Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany.
Heart Center Leipzig at University Leipzig, Leipzig, Germany.
JACC Heart Fail. 2020 Apr;8(4):265-276. doi: 10.1016/j.jchf.2019.12.006.
The goal of this study was to evaluate the effect of transcatheter edge-to-edge tricuspid valve repair (TTVR) for severe tricuspid regurgitation (TR) on hospitalization for heart failure (HHF) and HF-related endpoints.
Patients with severe TR need effective therapies beyond conservative treatment. The impact of TTVR on HHF and HF-related endpoints is unknown.
Isolated TTVR was performed in 119 patients. Assessments were conducted of New York Heart Association functional class, 6-min walk distance, Minnesota Living with Heart Failure Questionnaire scores, N-terminal pro-B-type natriuretic peptide level, and medication. HHFs were analyzed in the preceding 12 months before and until the longest available follow-up after TTVR. Results were compared with those of 114 patients who underwent combined mitral and tricuspid valve repair.
Procedural success with a reduction to moderate or less TR and no in-hospital death was achieved in 82% of patients. With a median follow-up of 360 days (interquartile range: 187 to 408 days), a durable TR reduction to moderate or less was achieved in 72% of patients (p < 0.001). TTVR reduced the annual rate of HHF by 22% (1.21 to 0.95 HHF/patient-year; p = 0.02), with concomitant clinical improvement in New York Heart Association functional class (patients in class II or lower: 9% to 67%; p < 0.001), 6-min walk distance (+39 m; p = 0.001), and Minnesota Living with Heart Failure Questionnaire score (-6 points; p = 0.02). N-terminal pro-B-type natriuretic peptide level decreased numerically by 783 pg/ml. Diuretic dose before TTVR was increased, but HF medication did not change after TTVR. Procedural success was associated with improved 1-year survival (79% vs. 60%; p = 0.04) and event-free-survival (death + first HHF: 67% vs. 40%; p = 0.001). Transcatheter mitral and tricuspid valve repair-treated patients had comparable outcomes.
TTVR for severe TR is associated with a reduction of HHF and improved clinical outcomes.
本研究旨在评估经导管缘对缘三尖瓣修复术（TTVR）治疗重度三尖瓣反流（TR）对心力衰竭（HF）住院和 HF 相关终点的影响。
需要对重度 TR 患者进行有效的治疗，而不仅仅是保守治疗。TTVR 对 HF 住院和 HF 相关终点的影响尚不清楚。
对 119 例患者进行孤立 TTVR。评估纽约心脏协会功能分级、6 分钟步行距离、明尼苏达心力衰竭生活质量问卷评分、N 端脑利钠肽前体水平和药物治疗情况。HF 住院在 TTVR 前 12 个月进行分析，直至 TTVR 后最长随访时间。将结果与 114 例行二尖瓣和三尖瓣联合修复术的患者进行比较。
82%的患者手术成功，TR 减轻至中度或更低程度，且无院内死亡。中位随访 360 天（四分位距：187 至 408 天），72%的患者持续降低至中度或更低程度的 TR（p<0.001）。TTVR 使 HF 住院的年发生率降低 22%（1.21 至 0.95 例 HF/患者年；p=0.02），同时改善了纽约心脏协会功能分级（Ⅱ级或更高级别的患者：9%至 67%；p<0.001）、6 分钟步行距离（+39 m；p=0.001）和明尼苏达心力衰竭生活质量问卷评分（-6 分；p=0.02）。N 端脑利钠肽前体水平数值下降 783 pg/ml。TTVR 前利尿剂剂量增加，但 TTVR 后 HF 药物治疗未改变。手术成功与改善 1 年生存率（79%比 60%；p=0.04）和无事件生存率（死亡+首次 HF 住院：67%比 40%；p=0.001）相关。经导管二尖瓣和三尖瓣联合修复术治疗的患者具有相似的结局。
TTVR 治疗重度 TR 可减少 HF 住院和改善临床结局。
