Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada.
Curr Opin Cardiol. 2019 Mar;34(2):164-172. doi: 10.1097/HCO.0000000000000607.
Worldwide experience in transcatheter tricuspid valve intervention is increasing as more options become available for the treatment of severe tricuspid regurgitation. These devices can be categorized by their primary mechanism of action, including edge-to-edge leaflet devices, space occupying devices, annuloplasty devices, complete valve replacement and caval valve implantation. This review summarizes the current technologies in use, early clinical results and factors that may affect procedural success.
Almost all transcatheter devices for tricuspid regurgitation are investigational with very limited evidence. The most commonly used device is the MitraClip (Abbott, Santa Clara, CA, USA) edge-to-edge leaflet device, which is often more effective when the leaflet coaptation gap is not too large (ideally under 7 mm). The Tricuspid Cardioband (Edwards Lifesciences, Irvine, CA, USA) annuloplasty device has CE mark approval with promising short-term procedural results. Guideline-based assessment of disease severity and medication optimization is crucial during heart team evaluation of eligibility for intervention.
Although important lessons have been learned thus far regarding patient and device selection for transcatheter tricuspid regurgitation interventions, the field remains young and further research is needed to optimize treatment in terms of who, when and with what device. Our proposed algorithm for patient selection based on current knowledge incorporates both clinical and anatomic factors.
随着越来越多的治疗重度三尖瓣反流的方法可供选择，经导管三尖瓣介入治疗的全球经验不断增加。这些器械可根据其主要作用机制进行分类，包括瓣叶对合器械、占位性器械、瓣环成形术器械、瓣膜置换和腔静脉瓣植入。本文综述了目前使用的技术、早期临床结果以及可能影响手术成功的因素。
几乎所有的三尖瓣反流经导管器械都处于研究阶段，仅有非常有限的证据。最常用的器械是 MitraClip（雅培，圣克拉拉，加利福尼亚州，美国）瓣叶对合器械，当瓣叶对合间隙不太宽（理想情况下<7mm）时，该器械通常更有效。Tricuspid Cardioband（爱德华兹生命科学，欧文，加利福尼亚州，美国）瓣环成形术器械已获得 CE 标志批准，短期手术结果有希望。在心脏团队评估介入治疗的适应证时，基于指南的疾病严重程度评估和药物优化至关重要。
尽管迄今为止在经导管三尖瓣反流介入治疗中，关于患者和器械选择方面已经积累了重要经验，但该领域仍处于起步阶段，需要进一步研究以优化治疗方法，包括哪些患者、何时以及使用何种器械。我们基于现有知识提出的患者选择算法，综合考虑了临床和解剖因素。
