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经导管三尖瓣介入治疗的挑战与未来展望:沿用旧策略还是适应新机遇?

Challenges and future perspectives of transcatheter tricuspid valve interventions: adopt old strategies or adapt to new opportunities?

机构信息

Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy.

Università Cattolica del Sacro Cuore, Rome, Italy.

出版信息

Eur J Heart Fail. 2022 Mar;24(3):442-454. doi: 10.1002/ejhf.2398. Epub 2021 Dec 21.

Abstract

Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease and is associated with an increased risk of cardiovascular events and death at long-term follow-up. Functional TR accounts for over 90% of TR and is mainly due to annular or right ventricular dilatation. Most often, TR is observed in patients with left-sided valvular heart disease (with or without previous surgical correction) and pulmonary hypertension. Isolated TR is less frequent, though burdened by high surgical mortality. This, together with an incomplete understanding of the disease, has brought to a significant undertreatment in spite of the growing evidence of the impact of severe TR on mortality. Moreover, uncertainties about the appropriate timing for intervention and the predictors of procedural success have contributed to limit TR treatment. Transcatheter tricuspid valve replacement or repair interventions represent novel and less invasive alternatives to surgery and have shown early promising results. The purpose of this review is to provide a complete and updated overview of TR pathology with a special focus on current percutaneous treatment options, future challenges and directions.

摘要

三尖瓣反流(TR)是一种高发的瓣膜性心脏病,与长期随访时心血管事件和死亡风险增加相关。功能性 TR 占 TR 的 90%以上,主要是由于瓣环或右心室扩张所致。TR 最常发生于左侧瓣膜性心脏病患者(无论是否接受过手术矫正)和肺动脉高压患者。孤立性 TR 虽较少见,但手术死亡率较高。此外,尽管严重 TR 对死亡率的影响证据不断增加,但由于对疾病的认识不完整,导致治疗严重不足。另外,关于干预的适当时机和手术成功率预测因素的不确定性也限制了 TR 的治疗。经导管三尖瓣置换或修复干预为手术提供了新颖的、微创的替代方法,早期结果令人鼓舞。本文的目的是全面而系统地阐述 TR 的病理学,特别关注当前经皮治疗选择、未来的挑战和方向。

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