Sannino Anna, Ilardi Federica, Hahn Rebecca T, Lancellotti Patrizio, Lurz Philipp, Smith Robert L, Esposito Giovanni, Grayburn Paul A
The Heart Hospital Baylor Plano, Plano, TX, United States.
Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
Front Cardiovasc Med. 2022 Jul 11;9:919395. doi: 10.3389/fcvm.2022.919395. eCollection 2022.
Medically managed tricuspid regurgitation (TR) has detrimental outcomes. Transcatheter tricuspid valve interventions (TTVIs) represent an alternative to surgery in high-risk patients; however, only early experiences exist.
The aim of this study was to analyze the clinical and echocardiographic outcomes of TTVI.
MEDLINE, ISI Web of Science, and SCOPUS databases were searched for studies published up to June 2021. Studies reporting data on outcome post-TTVIs were included. This study was designed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) requirements. The primary endpoint was all-cause mortality at 30-day and 1-year post-TTVI.
Out of 2,718 studies, 27 were included. Notably, 30-day and 1-year all-cause mortalities were 5% (95% confidence interval [CI]: 4-8%, < 0.001) and 25% (95% CI: 12-45%, = 0.016). Procedural success was associated with a 58% risk reduction in 1-year mortality vs. lack thereof (odds ratio 0.42, 95% CI: 0.27-0.66, < 0.001). TTVI is associated with a significant reduction in TR severity (TR EROA, mean difference [MD] 0.31 cm; 95% CI: 0.23-0.39 cm, < 0.001; regurgitant volume, MD 23.54 ml; 95% CI: 17.4-29.68 ml, = 0.03) and increase in forward stroke volume (FSV, MD 3.98 ml; 95% CI: 0.11-7.86 ml, = 0.04).
TTVI significantly reduces TR severity and increases FSV and is associated with improved survival at 1 year compared with patients without procedural success. Long-term outcomes compared with medical therapy await the results of ongoing pivotal trials; nonetheless, TTVIs appear to be a promising alternative to surgery for TR.
药物治疗的三尖瓣反流（TR）预后不佳。经导管三尖瓣介入治疗（TTVI）是高危患者手术治疗的替代方案；然而，目前仅有早期经验。
本研究旨在分析TTVI的临床和超声心动图结果。
检索MEDLINE、ISI科学网和SCOPUS数据库中截至2021年6月发表的研究。纳入报告TTVI术后结果数据的研究。本研究按照系统评价和Meta分析的首选报告项目（PRISMA）要求设计。主要终点是TTVI术后30天和1年的全因死亡率。
在2718项研究中，纳入了27项。值得注意的是，30天和1年的全因死亡率分别为5%（95%置信区间[CI]：4-8%，P<0.001）和25%（95%CI：12-45%，P=0.016）。与未成功进行手术的患者相比，手术成功使1年死亡率降低58%（优势比0.42，95%CI：0.27-0.66，P<0.001）。TTVI与TR严重程度显著降低相关（TR有效反流口面积，平均差值[MD]0.31cm²；95%CI：0.23-0.39cm²，P<0.001；反流容积，MD23.54ml；95%CI：17.4-29.68ml，P=0.03），并使前向搏出量增加（FSV，MD3.98ml；95%CI：0.11-7.86ml，P=0.04）。
与手术未成功的患者相比，TTVI显著降低TR严重程度，增加FSV，并使1年生存率提高。与药物治疗相比的长期结果有待正在进行的关键试验结果；尽管如此，TTVI似乎是TR手术治疗的一个有前景的替代方案。
