Zusammenfassung
Hintergrund
Die Trikuspidalklappe kann als die „vergessene“ Klappe bezeichnet werden, da in der Vergangenheit kaum Forschung in diesem Feld betrieben wurde und es folglich nur wenige Therapieoptionen gab. Die Prognose einer unbehandelten Trikuspidalklappeninsuffizienz (TI) ist bei erhöhter Mortalität deutlich eingeschränkt. Zudem kehren die betroffenen Patienten aufgrund kardialer Dekompensationen mit Luftnot und Beinödemen wiederholt in die Arztpraxen und Krankenhäuser zurück.
Ziel der Arbeit
Seit einigen Jahren wird verstärkt an kathetergestützten Behandlungstechniken geforscht. Aktuell befinden sich mehrere Systeme in der klinischen Forschung, die in diesem Beitrag vorgestellt werden.
Material und Methoden
Es erfolgte eine webbasierte Literaturrecherche, die um Informationen von internationalen kardiologischen Kongressen ergänzt wurde (TCT 2016 in Washington, DGK 2017 in Mannheim, EuroPCR 2017 in Paris).
Ergebnisse und Schlussfolgerung
Aktuell gibt es verschiedene Ansätze zur katheterinterventionellen Behandlung einer TI, die im Rahmen von Studien untersucht werden. Die meisten haben das Ziel, den Trikuspidalklappenring zu raffen und somit die Segelkoaptation zu verbessern. Die ersten Ergebnisse sind sehr vielversprechend. Durch den Einsatz dieser Therapieverfahren können heute Patienten behandelt werden, die bis vor Kurzem aufgrund einer hohen perioperativen Mortalität als nicht behandelbar galten.
Abstract
Background
The tricuspid valve can be considered the “forgotten” valve because in the past hardly any research has been conducted in this field and as a result only few therapeutic options existed. The prognosis of untreated tricuspid regurgitation (TR) is poor and mortality is high for patients with severe TR. Patients frequently return to medical practices and hospitals because of cardiac decompensation, with shortness of breath and leg edema.
Objective
Recent years have seen more development in catheter-based treatment options. Currently, several devices are in clinical evaluation, which are presented in this article.
Material and methods
A web-based literature search was carried out and information was gathered at international cardiology meetings (TCT 2016 in Washington, DGK 2017 in Mannheim, EuroPCR 2017 in Paris).
Results and conclusion
There are various options for interventional catheter procedures for TR, which are being investigated within the scope of clinical studies. Most aim at reducing the tricuspid annular diameter and optimizing leaflet coaptation. Because of these new therapy options patients can now be treated who were considered untreatable in the past because of the high perioperative mortality.
Literatur
Aboulhosn J, Cabalka AK, Levi DS et al (2017) Transcatheter valve-in-ring implantation for the treatment of residual or recurrent tricuspid valve dysfunction after prior surgical repair. JACC Cardiovasc Interv 10:53–63
Badano LP, Muraru D, Enriquez-Sarano M (2013) Assessment of functional tricuspid regurgitation. Eur Heart J 34:1875–1885
Braun D, Nabauer M, Orban M et al (2017) Transcatheter treatment of severe tricuspid regurgitation using the edge-to-edge repair technique. EuroIntervention 12:e1837–e1844. https://doi.org/10.4244/EIJ-D-16-00949
Campelo-Parada F, Perlman G, Philippon F et al (2015) First-in-man experience of a novel transcatheter repair system for treating severe tricuspid regurgitation. J Am Coll Cardiol 66:2475–2483
Denti P (2017) Pre-clinical experience with new percutaneous tricuspid valve repair system. EuroPCR, Paris
Figulla HR, Kiss K, Lauten A (2016) Transcatheter interventions for tricuspid regurgitation – heterotopic technology: TricValve. EuroIntervention 12:Y1–Y3
Fukuda S, Saracino G, Matsumura Y et al (2006) Three-dimensional geometry of the tricuspid annulus in healthy subjects and in patients with functional tricuspid regurgitation: a real-time, 3‑dimensional echocardiographic study. Circulation 114:I492–I498
Hahn RT, Meduri CU, Davidson CJ et al (2017) Early feasibility study of a transcatheter tricuspid valve annuloplasty: SCOUT trial 30-day results. J Am Coll Cardiol 69:1795–1806
Hammerstingl C, Schueler R, Malasa M et al (2016) Transcatheter treatment of severe tricuspid regurgitation with the MitraClip system. Eur Heart J 37:849–853
Hornick P, Harris PA, Taylor KM (1996) Tricuspid valve replacement subsequent to previous open heart surgery. J Heart Valve Dis 5:20–25
Huttin O, Voilliot D, Mandry D et al (2016) All you need to know about the tricuspid valve: tricuspid valve imaging and tricuspid regurgitation analysis. Arch Cardiovasc Dis 109:67–80
Jones JM, O’Kane H, Gladstone DJ et al (2001) Repeat heart valve surgery: risk factors for operative mortality. J Thorac Cardiovasc Surg 122:913–918
Kay JH, Maselli-Campagna G, Tsuji HK (1965) Surgical treatment of tricuspid insufficiency. Ann Surg 162:53–58
Kim YJ, Kwon DA, Kim HK et al (2009) Determinants of surgical outcome in patients with isolated tricuspid regurgitation. Circulation 120:1672–1678
Kuwata S, Taramasso M, Nietlispach F et al (2017) Transcatheter tricuspid valve repair toward a surgical standard: first-in-man report of direct annuloplasty with a cardioband device to treat severe functional tricuspid regurgitation. Eur Heart J 38(16):1261. https://doi.org/10.1093/eurheartj/ehw660
Latib A, Agricola E, Pozzoli A et al (2015) First-in-man implantation of a tricuspid annular remodeling device for functional tricuspid regurgitation. JACC Cardiovasc Interv 8:e211–e214
Laule M, Stangl V, Sanad W et al (2013) Percutaneous transfemoral management of severe secondary tricuspid regurgitation with Edwards Sapien XT bioprosthesis: first-in-man experience. J Am Coll Cardiol 61:1929–1931
Lauten A, Doenst T, Hamadanchi A et al (2014) Percutaneous bicaval valve implantation for transcatheter treatment of tricuspid regurgitation: clinical observations and 12-month follow-up. Circ Cardiovasc Interv 7:268–272
Lauten A, Sinning JM, Unbehaun A et al (2017) Caval Valve Implantation (CAVI) as interventional treatment option for severe TR. EuroPCR, Paris
McElhinney DB, Cabalka AK, Aboulhosn JA et al (2016) Transcatheter tricuspid valve-in-valve implantation for the treatment of dysfunctional surgical bioprosthetic valves: an international, multicenter registry study. Circulation 133:1582–1593
Nath J, Foster E, Heidenreich PA (2004) Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol 43:405–409
Navia JL, Nowicki ER, Blackstone EH et al (2010) Surgical management of secondary tricuspid valve regurgitation: annulus, commissure, or leaflet procedure? J Thorac Cardiovasc Surg 139:1473–1482.e5
https://www.navigatecsi.com/news/. Zugegriffen: 23. Mai 2017
Nickenig G, Kowalski M, Hausleiter J et al (2017) Transcatheter treatment of severe tricuspid regurgitation with the edge-to-edge: mitraclip technique. Circulation 135(19):1802. https://doi.org/10.1161/CIRCULATIONAHA.116.024848
Nishimura RA, Otto CM, Bonow RO et al (2014) 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation 129:e521–e643
Perlman G, Praz F, Puri R et al (2017) Transcatheter tricuspid valve repair with a new transcatheter coaptation device for the treatment of severe tricuspid regurgitation – One-year clinical and echocardiographic results. EuroPCR, Paris
http://www.prnewswire.com/news-releases/millipede-inc-announces-successful-clinical-use-of-the-first-adjustable-retrievable-transcatheter-complete-mitral-annuloplasty-ring-300456710.html. Zugegriffen: 23. Mai 2017
Rakita V, Lakhter V, Patil P et al (2017) Intermediate term hemodynamic effects of single inferior vena cava valve implant for the treatment of severe tricuspid regurgitation. Catheter Cardiovasc Interv. https://doi.org/10.1002/ccd.26931
Schofer J, Bijuklic K, Tiburtius C et al (2015) First-in-human transcatheter tricuspid valve repair in a patient with severely regurgitant tricuspid valve. J Am Coll Cardiol 65:1190–1195
Tchetche D, Denti P, Juliard JM et al (2016) TCT-88 innovative transcatheter tricuspid valve repair system. Initial outcomes from the first in human multi-centre study. J Am Coll Cardiol 68:B36
Vahanian A (2016) Transcatheter tricuspid valve therapies – 4‑tech description, results and a case. TCT.
Vahanian A, Alfieri O, Andreotti F et al (2012) Guidelines on the management of valvular heart disease (version 2012). The joint task force on the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 33:2451–2496
Van Garsse LA, Ter Bekke RM, van Ommen VG (2011) Percutaneous transcatheter valve-in-valve implantation in stenosed tricuspid valve bioprosthesis. Circulation 123:e219–e221
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
T. Wißt, C. Frerker, M. Schlüter geben an, dass kein Interessenkonflikt besteht. F. Kreidel gibt die folgenden potentiellen Interessenskonflikte an: Beratungs- und Referententätigkeiten für Edwards Lifesciences und Abbott Vascular. K.‑H. Kuck gibt die folgenden potentiellen Interessenskonflikte an: Beratungstätigkeiten für Abbott Vascular.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
Rights and permissions
About this article
Cite this article
Wißt, T., Kreidel, F., Schlüter, M. et al. Katheterinterventionelle Therapie der Trikuspidalklappeninsuffizienz. Internist 58, 1222–1230 (2017). https://doi.org/10.1007/s00108-017-0329-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00108-017-0329-6
Schlüsselwörter
- Regurgitation, Trikuspidalklappe
- Perkutane Therapien
- Herzklappenanuloplastie
- Segelkoaptation
- Herzklappenprothese