Kolte Dhaval, Elmariah Sammy
Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Cardiovasc Diagn Ther. 2020 Feb;10(1):89-97. doi: 10.21037/cdt.2019.09.11.
Tricuspid regurgitation (TR) is a common valvular heart disease affecting >1.6 million people in the United States (US) and >70 million people worldwide. The age- and sex-adjusted prevalence of more than or equal to moderate TR in the US is estimated to be 0.55%. One-year mortality increases with increasing severity of TR. Yet, the majority of patients with severe TR are managed medically in the absence of another indication for cardiac surgery, and isolated tricuspid valve (TV) surgery remains infrequent. To address this unmet clinical need, various transcatheter TV therapies are now being developed as an alternative to surgery in extreme- and high-risk patients with severe functional TR. Transcatheter TV repair devices are aimed at improving leaflet coaptation either directly by bringing the leaflets together (leaflet/coaptation devices) or indirectly by repairing the dilated annulus (annuloplasty devices). In this review, we describe the current state of transcatheter TV repair therapies and summarize the available data on the efficacy and safety of various devices. Procedural and clinical outcomes of transcatheter TV repair therapies are expected to improve in the coming years with technological advancement, newer device iterations, and increased experience in this field. Appropriate patient selection, optimal timing of intervention, and evaluation of long-term outcomes and device durability will be key in ongoing and future studies.
三尖瓣反流（TR）是一种常见的心脏瓣膜疾病，在美国影响着超过160万人，在全球影响着超过7000万人。据估计，在美国，年龄和性别调整后的中度及以上TR患病率为0.55%。TR的死亡率随病情严重程度增加而上升。然而，大多数重度TR患者在没有心脏手术其他指征的情况下接受药物治疗，单纯三尖瓣（TV）手术仍然很少见。为满足这一未被满足的临床需求，目前正在开发各种经导管TV治疗方法，作为重度功能性TR的极高风险和高风险患者手术的替代方案。经导管TV修复装置旨在通过直接将瓣叶拉拢在一起（瓣叶/贴合装置）或间接修复扩张的瓣环（瓣环成形术装置）来改善瓣叶贴合。在本综述中，我们描述了经导管TV修复治疗的现状，并总结了各种装置的有效性和安全性的现有数据。随着技术进步、更新的装置迭代以及该领域经验的增加，预计未来几年经导管TV修复治疗的手术和临床结果将得到改善。在正在进行的和未来的研究中，合适的患者选择、最佳干预时机以及长期结果和装置耐久性的评估将是关键。
