Nagaraja Vinayak, Kapadia Samir R, Miyasaka Rhonda, Harb Serge C, Krishnaswamy Amar
Division of Interventional Cardiology, Cleveland Clinic, Cleveland, OH, USA.
Department of Cardiovascular Medicine, Section Head, Interventional Cardiology, Cleveland Clinic, Cleveland, OH, USA.
Expert Rev Cardiovasc Ther. 2020 Apr;18(4):209-218. doi: 10.1080/14779072.2020.1750370. Epub 2020 Apr 13.
: Moderate to severe tricuspid regurgitation (TR) is a poor prognostic factor regardless of right ventricular function. However, a majority of patients are managed medically rather than undergoing isolated tricuspid valve surgery due to high in-hospital mortality. Percutaneous therapy in the form of transcatheter tricuspid valve repair or replacement is an attractive option for this high risk multimorbid cohort.: A literature search was performed for tricuspid valve repair or replacement using MEDLINE, Current Contents Connect, Google Scholar, EMBASE, Cochrane library, PubMed, ScienceDirect, and Web of Science (Till 10/19). This review outlines the anatomical challenges specific to the tricuspid valve, provides an insight into patient selection for percutaneous treatment, and summarizes the current evidence for the available devices.: With the recent understanding that percutaneous repair of TR is feasible and provides better patient outcomes, we must more closely evaluate our patients with tricuspid regurgitation and consider treatment. MitraClip in the tricuspid position (TriClip) is the most widely used TV repair device, and several prospective trials are currently investigating various devices in this arena that hopefully will hopefully provide greater insight into patient selection and anatomically specific device choice.
中重度三尖瓣反流(TR)是一个不良预后因素,无论右心室功能如何。然而,由于住院死亡率高,大多数患者接受药物治疗而非单纯的三尖瓣手术。经导管三尖瓣修复或置换形式的经皮治疗对于这个高风险的多病种队列来说是一个有吸引力的选择。
使用MEDLINE、《现刊目次连接》、谷歌学术、EMBASE、考克兰图书馆、PubMed、ScienceDirect和科学网(截至10/19)对三尖瓣修复或置换进行了文献检索。本综述概述了三尖瓣特有的解剖学挑战,深入探讨了经皮治疗的患者选择,并总结了现有器械的当前证据。
鉴于最近认识到经皮修复TR是可行的且能为患者带来更好的结果,我们必须更密切地评估我们的三尖瓣反流患者并考虑治疗。三尖瓣位置的MitraClip(TriClip)是使用最广泛的三尖瓣修复器械,目前有几项前瞻性试验正在研究该领域的各种器械,有望为患者选择和解剖学特定器械选择提供更多见解。