Beckhoff Frederik, Alushi Brunilda, Jung Christian, Navarese Eliano, Franz Marcus, Kretzschmar Daniel, Wernly Bernhard, Lichtenauer Michael, Lauten Alexander
Department of Cardiology, Charité University Hospital, Berlin, Germany.
German Centre for Cardiovascular Research (DZHK), Berlin, Germany.
Front Cardiovasc Med. 2018 May 28;5:49. doi: 10.3389/fcvm.2018.00049. eCollection 2018.
Severe tricuspid regurgitation (TR) is a complex condition of the right ventricle (RV) and tricuspid valve apparatus and is frequently associated with symptomatic heart failure and a significant morbidity and mortality. In these patients, left heart pathologies lead to chronic pressure overload of the RV, eventually causing progressive RV dilatation and functional TR. Therefore, TR cannot be considered as isolated heart valve disease pathology but has to be understood and treated as one component of a complex structural RV pathology and is frequently also a marker of an advanced stage of cardiac disease. In these patients, medical therapy restricted to diuretics and heart failure medication is frequently ineffective. Also, severe TR in the setting of advanced heart failure constitutes a high risk for cardiac surgery. Neither one of these treatment options has demonstrated a beneficial effect on long-term prognosis. The recent innovations in transcatheter technology led to efforts to develop interventional approaches to severe TR. Multiple innovative treatment concepts are currently under preclinical and clinical investigation to replace or repair TV function. However, up to date none of these approaches is established and there is still a lack of clinical data to support the efficacy of transcatheter TR treatment.
严重三尖瓣反流（TR）是一种涉及右心室（RV）和三尖瓣装置的复杂病症，常与有症状的心力衰竭以及较高的发病率和死亡率相关。在这些患者中，左心病变导致右心室慢性压力超负荷，最终引起右心室进行性扩张和功能性三尖瓣反流。因此，不能将三尖瓣反流视为孤立的心脏瓣膜疾病病理，而必须将其理解并作为复杂的右心室结构病理的一个组成部分来治疗，并且它常常也是心脏病晚期的一个标志。在这些患者中，仅使用利尿剂和心力衰竭药物的药物治疗通常无效。此外，晚期心力衰竭情况下的严重三尖瓣反流对心脏手术构成高风险。这些治疗选择均未显示出对长期预后有有益影响。最近导管技术的创新促使人们努力开发针对严重三尖瓣反流的介入方法。目前有多种创新治疗概念正在进行临床前和临床研究，以替代或修复三尖瓣功能。然而，到目前为止，这些方法均未确立，并且仍然缺乏临床数据来支持经导管三尖瓣反流治疗的疗效。
