经导管二尖瓣缘对缘修复(TEER)的过去、现在和未来  

Transcatheter edge-to-edge repair(TEER): Past, current and future perspectives

作　　者：潘文志 龙愉良 周达新 葛均波 PAN Wenzhi;LONG Yuliang;ZHOU Daxin;GE Junbo(Department of Cardiology,Zhongshan Hospital,Fudan University,Research Unit of Cardiovascular Techniques and Devices,Chinese Academy of Medical Sciences,Shanghai,200032,P.R.China;National Clinical Research Center for Interventional Medicine,Shanghai,200032,P.R.China)

机构地区：[1]复旦大学附属中山医院心内科中国医学科学院心血管技术与器械创新单元,上海200032 [2]国家放射与治疗临床医学研究中心,上海200032

出　　处：《中国胸心血管外科临床杂志》2021年第12期1409-1414,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家重点研发计划(2017YFC1104202)。

摘　　要：经导管缘对缘修复(transcatheter edge-to-edge repair,TEER)起源于外科缘对缘修复术式。MitraClip是首个成熟的TEER器械,基于MitraClip的TEER也是众多经导管二尖瓣修复(transcatheter mitral valve repair,TMVr)技术中在安全、有效、普及范围等方面远远领先的技术,因而在最新指南中被单独命名。TEER有以下优势:符合基本医学原理、植入物少、靶点精确、可以实现导管化、可多次进行等。但也存在经股静脉入路器械操作相对复杂、干预手段相对外科单一、适应证相对窄等不足。目前TEER主要的临床数据来自MitraClip的临床实践。基于COAPT 3年研究结果,2020年二尖瓣反流决策路径美国心脏病学会(ACC)专家共识,将最佳药物治疗后仍有症状性的心力衰竭合并重度二尖瓣反流列为TEER适应证。2020年ACC/美国心脏协会(AHA)指南也将此列为ⅡA类适应证。爱德华公司的PASCAL,是另一种TEER器械,目前有2种型号。国产TEER器械中捍宇医疗科技的ValveClamp,其具有操控简便、夹合面积大、夹合效能高、无需射线等优势。国产TEER器械DragonFly也完成探索性临床试验。TEER未来有5个发展趋势:进一步拓展适应证、与其它术式联合、可多次进行、TEER术后可再行经导管二尖瓣瓣膜置换以及器械不断改进创新。Transcatheter edge-to-edge repair(TEER) originated from surgical edge-to-edge repair. MitraClip is the first mature TEER device, and the TEER based on MitraClip is far ahead of many transcatheter mitral valve repair(TMVr) technologies in terms of safety, effectiveness and popularity, so it is named separately in the latest guidelines. The TEER has the following advantages: consistent with basic medical principles, few implants, precise target, less invasive and repeatable. However, there are also some shortcomings, such as the relatively complex design of transfemoral device,target single and relatively narrow indications. At present, the main clinical data of TEER are mainly from the clinical practice of MitraClip. Based on the three-year outcomes of COAPT study, both 2020 ACC/AHA guideline and 2020 ACC expert consensus decision pathway on the management of mitral regurgitation recommend in patients with chronic heart failure with left ventricular dysfunction and severe mitral regurgitation in nonresponders to medicine treatment. Edward’s PASCAL, another TEER device, has two models. Among the domestic TEER devices, the ValveClamp of Hanyu medical technology has many distinct advantages, such as simple operation, large clamping area, high clamping efficiency and no need of X-ray. DragonFly, another domestic TEER device, has also completed its feasibility study. There are five trends of TEER in the future: further expansion of indications, combination with other interventional techniques, repeatable operations, transcatheter mitral valve replacement after TEER, and continuous improvement and innovation of equipment.

关 键 词：经导管缘对缘修复 二尖瓣反流 进展 

分 类 号：R542.51[医药卫生—心血管疾病]