Percutaneous Interventions for Secondary Mitral Regurgitation.
Percutaneous Interventions for Secondary Mitral Regurgitation.
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DOI：
10.1161/circinterventions.120.008998
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发表时间：
2020-08
期刊：
影响因子：
--
通讯作者：
Kereiakes DJ
中科院分区：
文献类型：
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作者：
Ali M;Shreenivas SS;Pratt DN;Lynch DR;Kereiakes DJ
二尖瓣关闭不全常与心功能不全有关，死亡率高。指南指导的药物治疗、外科二尖瓣修复或置换，以及在晚期心力衰竭的情况下，心脏移植和左心室辅助装置一直是治疗的主要手段。然而，该领域的快速发展导致了MitraClip边缘到边缘二尖瓣修复术的批准，临床试验中有几种新的基于导管的经皮二尖瓣修复方案。经皮穿刺术虽然前景看好，但必须应用于最有可能受益的患者，因此，了解功能性二尖瓣反流患者特定亚组的病理生理学(例如，不成比例的二尖瓣反流与成比例的二尖瓣反流)是新装置成功的关键。我们回顾了功能性二尖瓣返流的病理生理学、经皮治疗选择和正在进行的临床试验。
Mitral regurgitation is frequently associated with ventricular dysfunction and carries a high mortality. Guideline-directed medical therapy, surgical mitral valve repair or replacement, and, in the setting of advanced heart failure, heart transplant and left ventricular assist devices have been the mainstay of treatment. However, rapid advancement in the field has resulted in approval of edge-to-edge mitral valve repair with the MitraClip, and there are several novel catheter-based percutaneous options in clinical trials. Percutaneous options, while promising, must be deployed in patients who are most likely to benefit, and thus, understanding the pathophysiology of specific subgroups of patients with functional mitral regurgitation (eg, disproportionate versus proportionate mitral regurgitation) is key to the success of new devices. We review the pathophysiology, percutaneous therapeutic treatment options, and ongoing clinical trials for functional mitral regurgitation.