共查询到20条相似文献，搜索用时 15 毫秒
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John G. Webb Dale J. Murdoch Robert H. Boone Robert Moss Adrian Attinger-Toller Philipp Blanke Anson Cheung Mark Hensey Jonathon Leipsic Kevin Ong Janarthanan Sathananthan David A. Wood Jian Ye Paolo Tartara 《Journal of the American College of Cardiology》2019,73(11):1239-1246
Background
Severe mitral regurgitation (MR) conveys significant morbidity and mortality, and surgical repair or replacement may not be a desirable option.Objectives
The purpose of this study was to evaluate the feasibility of a percutaneous transseptal transcatheter mitral valve replacement (TMVR) system.Methods
This first-in-human study was conducted between August 2017 and August 2018. The system comprises a nitinol dock, which encircles the chordae tendineae, and a balloon-expandable transcatheter heart valve. The dock and transcatheter heart valve form an ensemble, with the native mitral valve leaflets secured in between, thereby abolishing MR. Key inclusion criteria were severe symptomatic MR and high surgical risk; exclusion criteria included left ventricular ejection fraction <30% or screening suggesting unfavorable anatomy. The primary endpoint was technical success as defined by Mitral Valve Academic Research Consortium (MVARC) criteria at completion of the index procedure. The secondary endpoint was freedom from mortality, stroke, and device dysfunction (MR grade >1, mitral gradient >6 mm Hg, left ventricular outflow tract gradient >20 mm Hg) at 30 days.Results
Ten patients with severe MR of various etiologies (4 degenerative, 4 functional, and 2 mixed) were treated. The device was successfully implanted and the primary endpoint was achieved in 9 of 10 patients (90%). By transesophageal echocardiography, total MR was reduced to ≤ trivial in all implanted patients, and mean transmitral gradient was 2.3 ± 1.4 mm Hg. A pericardial effusion occurred in 1 patient: pericardiocentesis was performed, and the device was not implanted. Median length of hospital stay was 1.5 days. At 30 days, there was no stroke, myocardial infarction, rehospitalization, left ventricular outflow tract obstruction, device migration, embolization, or conversion to mitral surgery. One patient had recurrent regurgitation due to a paravalvular leak, treated with a closure device. All other treated patients had ≤1+ MR. No patients died.Conclusions
Percutaneous transvenous transseptal TMVR is feasible and safe in patients with severe MR who are at high risk for mitral valve surgery. Further evaluation is warranted. 相似文献16.
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Sung-Han Yoon Sabine Bleiziffer Azeem Latib Lena Eschenbach Marco Ancona Flavien Vincent Won-Keun Kim Axel Unbehaum Masahiko Asami Abhijeet Dhoble Miriam Silaschi Antonio H. Frangieh Verena Veulemans Gilbert H.L. Tang Shingo Kuwata Rajiv Rampat Tobias Schmidt Amisha J. Patel Raj R. Makkar 《JACC: Cardiovascular Interventions》2019,12(2):182-193
Objectives
The aim of this study was to evaluate the predictors of left ventricular outflow tract (LVOT) obstruction after transcatheter mitral valve replacement (TMVR).Background
LVOT obstruction is a major concern with TMVR, but limited data exist regarding its predictors and impact on outcomes.Methods
Patients with pre-procedural multidetector row computed tomography (MDCT) undergoing TMVR for failed mitral bioprosthetic valves (valve-in-valve), annuloplasty rings (valve-in-ring), and mitral annular calcification (valve-in-MAC) were included in this study. Echocardiographic and procedural characteristics were recorded, and comprehensive assessment with MDCT was performed to identify the predictors of LVOT obstruction (defined as an increment of mean LVOT gradient ≥10 mm Hg from baseline). The new LVOT (neo-LVOT) area left after TMVR was estimated by embedding a virtual valve into the mitral annulus on MDCT, simulating the procedure.Results
Among 194 patients with pre-procedural MDCT undergoing TMVR (valve-in-valve, 107 patients; valve-in-ring, 50 patients; valve-in-MAC, 37 patients), LVOT obstruction was observed in 26 patients (13.4%), with a higher rate after valve-in-MAC than valve-in-ring and valve-in-valve (54.1% vs. 8.0% vs. 1.9%; p < 0.001). Patients with LVOT obstruction had significantly higher procedural mortality compared with those without LVOT obstruction (34.6% vs. 2.4%; p < 0.001). Receiver-operating characteristic curve analysis showed that an estimated neo-LVOT area ≤1.7 cm2 predicted LVOT obstruction with sensitivity of 96.2% and specificity of 92.3%.Conclusions
LVOT obstruction after TMVR was associated with higher procedural mortality. A small estimated neo-LVOT area was significantly associated with LVOT obstruction after TMVR and may help identify patients at high risk for LVOT obstruction. 相似文献20.
Early Improvement in Left Atrial Remodeling and Function after Mitral Valve Repair or Replacement in Organic Symptomatic Mitral Regurgitation Assessed by Three‐Dimensional Echocardiography 
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下载免费PDF全文 David C. S. Le Bihan M.D. Dorival Julio Della Togna M.D. Ph.D. Rodrigo B. M. Barretto M.D. Ph.D. Jorge Eduardo Assef M.D. Ph.D. Lúcia Romero Machado M.D. Auristela Isabel de Oliveira Ramos M.D. Ph.D. Camilo Abdulmassih Neto M.D. Valdir Ambrosio Moisés M.D. Ph.D. Amanda G. M. R. Sousa M.D. Ph.D. Orlando Campos M.D. Ph.D. 《Echocardiography (Mount Kisco, N.Y.)》2015,32(7):1122-1130
