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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.

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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