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[三尖瓣反流的多学科管理]

[Interdisciplinary management of tricuspid valve regurgitation].

作者信息

Rogmann Marc Adrian, Zancanaro Edoardo, Treede Hendrik, Lurz Philipp, Kresoja Karl-Patrik

机构信息

Zentrum für Kardiologie, Kardiologie I, Universitätsmedizin, Johannes-Gutenberg Universität Mainz, Mainz, Deutschland.

Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universiätsmedizin, Johannes-Gutenberg Universität Mainz, Mainz, Deutschland.

出版信息

Herz. 2025 Aug 28. doi: 10.1007/s00059-025-05329-7.

DOI:10.1007/s00059-025-05329-7
PMID:40875034
Abstract

For decades tricuspid valve regurgitation (TR) was considered clinically insignificant and often left untreated. Only with the emergence of catheter-based treatment, particularly tricuspid transcatheter edge-to-edge repair (T-TEER), the condition has gained increasing clinical attention and therapeutic momentum. Concurrently, the surgical treatment has evolved towards minimally invasive endoscopic operations on the beating heart. This article explores the role of the interdisciplinary heart team in the evaluation and execution of T‑TEER or surgical treatment. Based on current guidelines, clinical trial data and echocardiographic selection criteria, it analyses the need for a structured, interdisciplinary decision-making process. Successful TR management requires broad interdisciplinary expertise, including heart failure management, cardiac imaging, interventional cardiology and cardiac surgery. Structured risk assessments using validated tools such as the TRI-score and imaging-based scoring systems enable an objective evaluation of prognosis and anatomical suitability. A key clinical challenge remains the identification of the optimal timing for an intervention, before irreversible deterioration of the right ventricular function or end-organ damage occurs. In conclusion, delivering high-quality, patient-centred care for severe TR is barely achievable without a well-functioning heart team. Early referral, close coordination with outpatient cardiologists, and comprehensive imaging are essential to achieving favourable and sustainable outcomes.

摘要

几十年来,三尖瓣反流(TR)在临床上一直被认为无足轻重,常常不予治疗。直到基于导管的治疗方法出现,尤其是经导管三尖瓣缘对缘修复术(T-TEER),这种情况才越来越受到临床关注并获得治疗动力。与此同时,外科治疗已朝着在跳动心脏上进行的微创内镜手术发展。本文探讨了跨学科心脏团队在评估和实施T-TEER或外科治疗中的作用。基于当前指南、临床试验数据和超声心动图选择标准,分析了结构化跨学科决策过程的必要性。成功管理TR需要广泛的跨学科专业知识,包括心力衰竭管理、心脏成像、介入心脏病学和心脏外科。使用经过验证的工具(如TRI评分)和基于成像的评分系统进行结构化风险评估,能够对预后和解剖学适宜性进行客观评估。一个关键的临床挑战仍然是在右心室功能或终末器官发生不可逆恶化之前确定最佳干预时机。总之,如果没有一个运作良好的心脏团队,几乎无法为严重TR提供高质量的以患者为中心的治疗。早期转诊、与门诊心脏病专家密切协调以及全面成像对于取得良好和可持续的治疗效果至关重要。

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本文引用的文献

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Echocardiographic Imaging Considerations for Post-Implant Evaluation of the Transcatheter EVOQUE Tricuspid Valve Replacement System.经导管EVOQUE三尖瓣置换系统植入后评估的超声心动图成像考量
JACC Cardiovasc Imaging. 2025 Jul 28. doi: 10.1016/j.jcmg.2025.06.011.
2
Etiology of tricuspid regurgitation and mortality: a multicenter cohort study.三尖瓣反流的病因与死亡率:一项多中心队列研究
Clin Res Cardiol. 2025 May 8. doi: 10.1007/s00392-025-02662-z.
3
Tricuspid Regurgitation Disease Stages and Treatment Outcomes After Transcatheter Tricuspid Valve Repair.
经导管三尖瓣修复术后三尖瓣反流疾病分期及治疗结果
JACC Cardiovasc Interv. 2025 Feb 10;18(3):339-348. doi: 10.1016/j.jcin.2024.10.034.
4
Personalized management of tricuspid valve regurgitation.三尖瓣反流的个体化管理
Eur Heart J. 2025 Mar 7;46(10):882-884. doi: 10.1093/eurheartj/ehae733.
5
Transcatheter Valve Replacement in Severe Tricuspid Regurgitation.严重三尖瓣反流的经导管瓣膜置换术
N Engl J Med. 2025 Jan 9;392(2):115-126. doi: 10.1056/NEJMoa2401918. Epub 2024 Oct 30.
6
Transcatheter Valve Repair for Tricuspid Regurgitation: 1-Year Results From a Large European Real-World Registry.经导管三尖瓣反流修复术:来自大型欧洲真实世界注册研究的1年结果
J Am Coll Cardiol. 2025 Jan 28;85(3):220-231. doi: 10.1016/j.jacc.2024.10.068. Epub 2024 Oct 28.
7
Clinical Outcomes of Mitral Valve Surgery in Atrial Functional Mitral Regurgitation in the REVEAL-AFMR Registry.在 REVEAL-AFMR 注册研究中,功能性二尖瓣反流患者行二尖瓣手术的临床结局。
JAMA Netw Open. 2024 Aug 1;7(8):e2428032. doi: 10.1001/jamanetworkopen.2024.28032.
8
One-Year Outcomes of Transseptal Mitral Valve-in-Valve in Intermediate Surgical Risk Patients.中度手术风险患者经房间隔二尖瓣瓣中瓣置换术的一年结局
Circ Cardiovasc Interv. 2024 Aug;17(8):e013782. doi: 10.1161/CIRCINTERVENTIONS.123.013782. Epub 2024 Jul 22.
9
GLIDE Score: Scoring System for Prediction of Procedural Success in Tricuspid Valve Transcatheter Edge-to-Edge Repair.GLIDE 评分:三尖瓣经导管缘对缘修复术术中成功率预测评分系统。
JACC Cardiovasc Imaging. 2024 Jul;17(7):729-742. doi: 10.1016/j.jcmg.2024.04.008. Epub 2024 Jun 5.
10
Implications of tricuspid regurgitation and right ventricular volume overload in patients with heart failure with preserved ejection fraction.射血分数保留的心力衰竭患者中三尖瓣反流和右心室容量超负荷的影响
Eur J Heart Fail. 2024 Apr;26(4):1025-1035. doi: 10.1002/ejhf.3195. Epub 2024 Mar 11.