经过连接管的两侧门更换在经过连接管边缘修复失败后:一个多中心的经验
Daryoush Samim1, Paul Sorajja2, Jonas Lanz3
1Department of Cardiology, Bern University Hospital, Bern, Switzerland. Electronic address: https://twitter.com/DaryoushSamim.
JACC. Cardiovascular interventions
|February 12, 2025
概括
经过ELASTA-Clip后的横管甲膜置换 (TMVR) 为失败的横管甲膜端到端修复 (M-TEER) 提供了一种不那么侵入性的解决方案. 这种方法成功地减少了额头管吐,并改善了患者的功能类,并取得了可接受的早期结果.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 医疗器械 医疗器械
背景情况:
- 经过交叉导管边缘到边缘修复 (M-TEER) 后,对复发性 mitrale regurgitation (MR) 或 iatrogenic mitral valve (MV) 狭窄的治疗具有临床意义.
- 在M-TEER后进行手术修复会带来高发病率和死亡率风险.
- 电外科手册撕裂和稳定植入物 (ELASTA-Clip),然后进行透导管中枢置换 (TMVR),为TEER失败提供了一种创新的,不那么侵入性的选择.
研究的目的:
- 为了评估ELASTA-Clip的早期安全性和有效性,然后进行跨吸管TMVR.
- 为了评估症状失败的M-TEER患者的结局,包括持续/复发的MR或阳性MV狭窄症.
主要方法:
- 从8个中心的22名高风险患者回顾性数据收集.
- 患者接受了ELASTA-Clip,随后使用Abbott Tendyne系统进行了跨膜TMVR.
- 根据米特拉学术研究联盟 (MVARC) 的标准,安全性和有效性评估长达1年.
主要成果:
- 联合ELASTA-Clip和TMVR程序在所有患者中都取得了成功 (22/22).
- 技术成功率 (MVARC) 为95.4%,没有LVOT阻塞或胸切割转换.
- 在所有患者中,MR显著减少 (≥3+至≤1+),持久结果为89.5%.
- 在出院时的81.3%和随访时的72.2%,NYHA功能类改进到≤II.
- 30天死亡率为0%;15%经历过缺血性中风,15%因心力衰竭重新住院.
结论:
- 在ELASTA-Clip后的TransapicalTMVR是M-TEER在被选中的高风险患者中失败的可行,不那么侵入性的选择.
- 观察到可接受的早期结果,显著减少了MR和功能类的改善.
- 未来的研究应侧重于尽量减少对膜泄漏和脑血管事件.
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