三尖瓣反流经导管治疗的中国专家共识Chinese expert consensus on transcatheter tricuspid valve intervention therapy
中国医师协会心血管内科医师分会结构性心脏病学组 ,潘文志,宋光远,刘先宝,陆方林,张晓春
摘要(Abstract):
三尖瓣反流(TR)是较常见的心脏瓣膜疾病之一,既往标准治疗为外科手术,但该方法创伤大、风险高。近年来,经导管三尖瓣介入治疗(TTVI)技术实现重大突破,在国外已步入临床推广阶段,并且相继推出了TTVI专家共识文件。但在我国,目前仍缺乏该方面的共识性文件。为推进该技术在我国安全、规范、健康地发展,特编写此专家共识。本共识将从TR的解剖与流行病学、分类与发病机制、传统治疗与TTVI、TTVI术前评估及临床疗效终点等方面予以介绍,并梳理总结10个核心观点,以便读者能够快速掌握共识的精髓要点。
关键词(KeyWords): 三尖瓣反流;经导管三尖瓣介入;专家共识
基金项目(Foundation):
作者(Author): 中国医师协会心血管内科医师分会结构性心脏病学组 ,潘文志,宋光远,刘先宝,陆方林,张晓春
参考文献(References):
- [1]Singh JP,Evans JC,Levy D,et al.Prevalence and clinical determinants of mitral,tricuspid,and aortic regurgitation(theFramingham Heart Study)[J].Am J Cardiol,1999,83(6):897-902.DOI:10.1136/openhrt-2014-000043.
- [2]Coffey S,d'Arcy JL,Loudon MA,et al.The OxVALVE population cohort study(OxVALVE-PCS)-population screening for undiagnosed valvular heart disease in the elderly:study design and objectives[J].Open Heart,2014,1(1):e000043.DOI:10.1136/openhrt-2014-000043.
- [3]G?ssl M,Stanbeny L,Benson G,et al.Burden of undiagnosed valvular heart disease in the elderly in the community:heart of new uhm valve study[J].JACC Cardiovasc Imaging,2023,16(8):1118-1120.DOI:10.1016/j.jcmg.2023.02.009.
- [4]Shiran A,Sagie A.Tricuspid regurgitation in mitral valve disease incidence,prognostic implications,mechanism,and management[J].J Am Coll Cardiol,2009,53(5):401-408.DOI:10.1016/jjacc.2008.09.048.
- [5]Genereux P.Pibarot P,Redfors B,et al.Staging classification of aortic stenosis based on the extent of cardiac damage[J].Eur Heart J,2017,38(45):3351-3358.DOI:10.1093/eurheartj/ehx381.
- [6]Vassileva CM,Shabosky J,Boley T,et al.Tricuspid valve surgery:the past 10 years from the Nationwide Inpatient Sample(NIS)database[J].J Thorac Cardiovasc Surg,2012,143(5):1043-1049.DOI:10.1016/j.jtcvs.2011.07.004.
- [7]Zack CJ,Fender EA,Chandrashekar P,et al.National trends and outcomes in isolated tricuspid valve surgery[J].J Am Coll Cardiol,2017,70(24):2953-2960.DOI:10.1016/j.jacc.2017.10.039.
- [8]Maisano F,Hahn R,Sorajja P,et al.Transcatheter treatment of the tricuspid valve:current status and perspectives[J].Eur Heart J,2024,45(11):876-894.DOI:10.1093/eurheartj/ehae0 82.
- [9]Hahn RT,Lawlor MK,Davidson CJ,et al.Tricuspid valve academic research consortium definitions for tricuspid regurgitation and trial endpoints[J].J Am Coll Cardiol,2023,82(17):1711-1735.DOI:10.1016/j.jacc.2023.08.008.
- [10]Davidson L J,Tang GHL,Ho EC,et al.Council on Cardiovascular surgery and anesthesia;and council on cardiovascular and stroke nursing.the tricuspid valve:a review of pathology,imaging,and current treatment options:a scientific statement from the American Heart Association[J].Circulation,2024,149(22):e1223-e1238.DOI:10.1161/CIR.0000000000001232.
- [11]Hahn RT,Weckbach LT,Noack T,et al.Proposal for a standard echocardiographic tricuspid valve nomenclature[J].JACC Cardiovasc Imaging,2021,14(7):1299-1305.DOI:10.1016/j.jcmg.2021.01.012.
- [12]Prihadi EA,van der Bijl P,Gursoy E,et al.Development of significant tricuspid regurgitation over time and prognostic implications:new insights into natural history[J].Eur Heart J,2018,39(39):3574-3581.DOI:10.1093/eurheartj/ehy352.
- [13]Mutlak D,Khalil J,Lessick J,et al.Risk factors for the development of functional tricuspid regurgitation and their population-attributable fractions[J].JACC Cardiovasc Imaging,2020,13(8):1643-1651.DOI:10.1016/j.jcmg.2020.01.015.
- [14]Wang N,Fulcher J,Abeysuriya N,et al.Tricuspid regurgitation is associated with increased mortality independent of pulmonary pressures and right heart failure:a systematic review and meta-analysis[J].Eur Heart J,2019,40(5):476-484.DOI:10.1093/eurheartj/ehy641.
- [15]Offen S,Playford D,Strange G,et al.Adverse prognostic impact of even mild or moderate tricuspid regurgitation:insights from the national echocardiography database of Australia[J].J Am Soc Echocardiogr,2022,35(8):810-817.DOI:10.1016/j.echo.2022.04.003.
- [16]Topilsky Y,Maltais S,Medina Inojosa J,et al.Burden of tricuspid regurgitation in patients diagnosed in the community setting[J].JACC Cardiovasc Imaging,2019,12(3):433-442.DOI:10.1016/j.j cmg.2018.06.014.
- [17]Wang TKM,Akyuz K,Mentias A,et al.Contemporary etiologies,outcomes,and novel risk score for isolated tricuspid regurgitation[J].JACC Cardiovasc Imaging,2022,15(5):731-744.DOI:10.1016/j.jcmg.2021.10.015.
- [18]Dreyfus J,Audureau E,Bohbot Y,et al.TRI-SCORE:a new risk score for in-hospital mortality prediction after isolated tricuspid valve surgery[J].Eur Heart J,2022,43(7):654-662.DOI:10.1093/eurheartj/ehab679.
- [19]Yang L,Chen H,Pan W,et al.Analyses for prevalence and outcome of tricuspid regurgitation in China:an echocardiography study of 134,874 patients[J].Cardiology,2019,142(1):40-46.DOI:10.1159/000496601.
- [20]Xu H,Liu Q,Cao K,et al.Distribution,characteristics,and management of older patients with valvular heart disease in China:China-DVD study[J].JACC Asia,2022,2(3):354-365.DOI:10.1016/j.jacasi.2021.11.013.
- [21]Otto CM,Nishimura RA,Bonow RO,et al.2020 ACC/AHA guideline for the management of patients with valvular heart disease:executive summary:a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines[J].Circulation,2021,143(5):e35-e71.DOI:10.1161/CIR.0000000000000932.
- [22]Adamo M,Chioncel O,Pagnesi M,et al.Epidemiology,pathophysiology,diagnosis and management of chronic right-sided heart failure and tricuspid regurgitation.A clinical consensus statement of the Heart Failure Association(HFA)and the European Association of Percutaneous Cardiovascular Interventions(EAPCI)of the ESC[J].Eur J Heart Fail,2024,26(1):18-33.DOI:10.1002/ejhf.3106.
- [23]Patlolla SH,Schaff HV,Nishimura RA,et al.Incidence and burden of tricuspid regurgitation in patients with atrial fibrillation[J].J Am Coll Cardiol,2022,80(24):2289-2298.DOI:10.1016/j.j acc.2022.09.045.
- [24]Cho MS,Cha MJ,Nam GB,et al.Incidence and predictors of severe tricuspid regurgitation in atrial fibrillation patients without structural heart disease[J].Am J Cardiol,2023,203:288-294.DOI:10.1016/j.amjcard.2023.07.005.
- [25]Vahanian A,Beyersdorf F,Praz F,et al.2021 ESC/EACTS Guidelines for the management of valvular heart disease[J].Eur Heart J,2022,43(7):561-632.DOI:10.1093/eurheartj/ehab395.
- [26]Chen Q,Bowdish ME,Malas J,et al.Isolated tricuspid operations:the society of thoracic surgeons adult cardiac surgery database analysis[J].Ann Thorac Surg,2023,115(5):1162-1170.DOI:10.1016/j.athoracsur.2022.12.041.
- [27]Sorajja P,Whisenant B,Hamid N,et al.Transcatheter repair for patients with tricuspid regurgitation[J].N Engl J Med,2023,388(20):1833-1842.DOI:10.1056/NEJMoa2300525.
- [28]Kodali SK,Hahn RT,Davidson CJ,et al.1-year outcomes of transcatheter tricuspid valve repair[J].J Am Coll Cardiol,2023,81(18):1766-1776.DOI:10.1016/j.jacc.2023.02.049.
- [29]Gray WA,Abramson SV,Lim S,et al.1-year outcomes of cardioband tricuspid valve reconstruction system early feasibility study[J].JACC Cardiovasc Interv,2022,15(19):1921-1932.DOI:10.1016/j.j cin.2022.07.006.
- [30]Zhang X,Jin Q,Pan W,et al.First-in-human study of the K-Clip~(TM)transcatheter annular repair system for severe functional tricuspid regurgitation[J].Int J Cardiol,2023,390:131174.DOI:10.1016/j.ijcard.2023.131174.
- [31]Kodali SK.TRISCENDⅡ:a randomized trial of transcatheter tricuspid valve replacement in patients with severe tricuspid regurgitation[EB/OL].(2023-10-27)[2024-09-10] https://www.tctmd.com/slide/triscend-ii-rando mized-trial-transcathetertricuspid-valve-replacement-patients-severe.
- [32]Zhang Y,Lu F,Li W,et al.A first-in-human study of transjugular transcatheter tricuspid valve replacement with the LuX-Valve Plus system[J].EuroIntervention,2023,18(13):e1088-e1089.DOI:10.4244/EIJ-D-22-00517.
- [33]Ge J.One-month outcomes of the multicenter TRAVELⅡ(transvascular tricuspid valve replacement with the LuX-Valve Plus System)study[EB/OL].(2023-10-26)[2024-09-10]https://www.tctmd.co m/slide/one-mo nth-outcomes-multicentertravel-ii-transvascular-tricuspid-valve-replacement-lux-valve.
- [34]Blasco-Turrión S,Briedis K,Estevez-Loureiro R,et al.Bicaval TricValve implantation in patients with severe symptomatic tricuspid regurgitation:1-year follow-up outcomes[J].JACC Cardiovasc Interv,2024,17(1):60-72.DOI:10.1016/j.jcin.2023.10.043.
- [35]McElhinney DB,Cabalka AK,Aboulhosn JA,et al.Transcatheter tricuspid valve-in-valve implantation for the treatment of dysfunctional surgical biopro sthetic valves:an international,multicenter registry study[J].Circulation,2016,133(16):1582-1593.DOI:10.1161/CIRCULATIONAHA.115.019353.
- [36]Bouleti C,Himbert D,Brochet E,et al.Transfemoral tricuspid valve-in-ring implantation using the edwards Sapien XT valve:one-year follow-up[J].Circ Cardiovasc Interv,2015,8(3):e002225.DOI:10.1161/CIRCINTERVENTIONS.114.002225.
- [37]Condado J,Leonardi R,Babaliaros V.Percutaneous tricuspid valve-in-ring replacement for the treatment of recurrent severe tricuspid regurgitation[J].Catheter Cardiovasc Interv,2015,86(7):1294-1298.DOI:10.1002/ccd.25980.
- [38]Besler C,Orban M,Rommel KP,et al.Predictors of procedural and clinical outcomes in patients with symptomatic tricuspid regurgitation undergoing transcatheter edge-to-edge repair[J].JACC Cardiovasc Interv,2018,11(12):1119-1128.DOI:10.1016/j.jcin.2018.05.002.
- [39]Utsunomiya H,Itabashi Y,Mihara H,et al.Usefulness of 3D echocardiographic parameters of tricuspid valve morphology to predict residual tricuspid regurgitation after tricuspid annuloplasty[J].Eur Heart J Cardiovasc Imaging,2017,18(7):809-817.DOI:10.1093/ehjci/jew323.
- [40]Fukuda S,Song JM,Gillinov AM,et al.Tricuspid valve tethering predicts residual tricuspid regurgitation after tricuspid annuloplasty[J].Circulation,2005,111(8):975-979.DOI:10.1161/01.CIR.0000156449.49998.51.
- [41]Praz F,Muraru D,Kreidel F,et al.Transcatheter treatment for tricuspid valve disease[J].EuroIntervention,2021,17(10):791-808.DOI:10.4244/EIJ-D-21-00695.
- [42]Dreyfus J,Galloo X,Taramasso M,et al.TRI-SCORE and benefit of intervention in patients with severe tricuspid regurgitation[J].Eur Heart J,2024,45(8):586-597.DOI:10.1093/eurheartj/ehad5 85.
- [43]Lu F,Xiong T,Chen M.Evaluation of systemic impact of tricuspid regurgitation:an appeal for the notion of tricuspid regurgitation syndrome[J].Chin Med J(Engl),2023,136(2):138-140.DOI:10.1097/CM9.0000000000002440.
- [44]Brener MI,Lurz P,Hausleiter I,et al.Right ventricularpulmonary arterial coupling and afterload reserve in patients undergoing transcatheter tricuspid valve repair[J].J Am Coll Cardiol,2022,79(5):448-461.DOI:10.1016/j.jacc.2021.11.031.
- [45]Fortuni F,Butcher SC,Dietz MF,et al.Right ventricularpulmonary arterial coupling in secondary tricuspid regurgitation[J].Am J Cardiol,2021,148:138-145.DOI:10.1016/j.amjcard.2021.02.037.
- [46]Sugiura A,Tanaka T,Kavsur R,et al.Leaflet configuration and residual tricuspid regurgitation after transcatheter edge-toedge tricuspid repair[J].JACC Cardiovasc Interv,2021,14(20):2260-2270.DOI:10.1016/j.jcin.2021.07.048.
- [47]Park JB,Kim HK,Jung JH,et al.Prognostic value of cardiac MR imaging for preoperative assessment of patients with severe functional tricuspid regurgitation[J].Radiology,2016,280(3):723-734.DOI:10.1148/radiol.2016151556.
- [48]Grapsa J,Praz F,Sorajja P,et al.Tricuspid regurgitation:from imaging to clinical trials to resolving the unmet need for treatment[J].JACC Cardiovasc Imaging,2024,17(1):79-95.DOI:10.1016/j.jcmg.2023.08.013.
- [49]Abraham WT,Psotka MA,Fiuzat M,et al.Standardized definitions for evaluation of heart failure therapies:scientific expert panel from the heart failure collaboratory and academic research consortium[J].JACC Heart Fail,2020,8(12):961-972.DOI:10.1016/j.jchf.2020.10.002.
- [50]Ferreira JP,Duarte K,Graves TL,et al.Natriuretic peptides,6-min walk test,and quality-of-life questionnaires as clinically meaningful endpoints in HF trials[J].J Am Coll Cardiol,2016,68(24):2690-2707.DOI:10.1016/j.jacc.2016.09.936.
- [51]Addetia K,Miyoshi T,Amuthan V,et al.Normal values of three-dimensional right ventricular size and function measurements:results of the world alliance societies of echocardiography study[J].J Am Soc Echocardiogr,2023,36(8):858-866.e1.DOI:10.1016/j.echo.2023.04.011.
- [52]Hahn RT,Kodali S,Fam N,et al.Early multinational experience of transcatheter tricuspid valve replacement for treating severe tricuspid regurgitation[J].JACC Cardiovasc Interv,2020,13(21):2482-2493.DOI:10.1016/j.jcin.2020.07.008.
- [53]Bugan B,?ekirdek?i EI,Onar L?,et al.Transcatheter tricuspid valve replacement for tricuspid regurgitation:a systematic review and Meta-analysis[J].Anatol J Cardiol,2022,26(7):505-519.DOI:10.5152/AnatolJCardiol.2022.1440.
- [54]Kodali S,Hahn RT,George I,et al.Transfemoral tricuspid valve replacement in patients with tricuspid regurgitation:TRISCEND study 30-day results[J].JACC Cardiovasc Interv,2022,15(5):471-480.DOI:10.1016/j.jcin.2022.01.016.