Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Can J Cardiol. 2021 Jul;37(7):953-967. doi: 10.1016/j.cjca.2020.12.029. Epub 2021 Jan 22.
Tricuspid valve disease, and particularly the management of severe tricuspid regurgitation (TR), has gained momentum in recent years. Although it is well known that this frequent condition is associated with poor clinical outcomes, these patients have been classically managed medically, leading to end-stage right ventricular heart failure. Moreover, late referral to surgery has contributed to a high rate of periprocedural complications and in-hospital surgical mortality. Thus, the development of a less invasive catheter-based therapy would be of high clinical relevance in this context. Several transcatheter tricuspid valve intervention (TTVI) devices have been developed in recent years. The particular characteristics of the tricuspid valve (large noncalcific annulus, presence of chief surrounding structures such as the conduction system or the right coronary artery) make multimodality imaging (eg, transesophageal echocardiography, computed tomography) key in the preprocedural assessment of TTVI. According to their mechanism of action and therapeutic target, TTVI includes transcatheter repair either with coaptation or annuloplasty systems, caval valve devices, and transcatheter tricuspid valve replacement. The initial TTVI experience showed that most procedures were well tolerated, with high procedural success and low in-hospital and early mortality. Also, most TTVI recipients improved their functional status and recent data suggest improved outcomes compared with medical management. However, the rate of significant residual TR after transcatheter tricuspid valve repair remains high and very scarce data exist on longer term (beyond 6-12 months) outcomes. The present review provides an overview regarding the framework of chronic TR and TTVI therapeutic options, and describes the updated current evidence in this challenging field.
三尖瓣疾病，特别是严重三尖瓣反流（TR）的管理，近年来受到了越来越多的关注。尽管众所周知，这种常见病症与不良临床结局相关，但这些患者一直采用经典的药物治疗方法，导致晚期右心室心力衰竭。此外，晚期转至手术治疗也导致围手术期并发症发生率和住院手术死亡率较高。因此，在这种情况下，开发一种微创的导管介入治疗方法将具有重要的临床意义。近年来，已经开发出几种经导管三尖瓣瓣膜介入（TTVI）装置。三尖瓣的特殊特征（大的非钙化瓣环，存在主要周围结构，如传导系统或右冠状动脉）使得多模态成像（例如经食管超声心动图、计算机断层扫描）成为 TTVI 术前评估的关键。根据其作用机制和治疗靶点，TTVI 包括通过贴附和瓣环成形系统、腔静脉瓣膜装置和经导管三尖瓣置换进行的经导管修复。最初的 TTVI 经验表明，大多数手术耐受良好，具有较高的手术成功率和较低的住院和早期死亡率。此外，大多数接受 TTVI 的患者的功能状态得到改善，最近的数据表明与药物治疗相比，结局得到改善。然而，经导管三尖瓣修复后的严重残余 TR 发生率仍然很高，关于更长时间（超过 6-12 个月）结局的非常少的数据。本综述提供了关于慢性 TR 和 TTVI 治疗选择的框架概述，并描述了这一具有挑战性领域的最新证据。
