Nagraj Sanjana, Goldberg Ythan H, Scotti Andrea, Ho Edwin, Assafin Manaf, Chau Mei, Latib Azeem
Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 14061, USA.
Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY 10461, USA.
Rev Cardiovasc Med. 2022 May 5;23(5):163. doi: 10.31083/j.rcm2305163. eCollection 2022 May.
As one of the most prevalent valvular pathologies affecting millions globally, moderate-to-severe tricuspid regurgitation (TR) predisposes to increased mortality. Despite the well-established risk of adverse outcomes, an overwhelming majority of TR patients are managed conservatively due to challenges associated with timely diagnosis, clinical course of the disease, competing comorbities that carry prohibitive surgical risk, and poor surgical outcomes. These challenges highlight the importance of transcatheter tricuspid valve replacement (TTVR) which has restructured TR management in promising and innovative ways.
We start with an overview of the pathophysiology of TR considering its implications in management. We then elaborate on the current state of TR management, including its limitations, thereby highlighting the unique role of TTVR. This is followed by a review of perioperative considerations such as careful patient selection, role of multimodality imaging, the various imaging techniques that are available and their contribution towards successful TTVR. We then review the valves that are currently available and under investigation, including the latest data available on device efficacy and safety, and highlight the ongoing clinical trials.
TTVR is evolving at an exponential pace and has made its mark in the treatment of severe symptomatic tricuspid regurgitation. The promising results sustained by currently available devices and ongoing investigation of valves under development continue to pave the path for further innovation in transcatheter interventions. However, it is important to acknowledge and appreciate the novelty of this approach, the lack of long-term data on safety, efficacy, morbidity, and mortality, and use the lessons learned from real-world experiences to provide a definitive and reproducible solution for patients with symptomatic TR.
作为全球影响数百万人的最常见瓣膜病变之一，中重度三尖瓣反流（TR）会增加死亡风险。尽管不良后果的风险已明确，但由于及时诊断存在挑战、疾病临床进程、伴有高手术风险的并存疾病以及手术效果不佳等原因，绝大多数TR患者采用保守治疗。这些挑战凸显了经导管三尖瓣置换术（TTVR）的重要性，它以有前景且创新的方式重塑了TR的治疗。
我们首先概述TR的病理生理学及其在治疗中的意义。然后详细阐述TR治疗的现状，包括其局限性，从而突出TTVR的独特作用。接着回顾围手术期的考虑因素，如仔细的患者选择、多模态成像的作用、可用的各种成像技术及其对成功TTVR的贡献。然后我们回顾目前可用和正在研究的瓣膜，包括关于器械疗效和安全性的最新数据，并突出正在进行的临床试验。
TTVR正以指数级速度发展，并在严重症状性三尖瓣反流的治疗中留下了印记。现有器械取得的有前景的结果以及对正在研发的瓣膜的持续研究继续为经导管干预的进一步创新铺平道路。然而，必须认识到并理解这种方法的新颖性、缺乏关于安全性、疗效、发病率和死亡率的长期数据，并借鉴现实世界经验中的教训，为有症状的TR患者提供明确且可重复的解决方案。
