Mitral regurgitation (MR) is a common heart valve disease. Mitral regurgitation is when incomplete closure of the mitral valve during the contraction of the left ventricle causes a part of the blood flow from the left atrium to the left ventricle to go back to the left atrium, resulting in a series of cardiac pathological changes and clinical symptoms, and in severe cases, heart failure.
MR is a common heart disease in China [1, 3]. According to a survey conducted by Fuwai Hospital of the National Center for Cardiovascular Diseases, the incidence of mild MR is as high as 23% and that of moderate and severe MR is 2.2% among people aged over 65 [2]. The incidence of all-cause mortality in asymptomatic severe MR patients reached (22±3)% [4] within 5 years, while the annual mortality rate in patients with severe heart failure reached 34% [5].
The current treatments of mitral regurgitation mainly include medication, surgery and interventional therapy. Clinical studies have shown that medication can only improve symptoms and cannot prolong survival or operative time [6]. In the United States, 49% of MR patients cannot undergo surgery due to high risks of cardiac insufficiency, complications and advanced age [7]. In China, more than 40,000 mitral valve surgeries are performed every year, but most MR patients are not effectively treated[8].
The rapid development of transcatheter mitral valve intervention techniques in the recent decade has brought new hope to MR patients. MR interventional techniques can be divided into two categories: transcatheter mitral valve repair and transcatheter mitral valve replacement. At present, the transcatheter edge-to-edge repair technique is the most mature in the transcatheter mitral valve repair. More than 100,000 repairs have been carried out and it is recommended by the guidelines [9]. At the same time, percutaneous valve replacement devices have been developed as an alternative and more effective option for reducing MR.
经导管二尖瓣缘对缘修复的出现改变了原发性与继发性二尖瓣反流的治疗方式[1]，提供了一种相较外科更为微创的介入治疗方式。同时经导管二尖瓣缘对缘修复已获得越来越多的临床询证支持[2-5]，该术式的应用也正逐步扩展至更为复杂的二尖瓣病变和临床情况[1]。
经导管二尖瓣置换术是一种可以克服当前缘对缘修复术式局限的一种微创介入二尖瓣反流治疗方式，该术式有望完全纠正反流并防止二尖瓣反流的长期发展[1]。尽管经导管二尖瓣置换发展速度慢于TAVI，自2012年起已有多个临床试验来探寻此类器械的可行性与安全性[2]，其中尤其是经房间隔路径的方式，可以带来更快的术后恢复并缩短住院时间，可以为患者带来更好的长期预后[1]。
参考文献
[1] Li J, Pan W, Yin Y, Cheng L, Shu X. Prevalence and correlates of mitral regurgitation in the current era: an echocardiography study of a Chinese patient population. Acta Cardiol. 2016 Feb;71(1):55–60.
[2] Nkomo VT,Gardin JM,Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M.Burden of valvular heart diseases: a population-based study.Lancet Lond Engl.2006 Sep;368(9540):1005–11.
[3] Hu P, Liu X-B, Liang J, Zhu Q-F, Pu C-X, Tang M-Y, et al.A hospital-based survey of patients with severe valvular heart disease in China.Int J Cardiol.2017 Mar;231:244–7.
[4] Enriquez-Sarano M, Avierinos J-F, Messika-Zeitoun D, Detaint D, Capps M, Nkomo V, et al. Quantitative determinants of the outcome of asymptomatic mitral regurgitation.N Engl J Med.2005 Mar;352(9):875–83.
[5] Ling LH, Enriquez-Sarano M, Seward JB, Tajik AJ, Schaff HV, Bailey KR, et al. Clinical outcome of mitral regurgitation due to flail leaflet. N Engl J Med. 1996 Nov;335(19):1417–23.
[6] Carabello BA.The current therapy for mitral regurgitation.J Am Coll Cardiol.2008 Jul;52(5):319–26.
[7] Head SJ, van Leeuwen WJ, Van Mieghem NM, Kappetein AP.Surgical or transcatheter mitral valve intervention: complex disease requires complex decisions.EuroIntervention J Eur Collab Work Group Interv Cardiol Eur Soc Cardiol.2014 Feb;9(10):1133–5.
[8] 赵举, 黑飞龙. 2015中国心脏外科和体外循环数据白皮书. 中国体外循环杂志. 2016;14(3):130–2.
[9] 结构心脏病年度报告2021.
参考文献
[1] Flint, N., Price, M., Little, S., Mackensen,G., Wunderlich, N.,Makar, M.,&Siegel, R.(2021). State of the Art: Transcatheter Edge-to-Edge Repair for Complex Mitral Regurgitation. Journal Of The American Society Of Echocardiography,34(10),1025-1037. https://doi.org/10.1016/j.echo.2021.03.240
参考文献
[1] Alperi, A., Granada, J., Bernier, M., Dagenais, F., & Rodés-Cabau, J. (2021). Current Status and Future Prospects of Transcatheter Mitral Valve Replacement. Journal Of The American College Of Cardiology, 77(24), 3058-3078. https://doi.org/10.1016/j.jacc.2021.04.051
[2] Dahle, G. (2020). Current Devices in TMVI and Their Limitations: Focus on Tendyne. Frontiers In Cardiovascular Medicine, 7. https://doi.org/10.3389/fcvm.2020.592909
