Department for Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria.
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Eur Heart J Cardiovasc Imaging. 2024 Feb 22;25(3):365-372. doi: 10.1093/ehjci/jead264.
Transcatheter tricuspid edge-to-edge repair (T-TEER) has gained widespread use for the treatment of tricuspid regurgitation (TR) in symptomatic patients with high operative risk. Although secondary TR is the most common pathology, some patients exhibit primary or predominantly primary TR. Characterization of patients with these pathologies in the T-TEER context has not been systematically performed.
Patients assigned to T-TEER by the interdisciplinary heart team were consecutively recruited in two European centres over 4 years. Echocardiographic images were evaluated to distinguish between primary and secondary causes of TR. Both groups were compared concerning procedural results. A total of 339 patients were recruited, 13% with primary TR and 87% with secondary TR. Patients with primary TR had a smaller right ventricle (basal diameter 45 vs. 49 mm, P = 0.004), a better right ventricular function (fractional area change 45 vs. 41%, P = 0.001), a smaller right (28 vs. 34 cm2, P = 0.021) and left (52 vs. 67 mL/m2, P = 0.038) atrium, and a better left ventricular ejection fraction (60 vs. 52%, P = 0.005). The severity of TR was similar in primary and secondary TR at baseline (TR vena contracta width pre-interventional 13 ± 4 vs. 14 ± 5 mm, P = 0.19), and T-TEER significantly reduced TR in both groups (TR vena contracta width post-interventional 4 ± 3 vs. 5 ± 5 mm, P = 0.10). These findings remained stable after propensity score matching. Complications were similar between both groups.
T-TEER confers equally safe and effective reduction of TR in patients with primary and secondary TR.
经导管三尖瓣缘对缘修复术（T-TEER）已广泛应用于高手术风险的症状性三尖瓣反流（TR）患者的治疗。虽然继发性 TR 是最常见的病变，但部分患者存在原发性或主要为原发性 TR。在 T-TEER 背景下，尚未对这些病理患者进行系统特征描述。
在 4 年内，两个欧洲中心的多学科心脏团队连续招募了被分配到 T-TEER 的患者。评估超声心动图图像以区分 TR 的原发性和继发性病因。比较两组患者的手术结果。共纳入 339 例患者，其中 13%为原发性 TR，87%为继发性 TR。原发性 TR 患者的右心室（基底直径 45 比 49mm，P=0.004）较小，右心室功能（分数面积变化 45 比 41%，P=0.001）更好，右心房（28 比 34cm2，P=0.021）和左心房（52 比 67mL/m2，P=0.038）更小，左心室射血分数（60 比 52%，P=0.005）更好。在基线时，原发性和继发性 TR 的 TR 瓣口收缩期宽度相似（TR 瓣口收缩期宽度术前 13±4 比 14±5mm，P=0.19），且 T-TEER 可使两组的 TR 均显著降低（TR 瓣口收缩期宽度术后 4±3 比 5±5mm，P=0.10）。在倾向评分匹配后，这些发现仍然稳定。两组的并发症相似。
T-TEER 可安全有效地降低原发性和继发性 TR 患者的 TR 严重程度。
