Nzeako Tochukwu R, Elendu Chukwuka, Moradi Ali, Olanisa Olawale, Kiladejo Adekunle
Christiana Care Hospital, Newark, Delaware, USA.
Federal University Teaching Hospital, Owerri, Nigeria.
Ann Med Surg (Lond). 2025 May 30;87(7):4262-4280. doi: 10.1097/MS9.0000000000003437. eCollection 2025 Jul.
Tricuspid valve disease (TVD), primarily tricuspid regurgitation (TR), is increasingly recognized for its significant morbidity and mortality. Traditional management with medical therapy or high-risk surgical interventions leaves many patients untreated. The emergence of percutaneous interventions introduces a transformative, minimally invasive alternative for high-risk surgical candidates. Clinical trials such as TRILUMINATE have demonstrated the efficacy of devices like TriClip, achieving TR reduction to moderate or less in 86% of patients at 1 year, alongside improvements in functional capacity (6MWT) and quality of life (KCCQ scores). Real-world data from the TriValve registry revealed a 91% procedural success rate, marked improvements in the NYHA functional class, and a low complication profile. Long-term follow-up confirms sustained symptom relief, reduced edema, and improved exercise tolerance, with KCCQ scores increasing by 18-22 points. Survival benefits have also been reported, with a 35% 1-year mortality reduction compared to medical management. Although long-term data are limited, emerging transcatheter tricuspid valve replacement (TTVR) devices like EVOQUE show promising outcomes. Challenges persist in patient selection, particularly in congenital or complex structural abnormalities. Integrating advanced imaging techniques, such as 3D echocardiography, enhances procedural planning and outcome assessment. Ongoing trials like TRILUMINATE Pivotal aim to address evidence gaps, refine techniques, and expand indications. As percutaneous approaches evolve, they can revolutionize TVD management, improving survival, quality of life, and functional capacity in this high-risk population. Further research will solidify their role in contemporary cardiac care.
三尖瓣疾病(TVD),主要是三尖瓣反流(TR),其显著的发病率和死亡率日益受到关注。传统的药物治疗或高风险手术干预方法使许多患者得不到治疗。经皮介入技术的出现为高风险手术候选者提供了一种变革性的、微创的替代方案。TRILUMINATE等临床试验已经证明了TriClip等设备的疗效,在1年时86%的患者三尖瓣反流减少至中度或更低,同时功能能力(6分钟步行试验)和生活质量(堪萨斯城心肌病问卷评分)得到改善。TriValve注册研究的真实世界数据显示手术成功率为91%,纽约心脏协会功能分级显著改善,并发症发生率低。长期随访证实症状持续缓解、水肿减轻、运动耐量提高,堪萨斯城心肌病问卷评分增加18 - 22分。也有生存获益的报道,与药物治疗相比,1年死亡率降低35%。尽管长期数据有限,但像EVOQUE这样新兴的经导管三尖瓣置换(TTVR)设备显示出了有前景的结果。在患者选择方面仍然存在挑战,特别是在先天性或复杂结构异常的情况下。整合先进的成像技术,如三维超声心动图,可加强手术规划和结果评估。像TRILUMINATE Pivotal这样正在进行的试验旨在填补证据空白、完善技术并扩大适应症。随着经皮治疗方法的不断发展,它们可以彻底改变三尖瓣疾病的管理,改善这一高风险人群的生存、生活质量和功能能力。进一步的研究将巩固它们在当代心脏护理中的作用。
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