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[经导管治疗三尖瓣反流]

[Transcatheter treatment of tricuspid regurgitation].

作者信息

Gallet R, Ternacle J, Teiger E

机构信息

Service de Cardiologie, CHU Henri-Mondor, 51, avenue du Maréchal de Lattre de-Tassigny, 94010 Créteil, France.

Service de Cardiologie, CHU Henri-Mondor, 51, avenue du Maréchal de Lattre de-Tassigny, 94010 Créteil, France.

出版信息

Ann Cardiol Angeiol (Paris). 2019 Dec;68(6):480-485. doi: 10.1016/j.ancard.2019.10.004. Epub 2019 Oct 23.

Abstract

Tricuspid regurgitation is serious disease for which surgical correction is underperformed because of a prohibitive risk. It is responsible for a 50% mortality at 3 years which is decreased by surgical treatment. However, only a negligible proportion of patients undergoes surgery. In this context, there is currently an unmet need for percutaneous treatment technique. Several technologies are undergoing preclinical or early clinical development. These techniques aim to mimic the different surgical strategies used for the treatment of tricuspid regurgitation. Thus, some target the leaflets, the tricuspid annulus or offer a complete tricuspid valve replacement. Before planning a transcatheter tricuspid intervention, a comprehensive evaluation is mandatory, addressing the patient clinical status and comorbidities, the tricuspid regurgitation ad its consequences on right heart and, the anatomy of the tricuspid annulus and the right heart to determine if the patient is eligible for the chosen technique. This article will review the indications, contraindications and exams to perform before transcatheter tricuspid intervention and will then detail the different strategies available or undergoing development.

摘要

三尖瓣反流是一种严重疾病,由于风险过高,手术矫正的实施情况不佳。它导致3年死亡率达50%,手术治疗可降低该死亡率。然而,只有极小比例的患者接受手术。在此背景下,目前对经皮治疗技术存在未满足的需求。几种技术正在进行临床前或早期临床开发。这些技术旨在模仿用于治疗三尖瓣反流的不同手术策略。因此,一些技术针对瓣叶、三尖瓣环,或提供完整的三尖瓣置换。在计划经导管三尖瓣干预之前,必须进行全面评估,包括患者的临床状况和合并症、三尖瓣反流及其对右心的影响,以及三尖瓣环和右心的解剖结构,以确定患者是否适合所选技术。本文将回顾经导管三尖瓣干预前的适应证、禁忌证和检查,然后详细介绍可用或正在开发的不同策略。

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