背景:经导管三尖瓣(TTV)修复技术的安全性已确立,但残余三尖瓣反流(TR)仍然是一个值得关注的问题.
目的:作者试图评估TTV修复后残余TR严重程度对生存的影响。
方法:我们根据出院时残余TR的严重程度,使用3级(轻度,中度,和严重)或4级方案(轻度,轻度至中度,中度至重度,和严重)。
结果:33%的残余TR为无/轻度,中等在52%,严重的15%。3组之间的2年调整生存率显着差异(85%,70%,44%,限制平均生存时间[RMST]:P=0.0001)。当319例具有中度残余TR的患者被细分为轻度至中度(n=201,33%)和中度至重度(n=118,19%)时,调整后的生存率在组间也有显著差异(85%,80%,55%,44%,分别为;RMST:P=0.001)。与轻度至中度残留TR患者相比,中度至重度残留TR患者的生存率显着降低(P=0.006)。无/轻度和轻度至中度残余TR患者之间的生存率没有差异(P=0.67),中度至重度和重度残余TR患者之间的生存率没有差异(P=0.96)。
结论:中度残余TR组是异质性的,包括临床结局明显不同的患者。用更细粒度的4级方案细化TR级分类改善了结果预测。我们的结果强调了在TTV修复期间实现轻度至中度或更低残留TR等级的重要性,这可以定义成功的干预。
BACKGROUND: The safety profile of transcatheter tricuspid valve (TTV) repair techniques is well established, but residual tricuspid regurgitation (TR) remains a concern.
OBJECTIVE: The authors sought to assess the impact of residual TR severity post-TTV repair on survival.
METHODS: We evaluated the survival rate at 2 years of 613 patients with severe isolated functional TR who underwent TTV repair in TRIGISTRY according to the severity of residual TR at discharge using a 3-grade (mild, moderate, and severe) or 4-grade scheme (mild, mild to moderate, moderate to severe, and severe).
RESULTS: Residual TR was none/mild in 33%, moderate in 52%, and severe in 15%. The 2-year adjusted survival rates significantly differed between the 3 groups (85%, 70%, and 44%, respectively; restricted mean survival time [RMST]: P = 0.0001). When the 319 patients with moderate residual TR were subdivided into mild to moderate (n = 201, 33%) and moderate to severe (n = 118, 19%), the adjusted survival rate was also significantly different between groups (85%, 80%, 55%, and 44%, respectively; RMST: P = 0.001). Survival was significantly lower in patients with moderate to severe residual TR compared to patients with mild to moderate residual TR (P = 0.006). No difference in survival rates was observed between patients with no/mild and mild to moderate residual TR (P = 0.67) or between patients with moderate to severe and severe residual TR (P = 0.96).
CONCLUSIONS: The moderate residual TR group was heterogeneous and encompassed patients with markedly different clinical outcomes. Refining TR grade classification with a more granular 4-grade scheme improved outcome prediction. Our results highlight the importance of achieving a mild to moderate or lower residual TR grade during TTV repair, which could define a successful intervention.