Huang Lei, Sun Zhenxing, Cai Yu, Xie Yuji, Zhang Ziming, Sun Wei, Li He, Fang Lingyun, He Lin, Zhang Li, Yang Yali, Wang Jing, Lv Qing, Li Yuman, Xie Mingxing
Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China.
Front Cardiovasc Med. 2024 Aug 5;11:1417757. doi: 10.3389/fcvm.2024.1417757. eCollection 2024.
Transcatheter tricuspid valve replacement (TTVR) has recently emerged as a novel therapeutic approach for managing severe tricuspid regurgitation (TR). However, surgical tricuspid valve replacement (STVR) continues to be the predominant treatment modality. There are limited comparative data on both procedures. This study aimed to compare clinical and echocardiographic outcomes between patients who underwent mini-thoracotomy transatrial LuX-Valve TTVR and those who underwent STVR.
This study prospectively collected patients with severe TR who underwent TTVR ( = 29) or isolated STVR ( = 59) at Wuhan Union Hospital from 2019 to 2022. All TTVR patients received the LuX-Valve via a mini-thoracotomy and transatrial approach. The clinical and echocardiographic outcomes were compared at 30-day and one-year follow-ups.
At baseline, patients with LuX-Valve TTVR had higher surgical risk scores and a greater proportion of right ventricular dysfunction compared with STVR. In the early postoperative period, the STVR group had a greater decrease in right ventricular function. Hospital length of stay (LOS), intensive care unit LOS, total procedure time, and tracheal intubation time were shorter in the TTVR than in the STVR group. The incidence of postoperative paravalvular leaks was higher among patients who underwent TTVR. Compared to the STVR group, the pacemaker implantation rate was lower in the TTVR group. During follow-up, the peak tricuspid valve velocity and mean gradient in the TTVR group were consistently lower than those in the STVR group. There was similar mortality between TTVR and STVR at 30-day and one-year follow-ups.
The mini-thoracotomy transatria LuX-Valve TTVR has a higher incidence of paravalvular leaks and a lower rate of pacemaker implantation than STVR, with similar 30-day and one-year mortality rates. In some respects, mini-thoracotomy transatrial LuX-Valve TTVR may be a feasible and safe treatment option for specific populations, or it could potentially serve as an alternative therapy to supplement conventional STVR. Further follow-up is required to assess differences in long-term clinical outcomes and valve durability.
经导管三尖瓣置换术（TTVR）最近已成为治疗严重三尖瓣反流（TR）的一种新的治疗方法。然而，外科三尖瓣置换术（STVR）仍然是主要的治疗方式。关于这两种手术的比较数据有限。本研究旨在比较接受微创开胸经心房LuX-Valve TTVR的患者与接受STVR的患者的临床和超声心动图结果。
本研究前瞻性收集了2019年至2022年在武汉协和医院接受TTVR（n = 29）或单纯STVR（n = 59）的严重TR患者。所有TTVR患者均通过微创开胸经心房途径接受LuX-Valve。在30天和1年随访时比较临床和超声心动图结果。
在基线时，与STVR相比，LuX-Valve TTVR患者的手术风险评分更高，右心室功能障碍的比例更大。术后早期，STVR组右心室功能下降更明显。TTVR组的住院时间（LOS）、重症监护病房LOS、总手术时间和气管插管时间均短于STVR组。接受TTVR的患者术后瓣周漏的发生率更高。与STVR组相比，TTVR组的起搏器植入率更低。在随访期间，TTVR组的三尖瓣峰值流速和平均压差始终低于STVR组。在30天和1年随访时，TTVR和STVR的死亡率相似。
微创开胸经心房LuX-Valve TTVR的瓣周漏发生率高于STVR，起搏器植入率低于STVR，30天和1年死亡率相似。在某些方面，微创开胸经心房LuX-Valve TTVR可能是特定人群可行且安全的治疗选择，或者有可能作为补充传统STVR的替代疗法。需要进一步随访以评估长期临床结果和瓣膜耐久性的差异。
