Transcatheter treatment of severe tricuspid regurgitation using the edge-to-edge repair technique
Transcatheter treatment of severe tricuspid regurgitation using the edge-to-edge repair technique
复制标题
DOI：
10.4244/eij-d-16-00949
复制
发表时间：
2017-02-01
期刊：
影响因子：
6.2
通讯作者：
Hausleiter, Joerg
中科院分区：
文献类型：
--
作者：
Braun, Daniel;Nabauer, Michael;Hausleiter, Joerg
目的：本研究的目的是探讨经导管三尖瓣边缘到边缘修复技术在重度三尖瓣反流（TR）的高度症状患者中的手术可行性和短期耐久性。方法和结果：连续18例主要由中度至重度三尖瓣反流引起的严重右侧心力衰竭（NYHA III-IV级）患者纳入研究。应用改良的夹送系统转向技术，6例患者治疗孤立的严重TR， 12例患者治疗中度至重度TR并合并严重二尖瓣反流。主要目标是手术成功，定义为至少降低一个TR等级，以及30天的超声心动图和临床结果。高风险患者（EuroSCORE II: 10 +/- 8%）置入三尖瓣共41个夹（每位患者2.3 +/- 0.7个）。所有患者手术成功；医院内未发生MACCE。在30天的随访中，TR等级>= 3的发生率从术前的94%（17例）降至33%（6例）（p< 0.001）。16例患者（89%）报告在30天NYHA功能分级有所改善。结论：采用改良的转向技术，可以成功地应用边缘到边缘修复技术治疗TR。在30天的随访中，TR复位的短期持久性很有希望，大多数患者临床得到改善。进一步的研究需要更大的患者群体和更长的随访时间来确定这种新型治疗方案对右侧心力衰竭和严重TR患者的作用。
Aims: The aim of this study was to investigate the procedural feasibility and short-term durability of the transcatheter tricuspid valve edge-to-edge repair technique in highly symptomatic patients with severe tricuspid regurgitation (TR).Methods and results: Eighteen consecutive patients suffering from severe right-sided heart failure (NYHA Class III-IV), primarily due to moderate to severe tricuspid regurgitation, were included in the study. Applying a modified steering technique for the clip delivery system, six patients were treated for isolated severe TR, while 12 patients were treated for moderate to severe TR and concomitant severe mitral regurgitation. The primary objectives were procedural success, defined as reduction of at least one TR grade, and 30-day echocardiographic and clinical outcomes. A total of 41 clips (2.3 +/- 0.7 per patient) were placed into the tricuspid valve of high surgical risk patients (EuroSCORE II: 10 +/- 8%). Procedural success was achieved in all patients; no MACCE occurred in hospital. The presence of a TR grade >= 3 was reduced from 94% (17 patients) before the procedure to 33% (six patients) at 30-day follow-up (p< 0.001). Sixteen patients (89%) reported an improvement in NYHA functional class at 30 days.Conclusions: Applying a modified steering technique, the edge-to-edge repair technique can be successfully used for the treatment of TR. At 30-day follow-up, the short-term durability of TR reduction appeared promising and the majority of patients improved clinically. Further studies with larger patient populations and longer follow-up have to define the role of this novel treatment option for patients with right-sided heart failure and severe TR.