Saito Tetsuya, Kuno Toshiki, Aikawa Tadao, Ueyama Hiroki A, Kampaktsis Polydoros N, Kolte Dhaval, Misumida Naoki, Takagi Hisato, Ahmad Yousif, Kaneko Tsuyoshi, Zajarias Alan, Latib Azeem
Department of Cardiology, Edogawa Hospital, Tokyo, Japan.
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA.
Clin Res Cardiol. 2025 Feb;114(2):272-280. doi: 10.1007/s00392-024-02579-z. Epub 2024 Dec 2.
Several transcatheter tricuspid valve (TV) repair devices for tricuspid regurgitation (TR) have emerged. However, few studies have compared transcatheter TV repair with medical therapy (MT) alone or isolated TV surgery.
PubMed and EMBASE were searched in February 2024. Studies comparing at least any of the following 2 were included: MT, surgical TV repair, surgical TV replacement, or transcatheter TV repair. The primary outcome was long-term mortality (≧ 1 year). The secondary outcomes were short-term mortality (30-day or in-hospital mortality) and periprocedural complications. We performed a network meta-analysis using a random effects model.
A total of 25,831 patients from 22 studies (one randomized trial and 21 observational studies) were included. MT alone was associated with higher long-term mortality compared to surgical TV repair (HR [95% CI] 1.72 [1.34-2.23]), surgical TV replacement (HR [95% CI] 1.49 [1.14-1.96]), and transcatheter TV repair (HR [95% CI] 1.52 [1.30-1.78]). Long-term mortality was comparable between transcatheter and surgical interventions. Transcatheter TV repair had a lower risk of short-term mortality (versus surgical TV repair; RR [95% CI] 0.40 [0.22-0.72], versus surgical TV replacement; RR [95% CI] 0.35 [0.19-0.66]) and lower rates of periprocedural complications, including new pacemaker implantation, renal complications, cardiogenic shock than surgical interventions.
MT alone for TR was associated with higher long-term mortality compared to surgical or transcatheter TV interventions. Transcatheter TV repair had better periprocedural outcomes compared to surgical interventions with similar long-term mortality. Despite the possibility of selection bias, transcatheter TV repair appears to be an attractive option for TR treatment.
用于治疗三尖瓣反流（TR）的几种经导管三尖瓣（TV）修复装置已出现。然而，很少有研究将经导管TV修复与单纯药物治疗（MT）或单纯TV手术进行比较。
于2024年2月检索了PubMed和EMBASE。纳入比较以下至少任意两项的研究：MT、外科TV修复、外科TV置换或经导管TV修复。主要结局为长期死亡率（≥1年）。次要结局为短期死亡率（30天或住院死亡率）和围手术期并发症。我们使用随机效应模型进行了网状Meta分析。
共纳入来自22项研究（1项随机试验和21项观察性研究）的25,831例患者。与外科TV修复（HR [95% CI] 1.72 [1.34 - 2.23]）、外科TV置换（HR [95% CI] 1.49 [1.14 - 1.96]）和经导管TV修复（HR [95% CI] 1.52 [1.30 - 1.78]）相比，单纯MT与更高的长期死亡率相关。经导管和外科干预的长期死亡率相当。经导管TV修复的短期死亡率风险较低（与外科TV修复相比；RR [95% CI] 0.40 [0.22 - 0.72]，与外科TV置换相比；RR [95% CI] 0.35 [0.19 - 0.66]），围手术期并发症发生率也低于外科干预，包括新起搏器植入、肾脏并发症、心源性休克。
与外科或经导管TV干预相比，单纯MT治疗TR与更高的长期死亡率相关。经导管TV修复与外科干预相比，围手术期结局更好，长期死亡率相似。尽管存在选择偏倚的可能性，但经导管TV修复似乎是TR治疗的一个有吸引力的选择。
