El-Eshmawi Ahmed, Pandis Dimosthenis, Adams David H, Tang Gilbert H
Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, NY, USA -
Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, NY, USA.
Minerva Cardioangiol. 2018 Dec;66(6):700-712. doi: 10.23736/S0026-4725.18.04687-X. Epub 2018 Apr 11.
The tricuspid valve has historically received less attention than any other cardiac valve with regard to pathophysiology and surgical management. The tricuspid valve is part of a complex functional apparatus that includes the right atrium, right ventricle, and pulmonary circulation. Functional tricuspid regurgitation is the most common tricuspid valve disease and it occurs secondary to dilatation of tricuspid annulus and/or tethering of valve leaflets from right ventricular dilatation and dysfunction. However, recent expansion in the use of right-sided transvenous devices such as pacemakers and implantable defibrillators has been met with a parallel increase in the risk of organic tricuspid disease. Recent data suggest that tricuspid regurgitation is not benign, and many patients will benefit from intervention at the time of left-sided valve surgery, or early in isolated tricuspid valve disease. This review describes the various surgical options and strategies in the treatment of common tricuspid valve diseases. Current American and European guidelines advocate for a more proactive surgical approach in the treatment of tricuspid regurgitation and/or annular dilatation at the time of left-sided valve surgery. Tricuspid annuloplasty is the preferred technique given its superior long-term outcomes. This renewed interest in surgical repair has been ushered by the development of a newer generation of tricuspid annuloplasty rings, as well as technological strides in transcatheter therapies which now extend to include tricuspid pathologies in otherwise inoperable patients with advanced tricuspid disease and cardiomyopathy. Tricuspid disease is not a benign entity. An aggressive approach to surgical management as well as prophylactic interventions are becoming more widely adopted. Aggressive tricuspid surgery however, remains an area of controversy in cardiac surgery, although surgical repair remains the gold standard for functional tricuspid regurgitation with replacement reserved for advanced or organic tricuspid disease. Transcatheter therapy is primarily directed toward non-surgical patients and is not included in this review.
在病理生理学和外科治疗方面，三尖瓣历来比其他任何心脏瓣膜受到的关注都要少。三尖瓣是一个复杂功能装置的一部分，该装置包括右心房、右心室和肺循环。功能性三尖瓣反流是最常见的三尖瓣疾病，它继发于三尖瓣环扩张和/或由于右心室扩张和功能障碍导致的瓣叶牵拉。然而，近年来，随着右侧经静脉装置（如起搏器和植入式除颤器）使用的增加，器质性三尖瓣疾病的风险也相应上升。最近的数据表明，三尖瓣反流并非良性，许多患者在进行左侧瓣膜手术时或在孤立性三尖瓣疾病早期进行干预会受益。本综述描述了治疗常见三尖瓣疾病的各种手术选择和策略。当前美国和欧洲的指南提倡在进行左侧瓣膜手术时，对三尖瓣反流和/或瓣环扩张采取更积极的手术方法。鉴于其优越的长期效果，三尖瓣环成形术是首选技术。新一代三尖瓣环成形环的开发以及经导管治疗技术的进步引发了对手术修复的新兴趣，现在经导管治疗技术已扩展到包括患有晚期三尖瓣疾病和心肌病的无法手术的患者的三尖瓣病变。三尖瓣疾病并非良性疾病。积极的手术管理方法以及预防性干预措施正被越来越广泛地采用。然而，积极的三尖瓣手术在心脏外科领域仍然存在争议，尽管手术修复仍然是功能性三尖瓣反流的金标准，而置换术则用于晚期或器质性三尖瓣疾病。经导管治疗主要针对非手术患者，本综述不包括该内容。
