Chen Vincent, Abdul-Jawad Altisent Omar, Puri Rishi
Department of Cardiovascular Medicine, Heart Vascular & Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH, 44195, USA.
Hospital Clinic Barcelona, Barcelona, Spain.
Curr Cardiol Rep. 2025 Jan 7;27(1):7. doi: 10.1007/s11886-024-02190-8.
We describe the evolution of caval valve implantation (CAVI) as a treatment for severe symptomatic tricuspid regurgitation (TR) in the high surgical risk patient.
Surgical treatment of severe TR is often limited by the high surgical risk of the patients who tend to develop severe secondary TR. Coaptation, annuloplasty, and orthotopic replacement strategies are all limited by annular and leaflet geometry, prior valve repair, and the presence of cardiac implantable device leads. CAVI appears to be a treatment strategy for severe symptomatic TR that improves functional capacity and quality of life while also reducing edema and ascites and improving cardiac output. Chronic kidney disease is a common comorbidity of patients with severe TR; zero-contrast CAVI has been described. Severe TR is undertreated, yet common in the elderly structural heart disease population. The evolution of CAVI as a viable treatment for severe TR underscores the deleterious systemic contribution of backwards flow to morbidity and mortality. There are good safety and efficacy outcomes from registry data using the TricValve platform. Randomized controlled trials for CAVI versus medical therapy for severe TR are ongoing.
我们描述了腔静脉瓣植入术（CAVI）作为一种治疗手术风险高的严重症状性三尖瓣反流（TR）患者的方法的演变。
严重TR的手术治疗通常受到患者手术风险高的限制，这些患者往往会发展为严重的继发性TR。瓣叶对合、瓣环成形术和原位置换策略都受到瓣环和瓣叶几何形状、先前的瓣膜修复以及心脏植入式设备导线的存在的限制。CAVI似乎是一种治疗严重症状性TR的策略，可改善功能能力和生活质量，同时还能减轻水肿和腹水并提高心输出量。慢性肾脏病是严重TR患者常见的合并症；已描述了零造影剂CAVI。严重TR的治疗不足，但在老年结构性心脏病人群中很常见。CAVI作为严重TR的一种可行治疗方法的演变强调了反流对发病率和死亡率的有害全身影响。使用TricValve平台的注册数据显示出良好的安全性和有效性结果。针对严重TR的CAVI与药物治疗的随机对照试验正在进行中。
