Vinciguerra Mattia, Sitges Marta, Luis Pomar Jose, Romiti Silvia, Domenech-Ximenos Blanca, D'Abramo Mizar, Wretschko Eleonora, Miraldi Fabio, Greco Ernesto
Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Front Cardiovasc Med. 2022 Feb 21;9:836441. doi: 10.3389/fcvm.2022.836441. eCollection 2022.
Severe tricuspid valve regurgitation has been for a long time a neglected valve disease, which has only recently attracted an increasing interest due to the notable negative impact on the prognosis of patients with cardiovascular disease. It is estimated that around 90% of tricuspid regurgitation is diagnosed as "functional" and mostly secondary to a primary left-sided heart disease and, therefore, has been usually interpreted as a benign condition that did not require a surgical management. Nevertheless, the persistence of severe tricuspid regurgitation after left-sided surgical correction of a valve disease, particularly mitral valve surgery, has been associated to adverse outcomes, worsening of the quality of life, and a significant increase in mortality rate. Similar results have been found when the impact of isolated severe tricuspid regurgitation has been studied. Current knowledge is shifting the "functional" categorization toward a more complex and detailed pathophysiological classification, identifying various phenotypes with completely different etiology, natural history and, potentially, an invasive management. The aim of this review is to offer a comprehensive guide for clinicians and surgeons with a systematic description of "functional" tricuspid regurgitation subtypes, an analysis centered on the effectiveness of existing surgical techniques and a focus on the emergent percutaneous procedures. This latter may be an attractive alternative to a standard surgical approach in patients with high-operative risk or isolated tricuspid regurgitation.
严重三尖瓣反流长期以来一直是一种被忽视的瓣膜疾病，直到最近，由于其对心血管疾病患者预后的显著负面影响，才越来越受到关注。据估计，约90%的三尖瓣反流被诊断为“功能性”，且大多继发于原发性左侧心脏病，因此通常被视为一种无需手术治疗的良性疾病。然而，在对瓣膜疾病进行左侧手术矫正后，尤其是二尖瓣手术，严重三尖瓣反流持续存在与不良预后、生活质量恶化以及死亡率显著增加有关。在研究孤立性严重三尖瓣反流的影响时也发现了类似结果。目前的认知正在将“功能性”分类转向更复杂、更详细的病理生理分类，识别出具有完全不同病因、自然史以及可能需要侵入性治疗的各种表型。本综述的目的是为临床医生和外科医生提供一份全面指南，系统描述“功能性”三尖瓣反流亚型，分析现有手术技术的有效性，并关注新兴的经皮手术。对于手术风险高或孤立性三尖瓣反流的患者，后者可能是标准手术方法的一个有吸引力的替代方案。
