Skip to main content
SpringerLink
Log in

T-TEER: Beschreibung eines Entwicklungsprozesses

T-TEER: description of a development process

  • Schwerpunkt
  • Published:
Herz Aims and scope Submit manuscript

Zusammenfassung

Die Trikuspidalklappeninsuffizienz (TI) gewinnt zunehmend an klinischer Bedeutung. Während sie früher als Begleitsymptom einer Linksherzpathologie betrachtet wurde, wird sie mittlerweile als eigenständige und klinisch bedeutsame Erkrankung angesehen. Sie kann zu einer Volumenüberlastung des rechten Ventrikels führen, was wiederum eine Dilatation des Trikuspidalklappenannulus und eine Verschlimmerung der Insuffizienz nach sich ziehen kann. Unerkannt oder unbehandelt führt die schwere TI zu rezidivierenden kardialen Dekompensationen mit Krankenhausaufenthalten, verminderter Lebensqualität und Tod. Chirurgische Therapieoptionen waren bisher mit hohen Komplikations- und Mortalitätsraten – insbesondere bei isolierter TI – assoziiert. Viele Patienten gelten daher als inoperabel, sodass die neuen interventionellen Therapiemaßnahmen heute oft die einzige Therapieoption darstellen. Interventionelle Therapieoptionen wie das Edge-to-edge-Verfahren (T-TEER) mit TriClip™- oder PASCAL™-System sind sehr sichere Eingriffe, die bereits heute vielversprechende Ergebnisse zeigen, einschließlich Reduktion der TI, Verbesserung der Herzinsuffizienzsymptome und der Lebensqualität. Der Einfluss auf die Mortalität und die Notwendigkeit für Herzinsuffizienzhospitalisationen wird derzeit in mehreren randomisierten Studien untersucht. Die Patientenauswahl und das Timing der Intervention sind entscheidend. Die kardiovaskuläre Bildgebung spielt hier eine entscheidende Rolle, um neben dem Zeitpunkt auch die geeignete Therapiemethode auszuwählen. Die Prognose hängt von Faktoren wie Schweregrad der TI, rechtsventrikuläre Dysfunktion und pulmonalarterielle Hypertonie ab. Insgesamt ist die interventionelle TI-Therapie ein vielversprechender Behandlungsfortschritt, von dem zukünftig viele Patienten profitieren können.

Abstract

Tricuspid valve regurgitation (TR) is becoming increasingly more clinically important. While considered as an accompanying symptom of left heart pathologies in the past, TR is now seen as an independent and clinically significant condition. TR can lead to volume overload of the right ventricle, resulting in dilatation of the tricuspid valve annulus and worsening of the regurgitation. Undetected or untreated severe TR can lead to recurrent cardiac decompensation with hospitalization, reduced quality of life and death. Previous treatment options were limited to cardiac surgery and associated with high complication and mortality rates, especially in isolated TR. Therefore, many patients are considered inoperable so that the new interventional treatment measures nowadays often represent the only treatment option. Interventional treatment options such as the edge-to-edge procedure (T-TEER) with TriClip™ or the PASCAL™ system are very safe interventions that have already shown promising results, including reduction of TR, improvement in heart failure symptoms and the quality of life. The influence on the mortality and the necessity for hospitalization due to heart failure are currently being investigated in several randomized studies. Patient selection and timing of the intervention are crucial. Cardiovascular imaging plays a decisive role in selecting the appropriate method and timing of the intervention. The prognosis depends on factors, such as the severity of TR, right ventricular dysfunction, and pulmonary arterial hypertension. Overall, interventional TR treatment is a promising advancement in treatment from which many patients can benefit in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J et al (2022) 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 43(7):561–632

    Article  PubMed  Google Scholar 

  2. Hahn RT (2023) Tricuspid regurgitation. N Engl J Med 388(20):1876–1891

    Article  PubMed  Google Scholar 

  3. Praz F, Muraru D, Kreidel F, Lurz P, Hahn RT, Delgado V et al (2021) Transcatheter treatment for tricuspid valve disease. EuroIntervention 17(10):791–808

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wang N, Fulcher J, Abeysuriya N, McGrady M, Wilcox I, Celermajer D et al (2019) Tricuspid regurgitation is associated with increased mortality independent of pulmonary pressures and right heart failure: a systematic review and meta-analysis. Eur Heart J 40(5):476–484

    Article  PubMed  Google Scholar 

  5. Dreyfus J, Flagiello M, Bazire B, Eggenspieler F, Viau F, Riant E et al (2020) Isolated tricuspid valve surgery: impact of aetiology and clinical presentation on outcomes. Eur Heart J 41(45):4304–4317

    Article  PubMed  Google Scholar 

  6. Hahn RT, Weckbach LT, Noack T, Hamid N, Kitamura M, Bae R et al (2021) Proposal for a standard echocardiographic tricuspid valve nomenclature. JACC Cardiovasc Imaging 14(7):1299–1305

    Article  PubMed  Google Scholar 

  7. Lancellotti P, Pibarot P, Chambers J, La Canna G, Pepi M, Dulgheru R et al (2022) Multi-modality imaging assessment of native valvular regurgitation: an EACVI and ESC council of valvular heart disease position paper. Eur Heart J Cardiovasc Imaging 23(5):e171–e232

    Article  PubMed  Google Scholar 

  8. Gavazzoni M, Heilbron F, Badano LP, Radu N, Cascella A, Tomaselli M et al (2022) The atrial secondary tricuspid regurgitation is associated to more favorable outcome than the ventricular phenotype. Front Cardiovasc Med 9:1022755

    Article  PubMed  PubMed Central  Google Scholar 

  9. Anvardeen K, Rao R, Hazra S, Hay K, Dai H, Stoyanov N et al (2019) Prevalence and significance of tricuspid regurgitation post-endocardial lead placement. JACC Cardiovasc Imaging 12(3):562–564

    Article  PubMed  Google Scholar 

  10. Al-Bawardy R, Krishnaswamy A, Bhargava M, Dunn J, Wazni O, Tuzcu EM et al (2013) Tricuspid regurgitation in patients with pacemakers and implantable cardiac defibrillators: a comprehensive review. Clin Cardiol 36(5):249–254

    Article  PubMed  PubMed Central  Google Scholar 

  11. Addetia K, Harb SC, Hahn RT, Kapadia S, Lang RM (2019) Cardiac implantable electronic device lead-induced tricuspid regurgitation. JACC Cardiovasc Imaging 12(4):622–636

    Article  PubMed  Google Scholar 

  12. Gmeiner J, Sadoni S, Orban M, Fichtner S, Estner H, Massberg S et al (2021) Prevention of pacemaker lead-induced tricuspid regurgitation by transesophageal echocardiography guided implantation. JACC Cardiovasc Interv 14(23):2636–2638

    Article  PubMed  Google Scholar 

  13. Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA et al (2017) Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. J Am Soc Echocardiogr 30(4):303–371

    Article  PubMed  Google Scholar 

  14. Hahn RT, Thomas JD, Khalique OK, Cavalcante JL, Praz F, Zoghbi WA (2019) Imaging assessment of tricuspid regurgitation severity. JACC Cardiovasc Imaging 12(3):469–490

    Article  PubMed  Google Scholar 

  15. Peri Y, Sadeh B, Sherez C, Hochstadt A, Biner S, Aviram G et al (2020) Quantitative assessment of effective regurgitant orifice: impact on risk stratification, and cut-off for severe and torrential tricuspid regurgitation grade. Eur Heart J Cardiovasc Imaging 21(7):768–776

    Article  PubMed  Google Scholar 

  16. Felker GM, Ellison DH, Mullens W, Cox ZL, Testani JM (2020) Diuretic therapy for patients with heart failure: JACC state-of-the-art review. J Am Coll Cardiol 75(10):1178–1195

    Article  CAS  PubMed  Google Scholar 

  17. Medvedofsky D, Aronson D, Gomberg-Maitland M, Thomeas V, Rich S, Spencer K et al (2017) Tricuspid regurgitation progression and regression in pulmonary arterial hypertension: implications for right ventricular and tricuspid valve apparatus geometry and patients outcome. Eur Heart J Cardiovasc Imaging 18(1):86–94

    Article  PubMed  Google Scholar 

  18. Geyer M, Keller K, Bachmann K, Born S, Tamm AR, Ruf TF et al (2021) Concomitant tricuspid regurgitation severity and its secondary reduction determine long-term prognosis after transcatheter mitral valve edge-to-edge repair. Clin Res Cardiol 110(5):676–688

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. LaPar DJ, Likosky DS, Zhang M, Theurer P, Fonner CE, Kern JA et al (2018) Development of a risk prediction model and clinical risk score for isolated tricuspid valve surgery. Ann Thorac Surg 106(1):129–136

    Article  PubMed  Google Scholar 

  20. Dreyfus J, Audureau E, Bohbot Y, Coisne A, Lavie-Badie Y, Bouchery M et al (2022) TRI-SCORE: a new risk score for in-hospital mortality prediction after isolated tricuspid valve surgery. Eur Heart J 43(7):654–662

    Article  CAS  PubMed  Google Scholar 

  21. Antunes MJ, Rodríguez-Palomares J, Prendergast B, De Bonis M, Rosenhek R, Al-Attar N et al (2017) Management of tricuspid valve regurgitation: position statement of the European society of cardiology working groups of cardiovascular surgery and valvular heart disease. Eur J Cardiothorac Surg 52(6):1022–1030

    Article  PubMed  Google Scholar 

  22. Bernal JM, Morales D, Revuelta C, Llorca J, Gutiérrez-Morlote J, Revuelta JM (2005) Reoperations after tricuspid valve repair. J Thorac Cardiovasc Surg 130(2):498–503

    Article  PubMed  Google Scholar 

  23. Fukunaga N, Koyama T (2019) Early and late outcomes of isolated tricuspid valve surgery following valvular surgery. Ann Thorac Cardiovasc Surg 25(2):111–116

    Article  PubMed  Google Scholar 

  24. Hammerstingl C, Schueler R, Malasa M, Werner N, Nickenig G (2016) Transcatheter treatment of severe tricuspid regurgitation with the MitraClip system. Eur Heart J 37(10):849–853

    Article  PubMed  Google Scholar 

  25. Braun D, Nabauer M, Massberg S, Hausleiter J (2016) Transcatheter repair of primary tricuspid valve regurgitation using the Mitraclip system. JACC Cardiovasc Interv 9(15):e153–e154

    Article  PubMed  Google Scholar 

  26. Nickenig G, Kowalski M, Hausleiter J, Braun D, Schofer J, Yzeiraj E et al (2017) Transcatheter treatment of severe tricuspid regurgitation with the edge-to-edge mitraclip technique. Circulation 135(19):1802–1814

    Article  PubMed  Google Scholar 

  27. Lurz P, von Bardeleben SR, Weber M, Sitges M, Sorajja P, Hausleiter J et al (2021) Transcatheter edge-to-edge repair for treatment of tricuspid regurgitation. J Am Coll Cardiol 77(3):229–239

    Article  PubMed  Google Scholar 

  28. Nickenig G, Weber M, Lurz P, von Bardeleben RS, Sitges M, Sorajja P et al (2019) Transcatheter edge-to-edge repair for reduction of tricuspid regurgitation: 6‑month outcomes of the TRILUMINATE single-arm study. Lancet 394(10213):2002–2011

    Article  PubMed  Google Scholar 

  29. Kodali S, Hahn RT, Eleid MF, Kipperman R, Smith R, Lim DS et al (2021) Feasibility study of the transcatheter valve repair system for severe tricuspid regurgitation. J Am Coll Cardiol 77(4):345–356

    Article  PubMed  Google Scholar 

  30. Baldus S, Schofer N, Hausleiter J, Friedrichs K, Lurz P, Luedike P et al (2022) Transcatheter valve repair of tricuspid regurgitation with the PASCAL system: TriCLASP study 30-day results. Cathet Cardio Intervent 100(7):1291–1299

    Article  Google Scholar 

  31. Orban M, Rommel KP, Ho EC, Unterhuber M, Pozzoli A, Connelly KA et al (2020) Transcatheter edge-to-edge tricuspid repair for severe tricuspid regurgitation reduces hospitalizations for heart failure. JACC Heart Fail 8(4):265–276

    Article  PubMed  Google Scholar 

  32. Sorajja P, Whisenant B, Hamid N, Naik H, Makkar R, Tadros P et al (2023) Transcatheter repair for patients with tricuspid regurgitation. N Engl J Med 388(20):1833–1842

    Article  PubMed  Google Scholar 

  33. Enriquez-Sarano M, Messika-Zeitoun D, Topilsky Y, Tribouilloy C, Benfari G, Michelena H (2019) Tricuspid regurgitation is a public health crisis. Prog Cardiovasc Dis 62(6):447–451

    Article  PubMed  Google Scholar 

  34. Park SJ, Gentry JL 3rd, Varma N, Wazni O, Tarakji KG, Mehta A et al (2018) Transvenous extraction of pacemaker and defibrillator leads and the risk of tricuspid valve regurgitation. JACC Clin Electrophysiol 4(11):1421–1428

    Article  PubMed  Google Scholar 

  35. Kresoja KP, Lauten A, Orban M, Rommel KP, Alushi B, Besler C et al (2020) Transcatheter tricuspid valve repair in the setting of heart failure with preserved or reduced left ventricular ejection fraction. Eur J Heart Fail 22(10):1817–1825

    Article  PubMed  Google Scholar 

  36. Doldi PM, Stolz L, Kalbacher D, Köll B, Geyer M, Ludwig S et al (2022) Right ventricular dysfunction predicts outcome after transcatheter mitral valve repair for primary mitral valve regurgitation. Eur J Heart Fail 24(11):2162–2171

    Article  PubMed  Google Scholar 

  37. Stolz L, Doldi PM, Weckbach LT, Trimborn F, Orban M, Stocker TJ et al (2023) Right ventricular contraction patterns in patients undergoing mitral valve transcatheter edge-to-edge repair. JACC Cardiovasc Interv 16(2):242–244

    Article  PubMed  Google Scholar 

  38. Doldi P, Stolz L, Orban M, Karam N, Praz F, Kalbacher D et al (2022) Transcatheter mitral valve repair in patients with atrial functional mitral regurgitation. JACC Cardiovasc Imaging. https://doi.org/10.1016/j.jcmg.2022.05.009

    Article  PubMed  Google Scholar 

  39. Karam N, Stolz L, Orban M, Deseive S, Praz F, Kalbacher D et al (2021) Impact of right ventricular dysfunction on outcomes after transcatheter edge-to-edge repair for secondary mitral regurgitation. JACC Cardiovasc Imaging 14(4):768–778

    Article  PubMed  Google Scholar 

  40. Orban M, Wolff S, Braun D, Stolz L, Higuchi S, Stark K et al (2021) Right ventricular function in transcatheter edge-to-edge tricuspid valve repair. JACC Cardiovasc Imaging 14(12):2477–2479

    Article  PubMed  Google Scholar 

  41. Brener MI, Lurz P, Hausleiter J, Rodés-Cabau J, Fam N, Kodali SK et al (2022) Right ventricular-pulmonary arterial coupling and Afterload reserve in patients undergoing transcatheter tricuspid valve repair. J Am Coll Cardiol 79(5):448–461

    Article  PubMed  Google Scholar 

  42. Stocker TJ, Hertell H, Orban M, Braun D, Rommel KP, Ruf T et al (2021) Cardiopulmonary hemodynamic profile predicts mortality after transcatheter tricuspid valve repair in chronic heart failure. JACC Cardiovasc Interv 14(1):29–38

    Article  PubMed  Google Scholar 

  43. Stolz L, Orban M, Besler C, Kresoja KP, Braun D, Doldi P et al (2022) Cardiohepatic syndrome is associated with poor prognosis in patients undergoing tricuspid transcatheter edge-to-edge valve repair. JACC Cardiovasc Interv 15(2):179–189

    Article  PubMed  Google Scholar 

  44. Nickenig G, Weber M, Schüler R, Hausleiter J, Nabauer M, von Bardeleben RS et al (2021) Tricuspid valve repair with the Cardioband system: two-year outcomes of the multicentre, prospective TRI-REPAIR study. EuroIntervention 16(15):e1264–e1271

    Article  PubMed  PubMed Central  Google Scholar 

  45. Hahn RT, Kodali S, Fam N, Bapat V, Bartus K, Rodés-Cabau J et al (2020) Early multinational experience of transcatheter tricuspid valve replacement for treating severe tricuspid regurgitation. JACC Cardiovasc Interv 13(21):2482–2493

    Article  PubMed  Google Scholar 

  46. Lu FL, An Z, Ma Y, Song ZG, Cai CL, Li BL et al (2021) Transcatheter tricuspid valve replacement in patients with severe tricuspid regurgitation. Heart 107(20):1664–1670

    Article  PubMed  Google Scholar 

  47. Kodali S, Hahn RT, George I, Davidson CJ, Narang A, Zahr F et al (2022) Transfemoral tricuspid valve replacement in patients with tricuspid regurgitation: TRISCEND study 30-day results. JACC Cardiovasc Interv 15(5):471–480

    Article  PubMed  Google Scholar 

  48. Weckbach LT, Stolz L, Chatfield AG, Fam NP, von Bardeleben SR, Davidson CJ et al (2023) Right ventricular reverse remodeling after transcatheter tricuspid valve replacement in patients with heart failure. J Am Coll Cardiol 81(7):708–710

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland

    Philipp M. Doldi MD, M.Sc., Lukas Stolz MD, Ludwig T. Weckbach MD & Jörg Hausleiter MD

  2. Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), München, Deutschland

    Philipp M. Doldi MD, M.Sc., Lukas Stolz MD, Ludwig T. Weckbach MD & Jörg Hausleiter MD

Authors
  1. Philipp M. Doldi MD, M.Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lukas Stolz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ludwig T. Weckbach MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jörg Hausleiter MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philipp M. Doldi MD, M.Sc..

Ethics declarations

Interessenkonflikt

P.M. Doldi gibt an, dass kein Interessenkonflikt besteht. J. Hausleiter hat Referentenhonorare und Forschungsunterstützung von Edwards Lifesciences erhalten. L. Stolz hat Referentenhonorare von Edwards Lifesciences erhalten. L.T. Weckbach erhält Referentenhonorare von Astra Zeneca und Bayer.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Doldi, P.M., Stolz, L., Weckbach, L.T. et al. T-TEER: Beschreibung eines Entwicklungsprozesses. Herz 48, 448–455 (2023). https://doi.org/10.1007/s00059-023-05213-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00059-023-05213-2

Schlüsselwörter

Keywords

Search

Navigation