Transcatheter Mitral Valve Replacement Using Annular Reduction by Cinching With TEER in the Commissure (ARCTIC).

IF 6.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Circulation: Cardiovascular Interventions Pub Date : 2024-11-06 DOI:10.1161/CIRCINTERVENTIONS.124.014224
Gregory J Condos, David Elison, Logan L Vincent, Rafael Harari, Cristina Sanina, Srdjan Jelacic, Richard Sheu, Christine J Chung, Gabriel S Aldea, G Burkhard Mackensen, James M McCabe
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引用次数: 0

Abstract

Background: Mitral annular calcification with valve dysfunction remains a challenging syndrome. Operative risk is high, and available transcatheter therapies are limited.

Methods: This study describes our initial experience with a novel procedure to address large mitral annuli when no surgical or trial-based transcatheter mitral valve replacement device is available. The rationale was to shorten the intercommissural distance using commissural mitral transcatheter edge-to-edge repair (TEER) followed by valve-in-mitral annular calcification transcatheter mitral valve replacement with a balloon-expandable aortic valve platform. Patients with long intercommissural distances and large mitral annulus areas were selected based on a high perceived risk of transcatheter valve embolization. Patients underwent mitral TEER with MitraClip in a commissural position, followed immediately by transseptal transcatheter mitral valve replacement with a 29 mm SAPIEN 3 valve.

Results: Thirteen patients were included. Median intercommissural distance and annular area were 39.1 mm and 930 mm2, respectively. Commissural mitral TEER was successful in all patients with no instances of single leaflet detachment. In 10 of 13 instances, an NTW device size was used. In 12 of 13 patients, valve implantation was successful, including 1 case that required a second valve for atrial positioning of the first valve. In 1 case, frank valve embolization into the left atrium occurred. Among the 12 successful cases, paravalvular leak was 1+ or less, and there were no instances of paravalvular leak adjacent to the TEER device.

Conclusions: In patients with large annuli and sufficient annular calcium, a hybrid mitral TEER and valve replacement with the SAPIEN platform can be successfully used to facilitate transcatheter mitral valve replacement.

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使用瓣环缩紧术和充盈试验(TEER)进行经导管二尖瓣置换术(ARCTIC)。
背景:二尖瓣环钙化伴瓣膜功能障碍仍是一种具有挑战性的综合征。手术风险高,现有的经导管疗法有限:本研究介绍了在没有手术或试验性经导管二尖瓣置换装置的情况下,我们采用一种新型手术治疗大面积二尖瓣瓣环的初步经验。该手术的原理是使用合并二尖瓣经导管边缘到边缘修补术(TEER)缩短二尖瓣伞间距离,然后使用球囊扩张主动脉瓣平台进行瓣膜-二尖瓣环钙化经导管二尖瓣置换术。由于经导管瓣膜栓塞的风险较高,因此选择了组织间距离长、二尖瓣瓣环面积大的患者。患者在会厌位置使用 MitraClip 接受二尖瓣 TEER,随后立即使用 29 毫米 SAPIEN 3 瓣膜进行经导管二尖瓣置换术:共纳入13名患者。中位二尖瓣间距和瓣环面积分别为39.1毫米和930平方毫米。所有患者的二尖瓣伞端 TEER 均获得成功,无一例单瓣瓣叶脱落。13 例患者中有 10 例使用了 NTW 装置。13 例患者中有 12 例成功植入了瓣膜,其中 1 例患者因第一个瓣膜在心房定位而需要第二个瓣膜。有 1 例患者的瓣膜栓塞到了左心房。在12例成功的病例中,瓣膜旁漏为1+或更低,没有出现邻近TEER装置的瓣膜旁漏:结论:对于瓣环较大、瓣环钙化程度较高的患者,SAPIEN平台的混合二尖瓣TEER和瓣膜置换术可成功用于经导管二尖瓣置换术。
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来源期刊
Circulation: Cardiovascular Interventions
Circulation: Cardiovascular Interventions CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
10.30
自引率
1.80%
发文量
221
审稿时长
6-12 weeks
期刊介绍: Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.
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