Doldi Philipp M, Stolz Lukas, Weckbach Ludwig T, Hausleiter Jörg
Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), München, Deutschland.
Herz. 2023 Dec;48(6):448-455. doi: 10.1007/s00059-023-05213-2. Epub 2023 Oct 13.
Tricuspid valve regurgitation (TR) is becoming increasingly more clinically important. While considered as an accompanying symptom of left heart pathologies in the past, TR is now seen as an independent and clinically significant condition. TR can lead to volume overload of the right ventricle, resulting in dilatation of the tricuspid valve annulus and worsening of the regurgitation. Undetected or untreated severe TR can lead to recurrent cardiac decompensation with hospitalization, reduced quality of life and death. Previous treatment options were limited to cardiac surgery and associated with high complication and mortality rates, especially in isolated TR. Therefore, many patients are considered inoperable so that the new interventional treatment measures nowadays often represent the only treatment option. Interventional treatment options such as the edge-to-edge procedure (T-TEER) with TriClip™ or the PASCAL™ system are very safe interventions that have already shown promising results, including reduction of TR, improvement in heart failure symptoms and the quality of life. The influence on the mortality and the necessity for hospitalization due to heart failure are currently being investigated in several randomized studies. Patient selection and timing of the intervention are crucial. Cardiovascular imaging plays a decisive role in selecting the appropriate method and timing of the intervention. The prognosis depends on factors, such as the severity of TR, right ventricular dysfunction, and pulmonary arterial hypertension. Overall, interventional TR treatment is a promising advancement in treatment from which many patients can benefit in the future.
三尖瓣反流(TR)在临床上正变得越来越重要。虽然过去被视为左心病变的伴随症状,但现在TR被视为一种独立且具有临床意义的病症。TR可导致右心室容量负荷过重,导致三尖瓣环扩张和反流加重。未被发现或未得到治疗的严重TR可导致反复的心功能不全,需要住院治疗,从而降低生活质量并导致死亡。以前的治疗选择仅限于心脏手术,且并发症和死亡率高,尤其是在孤立性TR中。因此,许多患者被认为无法进行手术,以至于如今新的介入治疗措施往往是唯一的治疗选择。诸如使用TriClip™或PASCAL™系统的缘对缘手术(T-TEER)等介入治疗选择是非常安全的干预措施,已经显示出有前景的结果,包括减少TR、改善心力衰竭症状和生活质量。目前正在多项随机研究中调查其对死亡率和因心力衰竭住院必要性的影响。患者选择和干预时机至关重要。心血管成像在选择合适的干预方法和时机方面起着决定性作用。预后取决于TR的严重程度、右心室功能障碍和肺动脉高压等因素。总体而言,介入性TR治疗是一种有前景的治疗进展,未来许多患者可从中受益。