Preda Alberto, Melillo Francesco, Liberale Luca, Montecucco Fabrizio, Agricola Eustachio
Cardiovascular Imaging Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy.
Eur J Clin Invest. 2021 Dec;51(12):e13653. doi: 10.1111/eci.13653. Epub 2021 Jul 26.
Newer approaches in transcatheter tricuspid valve replacement (TTVR) have recently showed optimistic data of efficacy and safety in patients at high risk for surgery. However, the absence of residual regurgitation (and subsequently higher likelihood for developing afterload mismatch) with TTVR compared with transcatheter tricuspid valve intervention may become a critical concern if RV dysfunction is misdiagnosed. Indeed, such sudden increase in afterload on the right ventricle (RV) may not be tolerable, resulting in higher risk of acute right heart failure in the early postoperative period. In this context, strain imaging may find a further application to provide a more comprehensive stratification of the severity of RV dysfunction and thus help to better define the eligibility criteria and timing for TTVR. Meanwhile, it is of paramount importance to underline the contribution given by the Trivalve study on the understanding of the role of RV function in TTVI, that so far was largely undefined, being evaluated only in small noncontrolled cohorts.
经导管三尖瓣置换术（TTVR）的最新方法最近在手术高风险患者中显示出了乐观的疗效和安全性数据。然而，如果右心室功能障碍被误诊，与经导管三尖瓣介入治疗相比，TTVR不存在残余反流（以及随后发生后负荷不匹配的可能性更高）可能会成为一个关键问题。事实上，右心室（RV）后负荷的这种突然增加可能无法耐受，导致术后早期急性右心衰竭的风险更高。在这种情况下，应变成像可能会得到进一步应用，以提供更全面的右心室功能障碍严重程度分层，从而有助于更好地确定TTVR的入选标准和时机。与此同时，强调Trivalve研究对理解右心室功能在经导管三尖瓣介入治疗（TTVI）中的作用所做出的贡献至关重要，到目前为止，这一作用在很大程度上尚未明确，仅在小型非对照队列中进行了评估。
