Alperi Alberto, Almendárez Marcel, Álvarez Rut, Moris Cesar, Leon Victor, Silva Iria, Hernández-Vaquero Daniel, Pascual Isaac, Avanzas Pablo
Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain.
Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain.
Front Cardiovasc Med. 2022 Sep 14;9:994502. doi: 10.3389/fcvm.2022.994502. eCollection 2022.
The development of transcatheter therapies to treat valvular heart diseases has changed the rules of the game, particularly in the case of aortic stenosis and mitral regurgitation. In the last years, the tricuspid valve has also been the focus of these percutaneous techniques for several reasons: (1) tricuspid regurgitation is a frequent disease associated with poor clinical outcomes in spite of medical treatment, leading to end-stage right ventricular heart failure, (2) surgical tricuspid valve repair or replacement has been the treatment of choice for patients with tricuspid valve disease, but high mortality rates for isolated surgical tricuspid valve intervention have been reported in the literature, and (3) most patients with tricuspid pathology are ultimately denied cardiac surgery because of their comorbidity burden. Thus, in this context the development of less invasive catheter-based therapies would be of high clinical relevance. The present review provides an overview regarding the framework of chronic tricuspid regurgitation transcatheter therapeutic options, summarizes the transcatheter systems under clinical use or clinical evaluation with their technical features, and describes the updated current evidence in this challenging and evolving field.
经导管治疗瓣膜性心脏病的发展改变了游戏规则，尤其是在主动脉瓣狭窄和二尖瓣反流的情况下。在过去几年中，三尖瓣也因多种原因成为这些经皮技术的焦点：（1）尽管进行了药物治疗，但三尖瓣反流仍是一种常见疾病，临床预后较差，会导致终末期右心室心力衰竭；（2）外科三尖瓣修复或置换一直是三尖瓣疾病患者的首选治疗方法，但文献报道孤立性外科三尖瓣干预的死亡率较高；（3）大多数患有三尖瓣病变的患者最终因合并症负担而被拒绝进行心脏手术。因此，在这种情况下，开发侵入性较小的基于导管的治疗方法具有高度的临床相关性。本综述概述了慢性三尖瓣反流经导管治疗选择的框架，总结了正在临床使用或临床评估中的经导管系统及其技术特点，并描述了在这个具有挑战性且不断发展的领域中的最新现有证据。
