{"id":39680071,"date":"2024-06-28T11:01:02","date_gmt":"2024-06-28T09:01:02","guid":{"rendered":"https:\/\/www.chu-poitiers.fr\/?p=39680071"},"modified":"2024-07-01T14:00:59","modified_gmt":"2024-07-01T12:00:59","slug":"technique-tripclip-pour-traiter-les-insuffisances-tricuspides","status":"publish","type":"post","link":"https:\/\/www.chu-poitiers.fr\/en\/technique-tripclip-pour-traiter-les-insuffisances-tricuspides\/","title":{"rendered":"Technique TriClip pour traiter les insuffisances tricuspides"},"content":{"rendered":"\n<p>L\u2019insuffisance tricuspide est li\u00e9e \u00e0 un d\u00e9faut d\u2019\u00e9tanch\u00e9it\u00e9 de la valve tricuspide<a href=\"#_ftn1\" name=\"_ftnref1\">[1]<\/a> situ\u00e9e entre l\u2019oreillette droite et le ventricule droit, entra\u00eenant un reflux de sang anormal du ventricule droit vers l\u2019oreillette droite. Dans 85 % des cas, elle est fonctionnelle et, le plus fr\u00e9quemment, secondaire \u00e0 une pathologie du c\u0153ur gauche (maladie valvulaire du c\u0153ur gauche, d\u00e9faillance du ventricule gauche) : une arythmie par fibrillation atriale, une maladie pulmonaire, une hypertension pulmonaire, ou \u00e0 la pr\u00e9sence d\u2019une sonde de stimulation cardiaque (pace maker ou d\u00e9fibrillateur). Les pathologies du c\u0153ur gauche finissent par engendrer une dilatation des cavit\u00e9s cardiaques droites favorisant la survenue et l\u2019aggravation de l\u2019insuffisance tricuspide.<\/p>\n<p>Une insuffisance tricuspide s\u00e9v\u00e8re entra\u00eene l\u2019apparition de signes d\u2019insuffisance cardiaque droite avec prise de poids li\u00e9e \u00e0 la r\u00e9tention d\u2019eau, essoufflement, fatigue, \u0153d\u00e8mes des membres inf\u00e9rieurs. Elle facilite la survenue de troubles du rythme, de d\u00e9faillance r\u00e9nale et h\u00e9patique. Elle entra\u00eene, par cons\u00e9quent, des hospitalisations r\u00e9p\u00e9t\u00e9es avec une qualit\u00e9 de vie tr\u00e8s d\u00e9grad\u00e9e. \u00c0 un stade avanc\u00e9, l\u2019insuffisance tricuspide s\u00e9v\u00e8re est associ\u00e9e \u00e0 un pronostic sombre avec un taux de mortalit\u00e9 proche de 60 % \u00e0 un an, directement corr\u00e9l\u00e9 au degr\u00e9 de la fuite tricuspide.<\/p>\n<p>En pratique, la chirurgie cardiaque conventionnelle, recommand\u00e9e pour le traitement des insuffisances tricuspides s\u00e9v\u00e8res, est peu r\u00e9alis\u00e9e (5 %) du fait du risque op\u00e9ratoire \u00e9lev\u00e9 (mortalit\u00e9 \u00e0 un mois \u00e9valu\u00e9e entre 8 et 10 %).\u00a0 Le CHU de Poitiers pratique depuis le 4 avril dernier la technique TriClip<sup>TM<\/sup> de r\u00e9paration valvulaire percutan\u00e9e qui constitue une alternative th\u00e9rapeutique chez les patients symptomatiques, malgr\u00e9 un traitement m\u00e9dical optimal et consid\u00e9r\u00e9s \u00e0 haut risque op\u00e9ratoire. Elle s\u2019adresse aux patients souffrant d\u2019une insuffisance tricuspide non \u00e9ligible au traitement conventionnel chirurgical. Cette nouvelle technique est propos\u00e9e gr\u00e2ce \u00e0 un financement exceptionnel accord\u00e9 par le CHU de Poitiers, ce dispositif n\u2019\u00e9tant pas encore rembours\u00e9 par la S\u00e9curit\u00e9 sociale. Elle est r\u00e9alis\u00e9e par les Drs Jean Mergy et Elisa Larrieu, cardiologues interventionnels, en collaboration \u00e9troite avec les docteurs Corinne Beaufort et Benjamin Alos, cardiologues \u00e9chographistes.<\/p>\n<p>Le syst\u00e8me TriClip<sup>TM<\/sup> est directement inspir\u00e9 du syst\u00e8me MitraClip<sup>TM<\/sup> (r\u00e9paration bord \u00e0 bord de la valve mitrale) qui a d\u00e9montr\u00e9 son efficacit\u00e9 et sa s\u00e9curit\u00e9 dans le traitement de l\u2019insuffisance mitrale depuis plusieurs ann\u00e9es.<\/p>\n<p>L\u2019objectif de la technique TriClip<sup>TM<\/sup> est de restaurer un accolement des feuillets de la valve dans la zone de fuite \u00e0 l\u2019aide de la pose de clips, ou \u00ab\u00a0pinces\u00a0\u00bb, et ainsi r\u00e9duire la fuite tricuspide. Elle est effectu\u00e9e par l\u2019insertion d\u2019un cath\u00e9ter muni du clip par une voie veineuse f\u00e9morale, au niveau du pli de l\u2019aine, sous anesth\u00e9sie g\u00e9n\u00e9rale, sans recours \u00e0 une ouverture du thorax et donc sans sternotomie. L\u2019anesth\u00e9sie g\u00e9n\u00e9rale est motiv\u00e9e par la n\u00e9cessit\u00e9 d\u2019une \u00e9chographie transoesophagienne pendant la proc\u00e9dure pour guider la mise en place des clips sur la valve tricuspide. En fonction de l\u2019anatomie et du type de fuite tricuspide, l\u2019implantation de plusieurs clips est souvent n\u00e9cessaire. Le traitement TriClip<sup>TM<\/sup> a montr\u00e9 une r\u00e9duction de la fuite tricuspide associ\u00e9e \u00e0 une diminution des sympt\u00f4mes d\u2019insuffisance cardiaque, permettant une am\u00e9lioration de la qualit\u00e9 de vie du patient et une diminution des hospitalisations<strong><em>.<\/em><\/strong><\/p>\n<p>Le dispositif TriClip<sup>TM<\/sup> est un traitement innovant. Il permet d\u2019offrir une v\u00e9ritable possibilit\u00e9 de r\u00e9paration de la valve tricuspide chez des patients symptomatiques, qui souffre d\u2019insuffisance tricuspide malgr\u00e9 un traitement m\u00e9dical bien conduit et qui ne peuvent b\u00e9n\u00e9ficier d\u2019une chirurgie cardiaque en raison d\u2019un risque op\u00e9ratoire important.<\/p>\n<p><a href=\"#_ftnref1\" name=\"_ftn1\">[1]<\/a> La valve tricuspide est l\u2019un des quatre valves qui composent le c\u0153ur avec les valves pulmonaire, aortique et mitrale.<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full is-resized\"><a href=\"https:\/\/www.chu-poitiers.fr\/wp-content\/uploads\/2024\/06\/Digital-Large-Transparent-Bknd-72ppi-SH_TEER_TRICLIP-VERTICAL-2-web.jpg\"><img decoding=\"async\" src=\"https:\/\/www.chu-poitiers.fr\/wp-content\/uploads\/2024\/06\/Digital-Large-Transparent-Bknd-72ppi-SH_TEER_TRICLIP-VERTICAL-2-web.jpg\" alt=\"\" class=\"wp-image-39696133\" width=\"349\" height=\"349\"\/><\/a><\/figure>\n<\/div>\n\n\n<p class=\"wp-block-paragraph\">Photos du laboratoire Abbott.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>L\u2019insuffisance tricuspide (IT) est une maladie de la valve tricuspide, assez fr\u00e9quente et associ\u00e9e \u00e0 un mauvais pronostic. Elle concerne environ\u2026","protected":false},"author":1,"featured_media":39680089,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[96],"tags":[],"class_list":["post-39680071","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-non-classifiee"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Technique TriClip pour traiter les insuffisances tricuspides - Site du CHU de Poitiers<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.chu-poitiers.fr\/technique-tripclip-pour-traiter-les-insuffisances-tricuspides\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Technique TriClip pour traiter les insuffisances tricuspides - Site du CHU de Poitiers\" \/>\n<meta property=\"og:description\" content=\"L\u2019insuffisance tricuspide (IT) est une maladie de la valve tricuspide, assez fr\u00e9quente et associ\u00e9e \u00e0 un mauvais pronostic. Elle concerne environ 0,8 % de la population g\u00e9n\u00e9rale. Son incidence augmente nettement avec l\u2019\u00e2ge. 4 % des patients de plus de 75 ans sont concern\u00e9s. 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Elle concerne environ 0,8 % de la population g\u00e9n\u00e9rale. Son incidence augmente nettement avec l\u2019\u00e2ge. 4 % des patients de plus de 75 ans sont concern\u00e9s. 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