A Novel Morphological Classification to Guide Transcatheter Mitral Valve Edge-to-Edge Repair for Commissural Mitral Regurgitation

JACC. Asia Pub Date : 2025-09-01 DOI:10.1016/j.jacasi.2025.05.008

Zhi-Nan Lu MD , Xu-Nan Guo MD , Yu-tong Ke MD , Yihua He MD , Xianbao Liu MD , Zhengming Jiang MD , Xinmin Liu MD , Wenhui Wu MD , Yi-Da Tang MD , Dajun Chai MD , Yansong Guo MD , Yongjian Wu MD , Yat-Yin Lam MD , Nicolo Piazza MD, PhD , Guangyuan Song MD

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引用次数: 0

Abstract

Background

Mitral commissural prolapse poses significant anatomical challenges that can hinder the effectiveness of transcatheter edge-to-edge repair (TEER).

Objectives

The aim of this study was to estimate the safety and effectiveness of applying a novel morphological classification to guide TEER in patients with commissural degenerative mitral regurgitation (DMR).

Methods

In this prospective, multicenter study across 18 centers in China, we classified patients with severe commissural DMR into 4 morphological types through detailed echocardiographic analysis. Customized TEER strategies were applied accordingly. Procedural success, clinical outcomes, echocardiographic parameters, and quality of life were assessed over a follow-up period, with a median follow-up of 18 months (Q1-Q3: 15-21 months).

Results

Among 540 patients screened, 126 (23.3%) exhibited commissural involvement. Tailored TEER strategies were successfully applied to 68 patients, achieving a technical success rate of 100% (n = 68 of 68; 95% CI: 0.933-1.000) and a device success rate of 97.1% (n = 66 of 68, 95% CI: 0.888-0.992). The 1-year follow-up revealed that 94.1% (n = 64 of 68; 95% CI: 0.849-0.981) of patients had residual mitral regurgitation of grade ≤2+, with 82.4% (n = 56 of 68; 95% CI: 0.708-0.902) at grade ≤1+, and no major complications. Additionally, significant improvements were noted in left ventricular dimensions and functional status.

Conclusions

Our results highlight the value of the morphological classification system in enhancing TEER for commissural DMR. By addressing specific anatomical challenges, this system promotes tailored interventions that optimize procedural success and improve patient outcomes.

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一种新的形态学分类指导经导管二尖瓣边缘对边缘修复二尖瓣返流

二尖瓣联合脱垂带来了重大的解剖学挑战，可能会阻碍经导管边缘到边缘修复（TEER）的有效性。目的本研究的目的是评估应用一种新的形态学分类来指导二尖瓣反流（DMR）患者的TEER的安全性和有效性。方法在这项涉及中国18个中心的前瞻性多中心研究中，我们通过详细的超声心动图分析将严重联合DMR患者分为4种形态类型。相应地采用了定制的TEER策略。在随访期间评估手术成功率、临床结果、超声心动图参数和生活质量，中位随访时间为18个月（Q1-Q3: 15-21个月）。结果540例患者中，126例（23.3%）表现出联合累及。量身定制的TEER策略成功应用于68例患者，技术成功率为100% (n = 68 / 68; 95% CI: 0.933-1.000)，器械成功率为97.1% （n = 66 / 68, 95% CI: 0.888-0.992）。1年随访显示，94.1% （n = 64 / 68; 95% CI: 0.849-0.981）的患者存在二尖瓣残余返流（≤2+级），82.4% （n = 56 / 68; 95% CI: 0.708-0.902）的患者存在二尖瓣残余返流（≤1+级），且无重大并发症。此外，左心室尺寸和功能状态也有显著改善。结论形态学分类系统在提高双侧DMR的TEER诊断中的应用价值。通过解决特定的解剖挑战，该系统促进量身定制的干预措施，优化手术成功并改善患者预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Asia Cardiology and Cardiovascular Medicine

CiteScore

4.00

自引率

0.00%

发文量