Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. Electronic address: https://twitter.com/MdMontalto.
Campus Bio-Medico di Roma, Rome, Italy; GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy.
JACC Cardiovasc Interv. 2020 Dec 14;13(23):2719-2729. doi: 10.1016/j.jcin.2020.08.020. Epub 2020 Nov 11.
The aim of this study was to assess the feasibility, efficacy, and clinical outcomes of transcatheter repair of tricuspid regurgitation (TR) in a pooled analysis of interventional studies.
New percutaneous devices are available to treat severe TR, but the evidence is sparse and limited to smaller cohorts.
Several electronic databases were searched for interventional studies involving percutaneous repair of TR. Devices used were the Cardioband, FORMA, MitraClip, PASCAL, and Trialign. Outcomes included in the final analysis were successful implantation, residual severe TR, post-procedural New York Heart Association (NYHA) functional class III or IV, 6-min walk distance, and echocardiographic parameters. Subgroup and meta-regression analysis were performed to further explore residual heterogeneity.
Seven studies and 454 patients undergoing transcatheter tricuspid valve repair were included in the pooled analysis; 95% of patients had at least severe TR, and 91% were in NYHA functional class III or IV. Successful implantation was achieved in 86% of patients. At the longest follow-up available (weighted mean 265 days), 9% had died. Compared with baseline, a significantly lower proportion of patients had at least severe TR (relative risk: 0.38; 95% confidence interval: 0.20 to 0.70; p = 0.004) and were in NYHA functional class III or IV (relative risk: 0.23; 95% confidence interval: 0.20 to 0.30; p < 0.001). Patients also experienced increases in 6-min walk distance (mean difference +64.6 m; p < 0.001) and significant reductions in tricuspid valve annular diameter (mean difference -3 mm; p < 0.001), while left and right ventricular function did not change significantly.
A strategy of transcatheter repair for severe TR appears to be feasible, effective, and associated with improved clinical outcomes at mid-term follow-up.
本研究旨在汇总分析介入研究，评估经导管三尖瓣反流（TR）修复的可行性、疗效和临床结果。
目前有新的经皮器械可用于治疗严重 TR，但证据有限，仅限于较小的队列。
检索了几项电子数据库，以寻找涉及经皮 TR 修复的介入研究。使用的器械包括 Cardioband、FORMA、MitraClip、PASCAL 和 Trialign。最终分析纳入的结果包括成功植入、残余严重 TR、术后纽约心脏协会（NYHA）功能分级 III 或 IV 级、6 分钟步行距离和超声心动图参数。进行了亚组和荟萃回归分析，以进一步探讨残余异质性。
共纳入 7 项研究和 454 例接受经导管三尖瓣瓣环修复的患者；95%的患者至少存在严重 TR，91%的患者 NYHA 功能分级为 III 或 IV 级。86%的患者成功植入。在可获得的最长随访时间（加权平均 265 天），有 9%的患者死亡。与基线相比，至少存在严重 TR 的患者比例显著降低（相对风险：0.38；95%置信区间：0.20 至 0.70；p=0.004），NYHA 功能分级 III 或 IV 级的患者比例也显著降低（相对风险：0.23；95%置信区间：0.20 至 0.30；p<0.001）。患者的 6 分钟步行距离也增加（平均差值+64.6 米；p<0.001），三尖瓣瓣环直径显著减小（平均差值-3 毫米；p<0.001），而左、右心室功能无明显变化。
经导管严重 TR 修复策略似乎是可行的、有效的，并在中期随访中改善了临床结果。
