原发性三尖瓣反流患者的经导管边缘对边缘修复

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2025-05-26 DOI:10.1016/j.jcin.2025.03.023

Atsushi Sugiura MD, PhD , Julien Dreyfus MD, PhD , Sara Bombace MD , Maria Ivannikova MD , Joanna Bartkowiak MD , Stephan Haussig MD , Leonhard Moritz Schneider MD , Mohammad Kassar MD , Patrick Horn MD , Maurizio Taramasso MD , Christos Iliadis MD , Itsuki Osawa MD , Tadahiro Goto MD, MPH, PhD , Marcel Weber MD , Tetsu Tanaka MD , Sebastian Zimmer MD , Jean-François Obadia MD, PhD , Gilbert Habib MD , Baptiste Bazire MD , Bernard Iung MD , Georg Nickenig MD

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引用次数: 0

摘要

背景：三尖瓣反流（TR）导致右心充血和死亡风险增加。与继发性TR不同，原发性TR由小叶变性引起。经导管边缘到边缘修复（TEER）被广泛应用于TR，但其可行性尚不确定。本研究的目的是评估TEER治疗原发性TR患者的安全性和可行性。方法原发性TR注册是一项多中心队列研究，对原发性TR患者进行TEER治疗。超声心动图评估将小叶病理分为1型（连枷）、2型（翻腾脱垂）、3型（穿孔）和4型（活动受限）。主要终点是出院时TR降低到中等或更低。结果2016年12月至2023年4月共纳入114例患者，平均年龄79.9岁，男性53.5%。大多数患者为NYHA功能III或IV级（83.3%），中位TRI-SCORE为5.0。TR病理类型为1型（28.1%）、2型（61.4%）和4型（10.5%），无3型病例。95.6%的患者实现了设备部署，83.3%的患者TR降低到中等或更低。住院死亡率为1.8%，单叶装置附着率为3.5%。1年后，79.7%的患者TR中度或更低，静脉收缩显著减少(- 5.0 mm；P & lt;0.001)，环径(- 2.0 mm；P = 0.003)，右心室中径(- 3.0 mm；P & lt;0.001)。NYHA功能分级也有显著改善(NYHA I或II功能分级：基线时17.1% vs随访时66.5%；P & lt;0.001)。结论steer是一种安全、有效的治疗原发性TR的方法，可促进右心反向重构和缓解症状，为特定患者提供了手术的重要选择。

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Transcatheter Edge-to-Edge Repair in Patients With Primary Tricuspid Regurgitation

Background

Tricuspid regurgitation (TR) leads to right heart congestion and increased mortality risk. Unlike secondary TR, primary TR results from leaflet degeneration. Transcatheter edge-to-edge repair (TEER) is widely used for TR. However, its feasibility primary TR remains uncertain.

Objectives

The aim of this study was to assess the safety and feasibility of TEER in patients with primary TR.

Methods

The primary TR registry is a multicenter cohort study of patients with primary TR undergoing TEER. Echocardiographic assessment classified leaflet pathology into type 1 (flail), type 2 (billowing prolapse), type 3 (perforation), and type 4 (restricted mobility). The primary endpoint was TR reduction to moderate or less at discharge.

Results

From December 2016 to April 2023, 114 patients (mean age 79.9 years, 53.5% men) were included. Most patients were in NYHA functional class III or IV (83.3%), with a median TRI-SCORE of 5.0. The TR pathologies were type 1 (28.1%), type 2 (61.4%), and type 4 (10.5%), with no type 3 cases. Device deployment was achieved in 95.6%, and 83.3% showed TR reduction to moderate or less. In-hospital mortality was 1.8%, and single-leaflet device attachment occurred in 3.5%. At 1 year, 79.7% of patients had TR moderate or less, with significant reductions in vena contracta (−5.0 mm; P < 0.001), annular diameter (−2.0 mm; P = 0.003), and mid right ventricular diameter (−3.0 mm; P < 0.001). NYHA functional class also improved significantly (NYHA functional class I or II: 17.1% at baseline vs 66.5% at follow-up; P < 0.001).

Conclusions

TEER is a safe and effective option for primary TR, promoting right heart reverse remodeling and symptomatic relief, offering a vital alternative to surgery in selected patients.

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.