Tricuspid regurgitation (TR) is the most common tricuspid valve disease. Tricuspid regurgitation refers to a failure in the normal closure of the tricuspid valve due to congenital abnormalities or acquired diseases, causing blood to flow back from the right ventricle to the right atrium. Tricuspid regurgitation occurs in 65% to 85% of the population [1, 2]. In its mild form, the disease is very common and generally benign, while moderate or severe cases may lead to irreversible myocardial injury and adverse consequences [3]. An epidemiological study in the United States has shown that the prevalence of moderate and more severe TR among the overall population is about 0.55%. However, the prevalence increases significantly with age, and the probability increases to 4% for people aged over 75 [4].
Current guidelines prefer concurrent tricuspid valve repair in surgical interventions for left heart-related disease, even if the TR is mild to moderate; whereas isolated tricuspid valve surgery requires careful consideration, especially in cases with late reoperation and a history of left heart valve surgery [5,6]. The interventional therapy of TR has been developed alongside those for aortic valve diseases and mitral regurgitation. Notably, the rapid development of instruments and technologies for mitral valve interventional therapy in recent years has led to the development of a number of tricuspid valve instruments and technologies, including: transcatheter edge-to-edge repair, annular contraction, regurgitant area blockade, chordae tendineae intervention, ectopic valve replacement and in-situ valve replacement [6].
Most tricuspid valve intervention devices are in the clinical study stage. At present, only three products in the world have been CE certified and approved for clinical application, including two for transcatheter edge-to-edge repair.
Although the application of transcatheter tricuspid valve intervention has been carried out for a relatively short period and is still in the initial stage, transcatheter tricuspid valve edge-to-edge repair is the most widely used interventional therapy for tricuspid regurgitation in the world [1], and the early clinical trial results have proven its feasibility and effectiveness [2]. Transcatheter tricuspid valve edge-to-edge repair provides a more promising alternative interventional therapy for patients with secondary tricuspid regurgitation compared to conventional techniques requiring thoracotomy [1].
References
[1] Lavie CJ, Hebert K, Cassidy M. Prevalence and severity of Doppler-detected valvular regurgitation and estimation of right-sided cardiac pressures in patients with normal two-dimensional echocardiograms. Chest 1993;103:226–231.
[2] Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol 1999;83:897–902.
[3] Mani Arsalan, Thomas Walther, Robert L.Smith,II, Paul A.Grayburn, Tricuspid regurgitation diagnosis and treatment, European Heart Journal, Volume 38, Issue 9, 1 March 2017, Pages 634–638, https://doi.org/10.1093/eurheartj/ehv487].
[4] 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 DOl:10.1016/j.jcmg.2018.06.014.
[5] Vahanian A, Beyersdorf F, Praz F, et al; ESC/EACTS Scientific Document Group; ESC Scientific Document Group. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2021 Aug 28:ehab395. doi: 10.1093/eurheartj/ehab395.
[6] 结构性心脏病年度报告2021
References
[1] Overtchouk, P.,Piazza, N., Granada, J., Soliman, O., Prendergast, B., & Modine,T.(2020).Advances in transcatheter mitral and tricuspid therapies. BMC Cardiovascular Disorders, 20(1). https://doi.org/10.1186/s12872-019-01312-3
[2] Besler,C.,Orban, M.,Rommel,K.,Braun,D.,Patel, M.,& Hagl, C.et al.(2018).Predictors of Procedural and Clinical Outcomes in Patients With Symptomatic Tricuspid Regurgitation Undergoing Transcatheter Edge-to-Edge Repair.JACC:Cardiovascular Interventions,11(12), 1119-1128. https://doi.org/10.1016/j.jcin.2018.05.002
