环扩张、瓣下结构改变和瓣叶对合扭曲的患者面临特殊挑战。大多数外科医生尝试完全修复，结合直接瓣膜修复和瓣环成形术器械。如果在我们向经皮经导管修复迈进的过程中要成功地更换防护装置，那么在多年的手术经验中吸取的宝贵教训就不能被遗忘。在经皮方法中，挑战被放大了几倍。
变革之风已经刮起。Alfieri（边缘对边缘）修复MR 7技术的临床成功和优雅简单性导致了经皮经导管技术的发展，该技术通过实现类似目标-无狭窄的双孔二尖瓣直接修复二尖瓣。个...
Treatment strategies for patients with mitral regurgitation (MR) are changing. Current guidelines suggest that patients with symptoms, atrial arrhythmias (especially atrial fibrillation), pulmonary hypertension, or left ventricular (LV) decompensation heralded by changes in LV ejection fraction should undergo mitral valve surgery.1 In addition, for patients in whom valvular repair is likely, the guidelines also suggest that an asymptomatic patient with severe MR and normal LV function might undergo mitral valve repair to prevent the sequelae of chronic MR. Earlier and earlier treatment and mitral valve repair are now the surgical norm. In one sense, the guard is already changing.2
See p 2183
Repair of the mitral valve is associated with an at least equivalent late survival rate compared with replacement, and perhaps lower operative risk.3,4 A reduced risk of endocarditis, fewer thromboembolic complications, and better preservation of LV function5,6 make repair an attractive strategy; however, successful mitral valve surgery is dependent on individual valve pathology. In rheumatic mitral regurgitation, the distorted leaflet anatomy, associated subvalvular fibrosis, and calcification rarely allow valve repair. Patients with ischemic or congestive heart disease, LV remodeling, annular dilation, alteration of the subvalvular apparatus, and distorted leaflet coaptation present special challenges. Most surgeons attempt a complete repair, combining direct valvular restoration with an annuloplasty device. If the guard is to change successfully as we move toward percutaneous transcatheter repair, then valuable lessons learned during many years of surgical experience must not be forgotten. The challenges are magnified severalfold in percutaneous approaches.
The wind of change is already blowing. The clinical success and elegant simplicity of the Alfieri, or edge-to-edge, technique for repair of MR7 has led to the development of percutaneous transcatheter techniques that directly repair the regurgitant mitral valve by accomplishing a similar goal—a double-orifice mitral valve without stenosis. A …