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Blusztein DI, Hahn RT. New therapeutic approach for tricuspid regurgitation: Transcatheter tricuspid valve replacement or repair. Front Cardiovasc Med 2023; 10:1080101. [PMID: 36910541 PMCID: PMC9995444 DOI: 10.3389/fcvm.2023.1080101] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
The tricuspid valve is a complex structure with normal function dependent on the leaflet morphology, right atrial and annular dynamics, and right ventricular and chordal support. Thus, the pathophysiology of tricuspid regurgitation (TR) is equally complex and current medical and surgical management options are limited. Transcatheter devices are currently being investigated as possible treatment options with lower morbidity and mortality than open surgical procedures. These devices can be divided by their implant location/mechanism of action: leaflet approximation devices, annuloplasty devices, orthotopic valve implants, and heterotopic valve implants. The current review will discuss each class of transcatheter device therapy, and further delve into the current understanding of who and when to treat. Finally, we will include a brief discussion of the future of device and surgical therapy trials for TR and the remaining questions to answer about this complex disease process.
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Affiliation(s)
- David I Blusztein
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY, United States
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY, United States
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Wu Z, Zhu W, Kaisaier W, Kadier M, Li R, Tursun G, Dong Y, Liu C, Chen Y. Periprocedural, short-term, and long-term outcomes following transcatheter tricuspid valve repair: a systemic review and meta-analysis. Ther Adv Chronic Dis 2023; 14:20406223231158607. [PMID: 36895329 PMCID: PMC9989399 DOI: 10.1177/20406223231158607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/03/2023] [Indexed: 03/06/2023] Open
Abstract
Background There has been an increasing use of transcatheter tricuspid valve repair (TTVR) recently. However, the periprocedural, short-term, and long-term outcomes of TTVR remain unclear. Objectives To determine the clinical outcomes in patients with significant tricuspid regurgitation undergoing TTVR. Design Systematic review and meta-analysis. Data Source and Methods The systematic review and meta-analysis is reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and EMBASE were searched for clinical trials and observational studies until March 2022. Studies reporting the incidence of clinical outcomes after TTVR were included. The clinical outcomes included periprocedural, short-term (in-hospital or within 30 days), and long-term (>6-month follow-up) outcomes. The primary outcome was all-cause mortality whereas the secondary outcomes included technical success, procedural success, cardiovascular mortality, rehospitalization for heart failure (HHF), major bleeding, and single leaflet device attachment. The incidence of these outcomes across studies was pooled by a random-effects model. Results A total of 21 studies with 896 patients were included. A total of 729 (81.4%) patients underwent isolated TTVR while only 167 (18.6%) patients underwent combined mitral and tricuspid valve repair. Over 80% of the patients used coaptation devices while approximately 20% used annuloplasty devices. The median follow-up duration was 365 days. Technical and procedural success was high at 93.9% and 82.1%, respectively. The pooled perioperative, short-term, and long-term all-cause mortality for patients undergoing TTVR was 1.0%, 3.3%, and 14.1%, respectively. The long-term cardiovascular mortality rate was 5.3% while the HHF rate was 21.5%. Major bleeding and single leaflet device attachment were two major complications, accounting for 14.3% and 6.4%, respectively, during long-term follow-up. Conclusion TTVR is associated with high procedural success and low procedural and short-term mortality. However, all-cause mortality, cardiovascular mortality, and HHF rates remain high during long-term follow-up. Registration PROSPERO (CRD42022310020).
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Affiliation(s)
- Zexuan Wu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, P.R. China
| | - Wengen Zhu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, P.R. China
| | - Wulamiding Kaisaier
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Miriding Kadier
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Runkai Li
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Gulpari Tursun
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Yugang Dong
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, P.R. China
| | - Chen Liu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P.R. China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, P.R. China
| | - Yili Chen
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P.R. China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, P.R. China
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Alipour Symakani RS, Bartelds B, Merkus D, Bogers AJJC, Taverne YJHJ. Guiding Interventions for Secondary Tricuspid Regurgitation: Follow the Intricate Interplay Between Form and Function. Cardiol Rev 2023; 31:7-15. [PMID: 34495894 DOI: 10.1097/crd.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Secondary tricuspid regurgitation (TR) has long been considered a benign and well-tolerated valvular lesion that resolves after treatment of the underlying disease. This view has been challenged by data indicating that long-standing TR can be a progressive disorder, contributing to right ventricular failure and end-organ damage, despite adequate treatment of the underlying disease. Surgical correction is curative, but infrequently performed and historically associated with poor outcomes. This may be due to delayed diagnosis, lack of well-defined surgical indications, and, consequently, late intervention in patients in poor clinical condition with failing right ventricles. Because of limited evidence about timing and corresponding outcome of tricuspid valve surgery, current guideline recommendations are rather conservative and show several inconsistencies. Nevertheless, there has been a trend toward a more aggressive approach in the surgical treatment of TR with improved outcomes. Moreover, emerging transcatheter options claim to provide a lower-risk alternative for selected patients. This may facilitate earlier treatment and improve the attitude toward an early treatment strategy of secondary TR, yet is not reflected in the guidelines. Future research is needed for risk stratification to determine inclusion criteria and optimal timing for intervention.
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Affiliation(s)
- Rahi S Alipour Symakani
- From the Division of Experimental Cardiology, Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Beatrijs Bartelds
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Daphne Merkus
- From the Division of Experimental Cardiology, Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Merdad A, Fam NP, Connelly KA, Hagemeyer D, Texiwala S, Ong G. Preprocedural Intravenous Diuresis to Facilitate Tricuspid Valve Intervention. JACC Cardiovasc Interv 2022; 15:2576-2578. [PMID: 36543456 DOI: 10.1016/j.jcin.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 12/23/2022]
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Patrascu AI, Binder D, Alashkar I, Schnabel P, Stähle W, Weinmann K, Schneider J, Conzelmann LO, Mehlhorn U, Ott I. Transcatheter Tricuspid Valve Repair in Prohibitive Risk Patients: Impact on Quality of Life and Major Organ Systems. Can J Cardiol 2022; 38:1921-1931. [PMID: 36096401 DOI: 10.1016/j.cjca.2022.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/01/2022] [Accepted: 09/01/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Percutaneous repair for severe tricuspid regurgitation (TR) is emerging as a viable option, but patient selection is challenging and predetermined by comorbidities. This study evaluated mid-term outcomes of transcatheter tricuspid valve repair (TTVR) in very sick inoperable patients and explored the concept of risk-based therapeutic futility. METHODS TTVR patients treated in our centre were prospectively assigned to prohibitive-risk (PR) and high-risk (HR) subgroups, based on Society of Thoracic Surgeons (STS) Score, frailty indices, and major organ system compromise. Efficacy and safety outcomes were compared at baseline, 30 days, and 6 months. RESULTS Thirty-three patients (mean age 81.9 ± 5.1 years) completed follow-up from May 2021 to March 2022: 18 PR (mean STS Score 15.5 ± 7%) and 15 HR (mean STS Score 6.4 ± 1.7%). The primary efficacy end point of at least 1 grade of TR reduction by 30 days was recorded in 93.9% of all patients, with no device-related adverse events. Improvement in initial New York Heart Association functional class III/IV occurred in 74% of PR and 93% of HR patients. Six-minute walk test increased by 81 ± 43.6 metres (P < 0.001) and 85.8 ± 47.9 metres (P < 0.001), respectively. Renal function tests improved by 15% (P = 0.048) and 7% (P = 0.050), while liver enzymes decreased by 18% (P = 0.020) and 28% (P = 0.052). Right ventricular systolic function increased in both subgroups by at least 24% (P < 0.001). Six-month mortality was 12.1%, with 6 hospitalisations for acute heart failure. CONCLUSIONS TR reduction significantly affected quality of life, functional capacity, cardiac remodelling, and multiorgan involvement similarly in PR and HR patients. TTVR is feasible in very sick symptomatic patients, regardless of predicted risk.
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Affiliation(s)
- Alexandru I Patrascu
- Department of Cardiology, Rhythmology, Electrophysiology, and Angiology Helios Hospital, Pforzheim, Germany; Private University in the Principality of Liechtenstein, Triesen, Liechtenstein.
| | - Donat Binder
- Department of Cardiology, Rhythmology, Electrophysiology, and Angiology Helios Hospital, Pforzheim, Germany
| | - Ibrahim Alashkar
- Department of Cardiology, Rhythmology, Electrophysiology, and Angiology Helios Hospital, Pforzheim, Germany
| | - Peter Schnabel
- Department of Cardiology, Rhythmology, Electrophysiology, and Angiology Helios Hospital, Pforzheim, Germany
| | - Wilfried Stähle
- Department of Cardiology, Rhythmology, Electrophysiology, and Angiology Helios Hospital, Pforzheim, Germany
| | - Kai Weinmann
- Department of Cardiology, Rhythmology, Electrophysiology, and Angiology Helios Hospital, Pforzheim, Germany
| | - Jochen Schneider
- Department of Cardiology, Rhythmology, Electrophysiology, and Angiology Helios Hospital, Pforzheim, Germany
| | | | - Uwe Mehlhorn
- Department of Cardiac Surgery Helios Hospital, Karlsruhe, Germany
| | - Ilka Ott
- Department of Cardiology, Rhythmology, Electrophysiology, and Angiology Helios Hospital, Pforzheim, Germany
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Gheorghe LL, Hegeman R, Vrijkorte M, Wunderlich N, Cavalcante J, Wang DD, Rana B, Vannan M, Timmers L, Swaans M. The evolving role of multi-modality imaging in transcatheter tricuspid valve interventions. Front Cardiovasc Med 2022; 9:793267. [DOI: 10.3389/fcvm.2022.793267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Tricuspid valve pathophysiology is not well-understood. Emergence of novel transcatheter tricuspid therapies has fueled the requirements for improved imaging visualization techniques and interventional imaging physician skillsets in guiding these complex transcatheter procedures. There is growing understanding on the clinical significance of tricuspid regurgitation which expanded the interest for percutaneous tricuspid valve interventions. The present review concentrates on three essential aspects of tricuspid valve pathophysiology: anatomical considerations for tricuspid interventions, optimal timing of tricuspid interventions by imaging guidance, and the role of interventional imaging physicians’ skillset and knowledge in this field.
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Körber MI, Rudolph V. Funktionelle Trikuspidalklappeninsuffizienz – Klinische und echokardiografische Parameter für die Auswahl von Patient und Verfahren. AKTUELLE KARDIOLOGIE 2022. [DOI: 10.1055/a-1912-5094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ZusammenfassungDie sekundäre Trikuspidalklappeninsuffizienz (TI) ist ein häufiger Klappenfehler und führt oft erst in fortgeschrittenen Stadien zu Symptomen. Die Prognose von betroffenen Patienten ist
eingeschränkt und die perioperative Letalität bei konventioneller Chirurgie der isolierten TI hoch, sodass kathetergestützte Verfahren einen enormen technischen Fortschritt in den letzten
Jahren gemacht haben. Zudem hat die anatomische und auch klinische Patientenauswahl an Bedeutung gewonnen, da sowohl in der klinischen Präsentation als auch in der individuellen Anatomie der
Trikuspidalklappe eine große Variabilität herrscht. Klinisch ist bzw. sind insbesondere das Vorhandensein einer (präkapillären) pulmonalen Hypertonie oder fortgeschrittene Stadien des
Rechtsherz-Remodelings mit einer reduzierten Prognose nach kathetergestützten Eingriffen assoziiert. Zudem sind relevante Komorbiditäten und funktionelle Fitness/Gebrechlichkeit zu
evaluieren. Echokardiografisch ist die funktionelle TI durch eine Anulus- und/oder rechtsventrikuläre bzw. rechtsatriale Dilatation gekennzeichnet, welche zu Koaptationsdefekten der
Trikuspidalklappensegel und einer Zügelung der Segel („Tethering“) führen können. Die Ausprägung dieser Parameter sowie die Anulusgröße, der Schweregrad der TI und das Vorhandensein von
transvalvulären Sonden im Bezug zur Trikuspidalklappe sind die wichtigsten echokardiografischen Parameter, die in die Patientenauswahl einfließen müssen.
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Affiliation(s)
- Maria Isabel Körber
- Herzzentrum der Universität Köln, Klinik III für Innere Medizin, Köln, Deutschland
| | - Volker Rudolph
- Department of General and Interventional Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Deutschland
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Freixa X, Arzamendi D, Del Trigo M, Cepas-Guillén PL, Li P, Sanchis L, Barreiro M, Regueiro A, Baz JA, Asmarats L, Calvo F, Moñivas V, Meduiña I, Goicolea J, Sitges M, Estévez-Loureiro R. The TriClip system for edge-to-edge transcatheter tricuspid valve repair. A Spanish multicenter study. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:797-804. [PMID: 35288060 DOI: 10.1016/j.rec.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/28/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES In patients with tricuspid regurgitation (TR), edge-to-edge transcatheter tricuspid valve repair (TTVR) is the strategy with the highest penetration worldwide. A dedicated edge-to-edge TTVR system has recently become available in Europe. The present study describes the initial experience with the system in Spain. METHODS This multicenter study collected individual data from the centers accepted for the use of the novel system within an initial limited release. Between June 2020 and March 2021, all patients undergoing an edge-to-edge TTVR using the TriClip system in Spain were included in the study. The primary endpoint was the achievement of a TR reduction of at least 1 grade at discharge. RESULTS We included 34 patients. Most of them reported a previous history of atrial fibrillation (91%) and only 1 had a pacemaker lead. The primary endpoint (TR reduction of at least 1 grade at discharge) was met in all patients. Most of the patients required 1 (47%) or 2 clips (44%) with a clear predominance of XT (87%) over NT (13%). The location of the first clip was anteroseptal in >90% of the patients. Only 1 patient had a partial detachment, which was stabilized with additional clips in the same procedure. At discharge, TR severity was≤2 in 91% of patients. At 3 months, mortality was nil. Overall, 88% of patients were in New York Heart Association functional class≤2 and 80% had residual TR≤2. CONCLUSIONS Edge-to-edge TTVR seemed to be effective and safe with a sustained TR reduction at 3 months. Further studies will be needed to confirm our findings.
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Affiliation(s)
- Xavier Freixa
- Departamento de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Dabit Arzamendi
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María Del Trigo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Pedro Luis Cepas-Guillén
- Departamento de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pedro Li
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Sanchis
- Departamento de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Manuel Barreiro
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Ander Regueiro
- Departamento de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José Antonio Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Lluis Asmarats
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Fran Calvo
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Vanessa Moñivas
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Irene Meduiña
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Javier Goicolea
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Marta Sitges
- Departamento de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Ben Ali W, Ruf T, Perrin N, Bouhout I, Fam N, Kresoja KP, Lurz P, von Bardeleben RS, Modine T, Ibrahim R. Indications, Limitations, and Development of Tricuspid Valve Interventions in Adults. Can J Cardiol 2022; 38:S66-S78. [PMID: 34464691 DOI: 10.1016/j.cjca.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/19/2021] [Accepted: 08/03/2021] [Indexed: 12/30/2022] Open
Abstract
Tricuspid regurgitation is associated with excessive mortality and poor outcomes regardless of the cause and associated comorbidities. Despite this clear association with mortality, tricuspid valve diseases remain undertreated. Tricuspid valve surgery, either repair or replacement, has shown little detectable survival benefit. Transcatheter tricuspid valve interventions have emerged as a less invasive approach to tricuspid valve diseases. They can be categorised into coaptation devices, annuloplasty devices, transcatheter tricuspid valve replacement, heterotopic caval valve implantation, and tricuspid valve-in-valve. Despite the late referral and the patient's profile, results remain fairly acceptable at least in the short term, with good procedural device success, excellent safety profile, and sustained reduction of tricuspid regurgitation for up to 1 year. Because results are limited to the mid-term, transcatheter tricuspid valve intervention durability will need to be established before broader adoption of these technologies.
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Affiliation(s)
- Walid Ben Ali
- Structural Heart Program and Interventional Cardiology, Université de Montréal, Montréal Heart Institute, Montréal, Québec, Canada; Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France.
| | - Tobias Ruf
- Heart Valve Center Mainz, Universitätsmedizin, Mainz, Germany
| | - Nils Perrin
- Structural Heart Program and Interventional Cardiology, Université de Montréal, Montréal Heart Institute, Montréal, Québec, Canada; Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Ismail Bouhout
- Structural Heart Program and Interventional Cardiology, Université de Montréal, Montréal Heart Institute, Montréal, Québec, Canada
| | - Neil Fam
- Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Philipp Lurz
- Heart Center Leipzig-University Hospital, Leipzig, Germany
| | | | - Thomas Modine
- Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France
| | - Reda Ibrahim
- Structural Heart Program and Interventional Cardiology, Université de Montréal, Montréal Heart Institute, Montréal, Québec, Canada
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Sala A, Beneduce A, Maisano F. Transcatheter and surgical treatment of tricuspid regurgitation: Predicting right ventricular decompensation and favorable responders. Front Cardiovasc Med 2022; 9:980639. [PMID: 36237912 PMCID: PMC9551023 DOI: 10.3389/fcvm.2022.980639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/12/2022] [Indexed: 12/03/2022] Open
Abstract
Isolated tricuspid regurgitation (TR) has gained increasing recognition in recent years both in the surgical and in the cardiological community. Left untreated, isolated TR significantly worsens survival. Despite being a strong predictor of negative prognosis, interventions to correct TR are rarely performed due to increased surgical risk and late patient presentation. Recently, the ultimate focus has been on patient selection, surgical or transcatheter indication, and correct timing. Furthermore, of paramount importance is the identification of predictors of outcome following treatment, in order to discriminate between favorable and unfavorable responders and guide the decision-making process of the most adequate treatment for every patient.
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Affiliation(s)
- Alessandra Sala
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Beneduce
- Department of Cardiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Maisano
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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Carpenito M, Cammalleri V, Vitez L, De Filippis A, Nobile E, Bono MC, Mega S, Bunc M, Grigioni F, Ussia GP. Edge-to-Edge Repair for Tricuspid Valve Regurgitation. Preliminary Echo-Data and Clinical Implications from the Tricuspid Regurgitation IMAging (TRIMA) Study. J Clin Med 2022; 11:jcm11195609. [PMID: 36233476 PMCID: PMC9571515 DOI: 10.3390/jcm11195609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/05/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The natural history of tricuspid valve regurgitation (TR) is characterized by poor prognosis and high in-hospital mortality when treated with isolated surgery. We report the preliminary echocardiographic and procedural results of a prospective cohort of symptomatic patients with high to prohibitive surgical risk and at least severe TR who underwent transcatheter edge-to-edge repair through the TriClipTM system. Methods: From June 2020 to March 2022, 27 consecutive patients were screened, and 13 underwent transcatheter TriClipTM repair. In-hospital, 30-day and six-month clinical and echocardiographic outcomes were collected. Results: Nine patients had severe, three massive and one baseline torrential TR. Sustained TR reduction of ≥1 grade was achieved in all patients, of which 90% reached a moderate TR or less. On transthoracic echocardiographic examination, there were significant reductions in vena contracta width (p < 0.001), effective regurgitant orifice area (p < 0.001) and regurgitant volume (p < 0.001) between baseline and hospital discharge. We also observed a significant reduction in tricuspid annulus diameter (p < 0.001), right ventricular basal diameter (p = 0.001) and right atrial area (p = 0.026). Conclusion: Treatment with the edge-to-edge TriClip device is safe and effective. The resulting echocardiographic improvements indicate tricuspid valve leaflet approximation does not just significantly reduce the grade of TR but also affects adjacent structures and improves right ventricular afterload adaptation.
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Affiliation(s)
- Myriam Carpenito
- Operative Research Unit of Cardiovascular Science, Fondazione Policlinico, Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Valeria Cammalleri
- Operative Research Unit of Cardiovascular Science, Fondazione Policlinico, Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Luka Vitez
- Department of Cardiology, University Medical Center Ljubljana, 1000 Lubljana, Slovenia
| | - Aurelio De Filippis
- Research Unit of Cardiovascular Science, Department Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Edoardo Nobile
- Research Unit of Cardiovascular Science, Department Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Maria Caterina Bono
- Operative Research Unit of Cardiovascular Science, Fondazione Policlinico, Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Simona Mega
- Operative Research Unit of Cardiovascular Science, Fondazione Policlinico, Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Matjaz Bunc
- Department of Cardiology, University Medical Center Ljubljana, 1000 Lubljana, Slovenia
| | - Francesco Grigioni
- Operative Research Unit of Cardiovascular Science, Fondazione Policlinico, Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Science, Department Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Gian Paolo Ussia
- Operative Research Unit of Cardiovascular Science, Fondazione Policlinico, Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Science, Department Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
- Correspondence: ; Tel.: +39-06225411612
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Alperi A, Almendárez M, Álvarez R, Moris C, Leon V, Silva I, Hernández-Vaquero D, Pascual I, Avanzas P. Transcatheter tricuspid valve interventions: Current status and future perspectives. Front Cardiovasc Med 2022; 9:994502. [PMID: 36187002 PMCID: PMC9518720 DOI: 10.3389/fcvm.2022.994502] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
The development of transcatheter therapies to treat valvular heart diseases has changed the rules of the game, particularly in the case of aortic stenosis and mitral regurgitation. In the last years, the tricuspid valve has also been the focus of these percutaneous techniques for several reasons: (1) tricuspid regurgitation is a frequent disease associated with poor clinical outcomes in spite of medical treatment, leading to end-stage right ventricular heart failure, (2) surgical tricuspid valve repair or replacement has been the treatment of choice for patients with tricuspid valve disease, but high mortality rates for isolated surgical tricuspid valve intervention have been reported in the literature, and (3) most patients with tricuspid pathology are ultimately denied cardiac surgery because of their comorbidity burden. Thus, in this context the development of less invasive catheter-based therapies would be of high clinical relevance. The present review provides an overview regarding the framework of chronic tricuspid regurgitation transcatheter therapeutic options, summarizes the transcatheter systems under clinical use or clinical evaluation with their technical features, and describes the updated current evidence in this challenging and evolving field.
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Affiliation(s)
- Alberto Alperi
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Marcel Almendárez
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Rut Álvarez
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Cesar Moris
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Victor Leon
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Iria Silva
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Daniel Hernández-Vaquero
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
- Isaac Pascual
| | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
- *Correspondence: Pablo Avanzas ;
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63
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Krikken JA, van den Heuvel AFM, Willemsen HM, Voors AA, Lipsic E. Transcatheter edge-to-edge repair of tricuspid regurgitation in the Netherlands: state of the art and future perspectives. Neth Heart J 2022; 30:393-399. [PMID: 35352275 PMCID: PMC9402843 DOI: 10.1007/s12471-022-01673-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/28/2022] Open
Abstract
Despite the high prevalence and adverse clinical outcomes of severe tricuspid regurgitation (TR), conventional treatment options, surgical or pharmacological, are limited. Surgery is associated with a high peri-operative risk and medical treatment has not clearly resulted in clinical improvements. Therefore, there is a high unmet need to reduce morbidity and mortality in patients with severe TR. During recent years, several transcatheter solutions have been studied. This review focuses on the transcatheter edge-to-edge repair of TR (TTVR) with respect to patient selection, the procedure, pre- and peri-procedural echocardiographic assessments and clinical outcomes. Furthermore, we highlight the current status of TTVR in the Netherlands and provide data from our initial experience at the University Medical Centre Groningen.
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Affiliation(s)
- Jan A Krikken
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - Ad F M van den Heuvel
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - H Marco Willemsen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik Lipsic
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Schlotter F, Dietz MF, Stolz L, Kresoja KP, Besler C, Sannino A, Rommel KP, Unterhuber M, von Roeder M, Delgado V, Thiele H, Hausleiter J, Bax JJ, Lurz P. Atrial Functional Tricuspid Regurgitation: Novel Definition and Impact on Prognosis. Circ Cardiovasc Interv 2022; 15:e011958. [PMID: 36126130 DOI: 10.1161/circinterventions.122.011958] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial functional tricuspid regurgitation (atrial TR) has received growing recognition as a TR entity with a distinct cause owing to its independence from valvular tethering as the predominant mechanism underlying TR. However, characterization of atrial TR varies, and a universal definition is lacking. METHODS In total, 651 patients with significant functional TR were analyzed, including 438 conservatively treated individuals and 213 patients who received transcatheter tricuspid valve repair (TTVR). Based on a clustering approach, we defined atrial TR as tricuspid valve (TV) tenting height ≤10 mm, midventricular right ventricular diameter ≤38 mm, and left ventricular ejection fraction ≥50%. RESULTS Patients with atrial TR were more often females, had higher right ventricular fractional area change, higher left ventricular ejection fraction, and lower LV end-diastolic diameter, TV tenting area and height, lower right ventricular and tricuspid annular size, enlarged, but lower right atrial area and lower TV effective regurgitant orifice area (all P<0.05). Patients with atrial TR had significantly better long-term survival than non-atrial TR in the conservatively treated TR cohort (P<0.01, n=438). Atrial TR was independently associated with a lower rate of the combined end point of mortality and heart failure hospitalization at 1-year follow-up in the TTVR cohort (hazard ratio, 0.39; P<0.05, n=213). TR degree was significantly reduced after TTVR in non-atrial and atrial TR (P<0.01). Functional parameters significantly improved following TTVR independent of TR cause (P<0.05). CONCLUSIONS An echocardiography-based atrial TR definition is associated with prognostic relevance in patients with functional TR in conservatively treated TR and after TTVR.
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Affiliation(s)
- Florian Schlotter
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Germany (F.S., K.-P.K., C.B., K.-P.R., M.U., M.v.R., H.T., P.L.)
| | - Marlieke F Dietz
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, the Netherlands (M.F.D., V.D., J.J.B.)
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany (L.S., J.H.)
| | - Karl-Patrik Kresoja
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Germany (F.S., K.-P.K., C.B., K.-P.R., M.U., M.v.R., H.T., P.L.)
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Germany (F.S., K.-P.K., C.B., K.-P.R., M.U., M.v.R., H.T., P.L.)
| | - Anna Sannino
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (A.S.).,Department of Cardiovascular Research, Baylor Scott & White Research Institute, Plano, TX (A.S.)
| | - Karl-Philipp Rommel
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Germany (F.S., K.-P.K., C.B., K.-P.R., M.U., M.v.R., H.T., P.L.)
| | - Matthias Unterhuber
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Germany (F.S., K.-P.K., C.B., K.-P.R., M.U., M.v.R., H.T., P.L.)
| | - Maximilian von Roeder
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Germany (F.S., K.-P.K., C.B., K.-P.R., M.U., M.v.R., H.T., P.L.)
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, the Netherlands (M.F.D., V.D., J.J.B.)
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Germany (F.S., K.-P.K., C.B., K.-P.R., M.U., M.v.R., H.T., P.L.)
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany (L.S., J.H.).,Munich Heart Alliance, Partner site German Centre for Cardiovascular Research (DZHK), Berlin, Germany (J.H.)
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, the Netherlands (M.F.D., V.D., J.J.B.)
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Germany (F.S., K.-P.K., C.B., K.-P.R., M.U., M.v.R., H.T., P.L.)
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Zaid S, Denti P, Tang GHL, Nazif TN, Bapat VN, Kaneko T, Modine T. Impact of Tricuspid Regurgitation on Outcomes of Mitral Valve Surgery after Transcatheter Edge-to-Edge Repair. Semin Thorac Cardiovasc Surg 2022; 36:11-25. [PMID: 35931346 DOI: 10.1053/j.semtcvs.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 11/11/2022]
Abstract
Tricuspid regurgitation (TR) severity after mitral transcatheter edge-to-edge repair (TEER) has been shown to impact outcomes but unknown in patients requiring mitral valve (MV) surgery after TEER. We sought to determine the impact of preoperative TR severity and right ventricular (RV) dysfunction on MV surgery after TEER. From 7/2009 to 7/2020, 260/332 patients in the CUTTING-EDGE registry who underwent MV surgery after TEER had paired echocardiographic evaluation on TR severity, and ≥moderate (2+) vs <2+ TR at the time of index TEER were compared. Median follow-up post-MV surgery was 9.1 months, 96.5% complete at 30 days and 81.9% complete at 1 year. Mean age was 73.8 ± 10.3; with primary/mixed and secondary MR present in 65.6% and 32.0%, respectively. Proportion of ≥2+ TR increased from TEER to MV surgery (40% vs 57%, P < 0.001). Compared to <2+ TR group, ≥2+ pre-TEER TR patients were older, had higher STS risk score at TEER, higher RVSP, more RV dysfunction, more MR post-TEER, and a shorter median interval from TEER to MV surgery (1.9 vs 4.9 months, P = 0.023). Mortality was higher in the ≥2+ pre-TEER TR group at 30 days(24.2% vs 13.8%, P = 0.043) and 1 year (45.3% vs 22.3%, P = 0.003). On Kaplan-Meier analysis, cumulative mortality was 23.8% at 1 year and 31.6% at 3 years after MV surgery overall, and was associated with preoperative RV dysfunction (P = 0.023), ≥2+ TR at pre-TEER (P = 0.001) and presurgery (P = 0.004), but not concomitant tricuspid surgery. Moderate or greater pre-TEER TR was associated with worse outcomes, and pre-TEER TR worsened significantly at MV surgery. Concomitant tricuspid surgery did not increase overall mortality.
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Affiliation(s)
- Syed Zaid
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | | | - Tamim N Nazif
- Columbia University Irving Medical Center, New York, New York. https://twitter.com/https://twitter.com/tnazifMD
| | - Vinayak N Bapat
- Abbott Northwestern Hospital, Minneapolis, Minnesota. https://twitter.com/https://twitter.com/bapat_savrtavr
| | - Tsuyoshi Kaneko
- Brigham & Women's Hospital, Boston, Massachusetts. https://twitter.com/https://twitter.com/TsuyoshiKaneko1
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Sannino A, Ilardi F, Hahn RT, Lancellotti P, Lurz P, Smith RL, Esposito G, Grayburn PA. Clinical and Echocardiographic Outcomes of Transcatheter Tricuspid Valve Interventions: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:919395. [PMID: 35898276 PMCID: PMC9309386 DOI: 10.3389/fcvm.2022.919395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Medically managed tricuspid regurgitation (TR) has detrimental outcomes. Transcatheter tricuspid valve interventions (TTVIs) represent an alternative to surgery in high-risk patients; however, only early experiences exist. Aim The aim of this study was to analyze the clinical and echocardiographic outcomes of TTVI. Methods MEDLINE, ISI Web of Science, and SCOPUS databases were searched for studies published up to June 2021. Studies reporting data on outcome post-TTVIs were included. This study was designed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) requirements. The primary endpoint was all-cause mortality at 30-day and 1-year post-TTVI. Results Out of 2,718 studies, 27 were included. Notably, 30-day and 1-year all-cause mortalities were 5% (95% confidence interval [CI]: 4-8%, p < 0.001) and 25% (95% CI: 12-45%, p = 0.016). Procedural success was associated with a 58% risk reduction in 1-year mortality vs. lack thereof (odds ratio 0.42, 95% CI: 0.27-0.66, p < 0.001). TTVI is associated with a significant reduction in TR severity (TR EROA, mean difference [MD] 0.31 cm2; 95% CI: 0.23-0.39 cm2, p < 0.001; regurgitant volume, MD 23.54 ml; 95% CI: 17.4-29.68 ml, p = 0.03) and increase in forward stroke volume (FSV, MD 3.98 ml; 95% CI: 0.11-7.86 ml, p = 0.04). Conclusion TTVI significantly reduces TR severity and increases FSV and is associated with improved survival at 1 year compared with patients without procedural success. Long-term outcomes compared with medical therapy await the results of ongoing pivotal trials; nonetheless, TTVIs appear to be a promising alternative to surgery for TR.
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Affiliation(s)
- Anna Sannino
- The Heart Hospital Baylor Plano, Plano, TX, United States
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Rebecca T. Hahn
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY, United States
| | - Patrizio Lancellotti
- Department of Cardiology and Radiology, GIGA Cardiovascular Sciences, CHU SartTilman, University of Liège Hospital, Liège, Belgium
- Gruppo Villa Maria Care and Research, Lugo, Italy
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
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Kresoja K, Rahgozar K, Kitamura M, Goldberg Y, Latib A, Lurz P. Transcatheter Tricuspid Valve Repair and Replacement. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Tanaka T, Sugiura A, Kavsur R, Vogelhuber J, Öztürk C, Becher MU, Zimmer S, Nickenig G, Weber M. Leaflet-to-annulus index and residual tricuspid regurgitation following tricuspid transcatheter edge-to-edge repair. EUROINTERVENTION 2022; 18:e169-e178. [PMID: 35193837 PMCID: PMC9904375 DOI: 10.4244/eij-d-21-00862] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND A mismatch between tricuspid leaflet size and annular dilation is one of the morphological features tied to the development of tricuspid regurgitation (TR). AIMS We assessed the association of the leaflet-to-annulus index (LAI) with residual TR after transcatheter edge-to-edge repair (TEER). METHODS Consecutive patients who underwent TEER for TR were enrolled. Significant residual TR was defined as a post-procedural TR ≥3+, and patients were divided into two groups according to the amount of residual TR. The LAI was retrospectively calculated using procedural transoesophageal echocardiography and was defined as follows: (anterior leaflet length+septal leaflet length)/septolateral tricuspid annulus diameter. RESULTS Of 140 patients, 43 patients had residual TR ≥3+ after TEER. The patients with residual TR ≥3+ had a lower LAI compared to those with residual TR <3+ (1.04±0.10 vs 1.13±0.09; p=0.001). In multivariable analysis, the LAI was associated with residual TR ≥3+ (odds ratio [OR] [per 0.1 increase]: 0.57; 95% confidence interval [95% CI]: 0.35-0.94; p=0.02), independent of baseline TR severity or coaptation gap size. Patients with residual TR ≥3+ had a higher incidence of the composite outcome, consisting of all-cause mortality and heart failure hospitalisation within one year after TEER (47.1% vs 26.6%, p=0.02). Residual TR ≥3+ was an independent predictor of the composite outcome within one year (hazard ratio: 2.04; 95% CI: 1.01-4.11; p=0.04). CONCLUSIONS The leaflet-to-annulus mismatch (i.e., LAI) is associated with residual TR ≥3+ after TEER for TR. A detailed echocardiographic analysis of the tricuspid valve will be conducive to identifing suitable subjects for TEER.
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Affiliation(s)
- Tetsu Tanaka
- Medzinische Klinik und Poliklinik Ⅱ, Universitätsklinikum Bonn, Bonn, Germany
| | - Atsushi Sugiura
- Herzzentrum Bonn, Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Refik Kavsur
- Medzinische Klinik und Poliklinik Ⅱ, Universitätsklinikum Bonn, Bonn, Germany
| | - Johanna Vogelhuber
- Medzinische Klinik und Poliklinik Ⅱ, Universitätsklinikum Bonn, Bonn, Germany
| | - Can Öztürk
- Medzinische Klinik und Poliklinik Ⅱ, Universitätsklinikum Bonn, Bonn, Germany
| | - Marc Ulrich Becher
- Medzinische Klinik und Poliklinik Ⅱ, Universitätsklinikum Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Medzinische Klinik und Poliklinik Ⅱ, Universitätsklinikum Bonn, Bonn, Germany
| | - Georg Nickenig
- Medzinische Klinik und Poliklinik Ⅱ, Universitätsklinikum Bonn, Bonn, Germany
| | - Marcel Weber
- Medzinische Klinik und Poliklinik Ⅱ, Universitätsklinikum Bonn, Bonn, Germany
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Dannenberg V, Koschutnik M, Donà C, Nitsche C, Mascherbauer K, Heitzinger G, Halavina K, Kammerlander AA, Spinka G, Winter MP, Andreas M, Mach M, Schneider M, Bartunek A, Bartko PE, Hengstenberg C, Mascherbauer J, Goliasch G. Invasive Hemodynamic Assessment and Procedural Success of Transcatheter Tricuspid Valve Repair-Important Factors for Right Ventricular Remodeling and Outcome. Front Cardiovasc Med 2022; 9:891468. [PMID: 35722132 PMCID: PMC9200997 DOI: 10.3389/fcvm.2022.891468] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/28/2022] [Indexed: 12/21/2022] Open
Abstract
Introduction Severe tricuspid regurgitation (TR) is a common condition promoting right heart failure and is associated with a poor long-term prognosis. Transcatheter tricuspid valve repair (TTVR) emerged as a low-risk alternative to surgical repair techniques. However, patient selection remains controversial, particularly regarding the benefits of TTVR in patients with pulmonary hypertension (PH). Aim We aimed to investigate the impact of preprocedural invasive hemodynamic assessment and procedural success on right ventricular (RV) remodeling and outcome. Methods All patients undergoing TTVR with a TR reduction of ≥1 grade without precapillary or combined PH [mean pulmonary artery pressure (mPAP) ≥25 mmHg, mean pulmonary artery Wedge pressure ≤ 15 mmHg, pulmonary vascular resistance ≥3 Wood units] were assigned to the responder group. All patients with a TR reduction of ≥1 grade and precapillary or combined PH were classified as non-responders. Patients with a TR reduction ≥2 grade were directly classified as responders, and patients without TR reduction were directly assigned as non-responders. Results A total of 107 patients were enrolled, 75 were classified as responders and 32 as non-responders. We observed evidence of significant RV reverse remodeling in responders with a decrease in RV diameters (-2.9 mm, p = 0.001) at a mean follow-up of 229 days (±219 SD) after TTVR. RV function improved in responders [fractional area change (FAC) + 5.7%, p < 0.001, RV free wall strain +3.9%, p = 0.006], but interestingly further deteriorated in non-responders (FAC -4.5%, p = 0.003, RV free wall strain -3.9%, p = 0.007). Non-responders had more persistent symptoms than responders (NYHA ≥3, 72% vs. 11% at follow-up). Subsequently, non-response was associated with a poor long-term prognosis in terms of death, heart failure (HF) hospitalization, and re-intervention after 2 years (freedom of death, HF hospitalization, and reintervention at 2 years: 16% vs. 78%, log-rank: p < 0.001). Conclusion Hemodynamic assessment before TTVR and procedural success are significant factors for patient prognosis. The hemodynamic profiling prior to intervention is an essential component in patient selection for TTVR. The window for edge-to-edge TTVR might be limited, but timely intervention is an important factor for a better outcome and successful right ventricular reverse remodeling.
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Affiliation(s)
- Varius Dannenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Matthias Koschutnik
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Carolina Donà
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christian Nitsche
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Katharina Mascherbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Gregor Heitzinger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Kseniya Halavina
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Andreas A. Kammerlander
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Georg Spinka
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Max-Paul Winter
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Markus Mach
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Matthias Schneider
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin (Campus Virchow-Klinikum), Berlin, Germany
- Department of Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Anna Bartunek
- Department of Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Philipp E. Bartko
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Julia Mascherbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Georg Goliasch
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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Nisar H, Fakim D, Bainbridge D, Chen ECS, Peters T. 3D localization of vena contracta using Doppler ICE imaging in tricuspid valve interventions. Int J Comput Assist Radiol Surg 2022; 17:1569-1577. [PMID: 35588338 PMCID: PMC9463221 DOI: 10.1007/s11548-022-02660-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/25/2022] [Indexed: 11/27/2022]
Abstract
Purpose Tricuspid valve (TV) interventions face the challenge of imaging the anatomy and tools because of the ‘TEE-unfriendly’ nature of the TV. In edge-to-edge TV repair, a core step is to position the clip perpendicular to the coaptation gap. In this study, we provide a semi-automated method to localize the VC from Doppler intracardiac echo (ICE) imaging in a tracked 3D space, thus providing a pre-mapped location of the coaptation gap to assist device positioning. Methods A magnetically tracked ICE probe with Doppler imaging capabilities is employed in this study for imaging three patient-specific TVs placed in a pulsatile heart phantom. For each of the valves, the ICE probe is positioned to image the maximum regurgitant flow for five cardiac cycles. An algorithm then extracts the regurgitation imaging and computes the exact location of the vena contracta on the image. Results Across the three pathological, patient-specific valves, the average distance error between the detected VC and the ground truth model is \documentclass[12pt]{minimal}
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\begin{document}$$({1.22 \pm 2.00})$$\end{document}(1.22±2.00)mm. For each of the valves, one case represented the outlier where the algorithm misidentified the vena contracta to be near the annulus. In such cases, it is recommended to retake the five-second imaging data. Conclusion This study presented a method for ultrasound-based localization of vena contracta in 3D space. Mapping such anatomical landmarks has the potential to assist with device positioning and to simplify tricuspid valve interventions by providing more contextual information to the interventionalists, thus enhancing their spatial awareness. Additionally, ICE can be used to provide live US and Doppler imaging of the complex TV anatomy throughout the procedure.
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Affiliation(s)
- Hareem Nisar
- Robarts Research Institute, 1151 Richmond St., London, ON, N6A5B7, Canada. .,School of Biomedical Engineering, Western University, 1151 Richmond St, London, ON, N6A3K7, Canada.
| | - Djalal Fakim
- Schulic School of Medicine and Dentistry, Western University, 1151 Richmond St., London, ON, N6A3K7, Canada
| | - Daniel Bainbridge
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, 339 Windermere Rd., London, ON, N6A5A5, Canada
| | - Elvis C S Chen
- Robarts Research Institute, 1151 Richmond St., London, ON, N6A5B7, Canada.,School of Biomedical Engineering, Western University, 1151 Richmond St, London, ON, N6A3K7, Canada.,Schulic School of Medicine and Dentistry, Western University, 1151 Richmond St., London, ON, N6A3K7, Canada.,Department of Medical Biophysics, Western University, 1151 Richmond St., London, ON, N6A3K7, Canada
| | - Terry Peters
- Robarts Research Institute, 1151 Richmond St., London, ON, N6A5B7, Canada.,School of Biomedical Engineering, Western University, 1151 Richmond St, London, ON, N6A3K7, Canada.,Schulic School of Medicine and Dentistry, Western University, 1151 Richmond St., London, ON, N6A3K7, Canada.,Department of Medical Biophysics, Western University, 1151 Richmond St., London, ON, N6A3K7, Canada
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71
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Wild MG, Weckbach L, Braun D, Massberg S, Stolz L, Näbauer M, Hausleiter J. Mind the Gap: Facilitating Tricuspid Transcatheter Edge-to-Edge Repair Procedures by Standardized Table Tilt. JACC Cardiovasc Interv 2022; 15:1004-1006. [PMID: 35512913 DOI: 10.1016/j.jcin.2022.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
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72
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Muraru D. 22nd Annual Feigenbaum Lecture Right Heart, Right Now: The Role of Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2022; 35:893-909. [DOI: 10.1016/j.echo.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/15/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
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73
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Freixa X, Arzamendi D, del Trigo M, Cepas-Guillén PL, Li P, Sanchis L, Barreiro M, Regueiro A, Baz JA, Asmarats L, Calvo F, Moñivas V, Meduiña I, Goicolea J, Sitges M, Estévez-Loureiro R. El sistema TriClip para la reparación transcatéter de la válvula tricúspide. Estudio multicéntrico español. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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74
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Gill H, Adams HSL, Chehab O, Allen C, Hancock J, Lamata P, Lucchese G, Prendergast B, Redwood S, Patterson T, Rajani R. Anatomy of a Transcatheter Mitral Valve Service. Front Cardiovasc Med 2022; 9:862471. [PMID: 35497993 PMCID: PMC9051038 DOI: 10.3389/fcvm.2022.862471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Transcatheter mitral therapies offer treatment options to selected patients who are unable to undergo open procedures due to prohibitive surgical risk. Data detailing the design and structure of transcatheter mitral services to ensure appropriate patient selection and tailored management strategies is lacking. We report our initial experience of developing and running a purpose-built transcatheter mitral service. The nature and number of referral sources, the multi-disciplinary make-up of the dedicated Mitral Heart Team and the use of integrative imaging assessment with incorporation of computational solutions are discussed. In addition, a summary of the clinical decision-making process is presented. This report sets out a framework from which future clinics can evolve to improve and streamline the delivery of transcatheter mitral therapies.
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Affiliation(s)
- Harminder Gill
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences Engineering, King's College London, London, United Kingdom
| | - Heath S. L. Adams
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Omar Chehab
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Christopher Allen
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Jane Hancock
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Pablo Lamata
- School of Biomedical Engineering and Imaging Sciences Engineering, King's College London, London, United Kingdom
| | - Gianluca Lucchese
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Bernard Prendergast
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Simon Redwood
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Tiffany Patterson
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Ronak Rajani
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences Engineering, King's College London, London, United Kingdom
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75
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Brunner S, Wolfrum M, Moccetti F, Stämpfli SF, Attinger-Toller A, Bossard M, Matt P, Cuculi F, Kobza R, Toggweiler S. The relevance of tricuspid regurgitation in patients undergoing percutaneous treatment of mitral regurgitation. Catheter Cardiovasc Interv 2022; 99:1848-1856. [PMID: 35114065 DOI: 10.1002/ccd.30114] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/22/2021] [Accepted: 01/13/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Investigate the impact of concomitant tricuspid regurgitation (TR) on clinical outcomes during long-term follow-up in patients undergoing percutaneous treatment of mitral regurgitation (MR) with the MitraClip system. BACKGROUND Patients undergoing mitral repair using the MitraClip frequently present with concomitant TR. It is uncertain how the presence of TR impacts the long-term outcomes of such patients. METHODS We analyzed consecutive patients with MitraClip implantation from the prospective MitraSwiss registry. Endpoints were all-cause mortality, hospitalization for heart failure, and the composite endpoint of the two. RESULTS We enrolled 177 patients (mean age 76 ± 9 years, 37% female). Acute procedural success was achieved in 149 (84%). Concomitant moderate or severe TR was present in 31% at baseline and 32% before discharge. After a median follow-up of 1103 days (IQR: 555-1766 days), 70 (40%) of patients had died, and 34 (19%) were hospitalized for heart failure. In multivariable analysis, TR at baseline was associated with an increase in all-cause mortality (HR: 2.34, 95% CI: 1.36-4.03, p < 0.01), hospitalization for heart failure (HR: 3.19, 95% CI: 1.37-7.41, p = 0.01), and the composite endpoint (HR: 2.00, 95% CI: 1.19-3.36, p = 0.01). CONCLUSION Despite treatment of MR, TR did not improve in most patients. The presence of relevant TR at baseline was associated with reduced survival and higher rates of hospitalization for heart failure. More research is needed to understand the causal role of TR in such patients and to investigate if simultaneous treatment of concomitant TR may improve prognosis in patients undergoing percutaneous treatment of MR.
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Affiliation(s)
- Stephanie Brunner
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mathias Wolfrum
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Federico Moccetti
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Simon F Stämpfli
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Adrian Attinger-Toller
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matthias Bossard
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Peter Matt
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Florim Cuculi
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Stefan Toggweiler
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
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76
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Sala A, Lorusso R, Alfieri O. Isolated tricuspid regurgitation: A plea for early correction. Int J Cardiol 2022; 353:80-85. [DOI: 10.1016/j.ijcard.2022.01.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
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77
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Lawlor MK, Hamid N, Kampaktsis P, Ning Y, Wang V, Akkoc D, Dershowitz L, Placheril E, Vahl TP, Nazif T, Khalique O, Ng V, Brener MI, Burkhoff D, Dickstein M, Kurlansky P, Leon MB, Hahn RT, Kodali S, George I. Incidence and predictors of cardiogenic shock following surgical or transcatheter tricuspid valve intervention. Catheter Cardiovasc Interv 2022; 99:1668-1678. [DOI: 10.1002/ccd.30073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/26/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Matthew K. Lawlor
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Nadira Hamid
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
- Structural Heart & Valve Center, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Polydoros Kampaktsis
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Yuming Ning
- Divison of Cardiothoracic & Vascular Surgery, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Victoria Wang
- Divison of Cardiothoracic & Vascular Surgery, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Deniz Akkoc
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Lyle Dershowitz
- Vagelos College of Physicians and Surgeons Columbia University New York New York USA
| | - Elizabeth Placheril
- Divison of Cardiothoracic & Vascular Surgery, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Torsten P. Vahl
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
- Structural Heart & Valve Center, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Tamim Nazif
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
- Structural Heart & Valve Center, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Omar Khalique
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
- Structural Heart & Valve Center, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Vivian Ng
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
- Structural Heart & Valve Center, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Michael I. Brener
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | | | - Marc Dickstein
- Department of Anesthesiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Paul Kurlansky
- Columbia HeartSource, Center for Innovation and Outcomes Research Columbia University Irving Medical Center New York New York USA
| | - Martin B. Leon
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
- Structural Heart & Valve Center, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
- Cardiovascular Research Foundation New York New York USA
| | - Rebecca T. Hahn
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
- Structural Heart & Valve Center, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Susheel Kodali
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
- Structural Heart & Valve Center, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Isaac George
- Structural Heart & Valve Center, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
- Divison of Cardiothoracic & Vascular Surgery, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
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Florescu DR, Muraru D, Volpato V, Gavazzoni M, Caravita S, Tomaselli M, Ciampi P, Florescu C, Bălșeanu TA, Parati G, Badano LP. Atrial Functional Tricuspid Regurgitation as a Distinct Pathophysiological and Clinical Entity: No Idiopathic Tricuspid Regurgitation Anymore. J Clin Med 2022; 11:382. [PMID: 35054074 PMCID: PMC8781398 DOI: 10.3390/jcm11020382] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 02/06/2023] Open
Abstract
Functional tricuspid regurgitation (FTR) is a strong and independent predictor of patient morbidity and mortality if left untreated. The development of transcatheter procedures to either repair or replace the tricuspid valve (TV) has fueled the interest in the pathophysiology, severity assessment, and clinical consequences of FTR. FTR has been considered to be secondary to tricuspid annulus (TA) dilation and leaflet tethering, associated to right ventricular (RV) dilation and/or dysfunction (the "classical", ventricular form of FTR, V-FTR) for a long time. Atrial FTR (A-FTR) has recently emerged as a distinct pathophysiological entity. A-FTR typically occurs in patients with persistent/permanent atrial fibrillation, in whom an imbalance between the TA and leaflet areas results in leaflets malcoaptation, associated with the dilation and loss of the sphincter-like function of the TA, due to right atrium enlargement and dysfunction. According to its distinct pathophysiology, A-FTR poses different needs of clinical management, and the various interventional treatment options will likely have different outcomes than in V-FTR patients. This review aims to provide an insight into the anatomy of the TV, and the distinct pathophysiology of A-FTR, which are key concepts to understanding the objectives of therapy, the choice of transcatheter TV interventions, and to properly use pre-, intra-, and post-procedural imaging.
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Affiliation(s)
- Diana R. Florescu
- Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (D.R.F.); (C.F.); (T.A.B.)
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
| | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Valentina Volpato
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Mara Gavazzoni
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
| | - Sergio Caravita
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Management, Information and Production Engineering, University of Bergamo, 24044 Dalmine, Italy
| | - Michele Tomaselli
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Pellegrino Ciampi
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, 20123 Rome, Italy
| | - Cristina Florescu
- Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (D.R.F.); (C.F.); (T.A.B.)
| | - Tudor A. Bălșeanu
- Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (D.R.F.); (C.F.); (T.A.B.)
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Luigi P. Badano
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (D.M.); (V.V.); (M.G.); (S.C.); (M.T.); (P.C.); (G.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
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OUP accepted manuscript. Eur Heart J Cardiovasc Imaging 2022; 23:913-929. [DOI: 10.1093/ehjci/jeac009] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/05/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
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Vogelhuber J, Weber M, Nickenig G. Transcatheter Leaflet Strategies for Tricuspid Regurgitation TriClip and CLASP. Interv Cardiol Clin 2021; 11:51-66. [PMID: 34838297 DOI: 10.1016/j.iccl.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since the recognition of the impact of significant tricuspid regurgitation on the clinical course and mortality, intensive efforts have been made in identifying and developing individually suitable and catheter-based therapy strategies to offer those often older and multimorbid patients at high surgical risk safe, feasible, and efficacious treatment options with justifiable risk. Up to now, transcatheter edge-to-edge repair with leaflet approximation devices such as TriClip (Abbott, Santa Clara, CA, USA) and PASCAL Implant System (Edwards Lifesciences, Irvine, CA, USA) have been evaluated best and several clinical trials could prove safety, feasibility, and efficacy of said devices leading to their recent CE mark. However, further randomized controlled trial are pending and necessary to evaluate their impact on clinical course and outcome in comparison to established treatment recommendations.
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Affiliation(s)
- Johanna Vogelhuber
- Heart Centre, Department of Cardiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Marcel Weber
- Heart Centre, Department of Cardiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Georg Nickenig
- Heart Centre, Department of Cardiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
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81
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Bruoha S, Mangieri A, Ho EC, Goldberg Y, Chau M, Latib A. Transcatheter Annular Approaches for Tricuspid Regurgitation (Cardioband and Others). Interv Cardiol Clin 2021; 11:67-80. [PMID: 34838298 DOI: 10.1016/j.iccl.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The tricuspid valve often is referred to as "the forgotten valve" because it frequently is managed conservatively due to poor prognostic outcomes with conventional surgical intervention, in particular, in high-risk patients. Nevertheless, a paradigm shift has occurred in recent years, due to a growing evidence base supporting the independent prognostic influence of severe tricuspid regurgitation (TR) on patient outcomes. Both transcatheter valve replacement and valve repair have emerged as feasible and efficacious interventions for TR correction. Novel transcatheter repair techniques that replicate surgical annuloplasty are evolving as potentially lower-risk alternatives.
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Affiliation(s)
- Sharon Bruoha
- Department of Cardiology, Montefiore Medical Center, 1825 Eastchester Road, Bronx, NY 10461, USA
| | - Antonio Mangieri
- Department of Invasive Cardiology, Humanitas Clinical and Reasearch Center, IRCCS, Via Manzoni, 56, Rozzano, Milan 20089, Italy
| | - Edwin C Ho
- Department of Cardiology, Montefiore Medical Center, 1825 Eastchester Road, Bronx, NY 10461, USA
| | - Ythan Goldberg
- Department of Cardiology, Montefiore Medical Center, 1825 Eastchester Road, Bronx, NY 10461, USA
| | - Mei Chau
- Department of Cardiology, Montefiore Medical Center, 1825 Eastchester Road, Bronx, NY 10461, USA
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, 1825 Eastchester Road, Bronx, NY 10461, USA.
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82
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Greenbaum AB, Babaliaros VC, Eng MH. Orthotopic Transcatheter Tricuspid Valve Replacement. Interv Cardiol Clin 2021; 11:87-94. [PMID: 34838300 DOI: 10.1016/j.iccl.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Severe tricuspid regurgitation renders patients frail, and surgical treatment is associated with high mortality. Because most of the tricuspid regurgitation patients are functional and have significant annular dilation, large coaptation gaps are seen. This anatomy is best addressed with transcatheter tricuspid valve replacement (TTVR), and promising therapies are under clinical investigation. Most TTVR devices are in early clinical development with one transcatheter heart valve in pivotal trial; TTVR is expected to significantly affect tricuspid regurgitation and survival.
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Affiliation(s)
- Adam B Greenbaum
- Structural Heart and Valve Center, Department of Internal Medicine-Cardiology, Emory University, 550 Peachtree St Ne Medical, Office Tower, Fl 6, Atlanta, GA 30308, USA
| | - Vasilis C Babaliaros
- Structural Heart and Valve Center, Department of Internal Medicine-Cardiology, Emory University, 550 Peachtree St Ne Medical, Office Tower, Fl 6, Atlanta, GA 30308, USA
| | - Marvin H Eng
- Division of Cardiology, Structural Heart Program, Banner University Medical Center- Phoenix, University of Arizona, 1111 East McDowell Road, Phoenix, AZ 85006, USA.
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Mahowald MK, Nishimura RA, Pislaru SV, Mankad SV, Nkomo VT, Padang R, Thaden JJ, Alkhouli M, Guerrero M, Rihal CS, Eleid MF. Reduction in Right Atrial Pressures Is Associated With Hemodynamic Improvements After Transcatheter Edge-to-Edge Repair of the Tricuspid Valve. Circ Cardiovasc Interv 2021; 14:e010557. [PMID: 34814697 DOI: 10.1161/circinterventions.121.010557] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Investigational transcatheter edge-to-edge repair (TEER) for severe tricuspid regurgitation (TR) has shown promise as an alternative to surgery, but factors influencing outcomes, optimal patient selection, and procedural timing remain incompletely defined. Given the limitations of determining TR severity by conventional echocardiography, our objectives were to determine whether invasive right atrial (RA) pressures performed during the procedure are related to patient outcomes. METHODS This study was a retrospective review of patients who underwent off-label tricuspid TEER using MitraClip (Abbott Vascular, Menlo Park, CA) for significant TR at a single institution. Intraprocedural mean RA pressure, RA peak V-wave, RA pressure nadir, and systolic increase in RA pressure (XV height) were recorded. RESULTS Thirty-eight patients underwent tricuspid TEER; 33 underwent concomitant mitral TEER for mitral regurgitation. The study cohort was 39% female with a mean age of 78.6±14.3 years. Median follow-up was 339 days (interquartile range, 100-601). Any reduction in mean RA pressure, RA peak V-wave, RA nadir, and XV height occurred in 74%, 82%, 45%, and 87% of patients, respectively. At 1 year, event-free survival was 47%. Postprocedure XV height correlated with TR severity as determined by echocardiography (P<0.0001). The highest quartile of postprocedure XV height (>8 mm Hg) had worse event-free survival compared with those who had concluding XV height ≤8 mm Hg (P=0.02). Attainment of a concluding XV height less than or equal to median value was associated with a lower creatinine the next day (1.27±0.47 versus 1.64±0.47 mg/dL, P=0.04). CONCLUSIONS Intraprocedural XV height correlates with TR severity after tricuspid TEER, and lower concluding pressures are associated with improved outcomes. Analysis of RA pressures may serve as a complementary tool for the evaluation of disease severity and procedural guidance.
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Affiliation(s)
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Sunil V Mankad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Jeremy J Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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84
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Praz F, Muraru D, Kreidel F, Lurz P, Hahn RT, Delgado V, Senni M, von Bardeleben RS, Nickenig G, Hausleiter J, Mangieri A, Zamorano JL, Prendergast BD, Maisano F. Transcatheter treatment for tricuspid valve disease. EUROINTERVENTION 2021; 17:791-808. [PMID: 34796878 PMCID: PMC9724890 DOI: 10.4244/eij-d-21-00695] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/23/2022]
Abstract
Approximately 4% of subjects aged 75 years or more have clinically relevant tricuspid regurgitation (TR). Primary TR results from anatomical abnormality of the tricuspid valve apparatus and is observed in only 8-10% of the patients with tricuspid valve disease. Secondary TR is more common and arises as a result of annular dilation caused by right ventricular enlargement and dysfunction as a consequence of pulmonary hypertension, often caused by left-sided heart disease or atrial fibrillation. Irrespective of its aetiology, TR leads to volume overload and increased wall stress, both of which negatively contribute to detrimental remodelling and worsening TR. This vicious circle translates into impaired survival and increased heart failure symptoms in patients with and without reduced left ventricular ejection fraction. Interventions to correct TR are underutilised in daily clinical practice owing to increased surgical risk and late patient presentation. The recently introduced transcatheter tricuspid valve interventions aim to address this unmet need. Dedicated expertise and an interdisciplinary Heart Team evaluation are essential to integrate these new techniques successfully and select patients. The present article proposes a standardised approach to evaluate patients with TR who may be candidates for transcatheter interventions. In addition, a state-of-the-art review of the available transcatheter therapies, the main criteria for patient and device selection, and information concerning the remaining uncertainties are provided.
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Affiliation(s)
- Fabien Praz
- Bern University Hospital, University of Bern, Bern, Switzerland
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85
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Mesnier J, Alperi A, Panagides V, Bédard E, Salaun E, Philippon F, Rodés-Cabau J. Transcatheter tricuspid valve interventions: Current devices and associated evidence. Prog Cardiovasc Dis 2021; 69:89-100. [PMID: 34801577 DOI: 10.1016/j.pcad.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 11/14/2021] [Indexed: 11/15/2022]
Abstract
Tricuspid regurgitation (TR) is a common finding in patients with chronic cardiopathy, and often a marker of an advanced disease. Being silent or with symptoms intertwined with the primitive left heart disease, TR has often been neglected, leading to the late referral of patients with advanced right-heart failure. Hence, isolated tricuspid surgery has been associated with high morbidity and mortality rates, the worse of all valve interventions, and medical management has been limited to symptomatic treatment. In this context, percutaneous therapies for severe TR have gained traction, addressing the unmet therapeutic gap for a less invasive disease-modifying management. The aim of this review is to provide an updated overview on transcatheter tricuspid valve interventions, focusing on devices' characteristics, associated evidence, and future perspectives.
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Affiliation(s)
- Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Alberto Alperi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Vassili Panagides
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Elisabeth Bédard
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Erwan Salaun
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - François Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clínic Barcelona, Barcelona, Spain.
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86
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da Rocha E Silva JG, Ruf TF, Hell MM, Tamm A, Geyer M, Munzel T, von Bardeleben RS, Kreidel F. Transgastric imaging-The key to successful periprocedural TEE guiding for edge-to-edge repair of the tricuspid valve. Echocardiography 2021; 38:1948-1958. [PMID: 34729813 DOI: 10.1111/echo.15196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/11/2021] [Accepted: 08/22/2021] [Indexed: 11/28/2022] Open
Abstract
Intraprocedural transesophageal echocardiography (TEE) guidance plays an essential role in transcatheter repair therapy of the tricuspid valve (TV). So far, several different imaging concepts are in use. We propose an imaging protocol that fully addresses the morphological complexity of the TV and further offers efficacious workarounds for the frequently occurring restrictions of TV imaging in edge-to-edge repair of the TV. As a tertiary referral center with a large experience of more than 250 cases of transcatheter edge-to-edge repair (TEER) of the TV performed at the Heart Valve Center in Mainz/Germany, we have constantly adapted our peri-interventional echocardiographic approach to accomplish both. As a key measure for success, we intensely rely on the transgastric acoustic windows that not only deliver high-resolution information on the morphology of the TV and all relevant procedural steps but also help to avoid the frequent shadowing artifacts experienced in transesophageal imaging.
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Affiliation(s)
| | - Tobias F Ruf
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Michaela M Hell
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Alexander Tamm
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Martin Geyer
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Thomas Munzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | | | - Felix Kreidel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
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87
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Sugiura A, Tanaka T, Kavsur R, Öztürk C, Vogelhuber J, Wilde N, Becher MU, Zimmer S, Nickenig G, Weber M. Leaflet Configuration and Residual Tricuspid Regurgitation After Transcatheter Edge-to-Edge Tricuspid Repair. JACC Cardiovasc Interv 2021; 14:2260-2270. [PMID: 34424200 DOI: 10.1016/j.jcin.2021.07.048] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study aimed to assess the anatomical leaflet variation and investigate its impact on the procedural outcome in patients undergoing transcatheter edge-to-edge tricuspid repair. BACKGROUND Tricuspid regurgitation (TR) is associated with a poor prognosis. METHODS The study participants were consecutive patients who underwent transcatheter edge-to-edge tricuspid repair with the MitraClip, TriClip, or PASCAL systems from June 2015 to July 2020 at the Bonn Heart Center. The tricuspid leaflet morphologies were imaged using 2-dimensional and 3-dimensional transesophageal echocardiography. The severity of TR was assessed according to the 5-grade scheme. The primary endpoint was residual TR ≥3+ within 30 days. RESULTS Of the 145 study participants, 103 (71.1%) participants were categorized as the 3-leaflet configuration, while 42 (28.9%) were categorized as the 4-leaflet configuration. Successful device implantation was achieved in 136 (93.8%) patients, with no statistical difference between the 3-leaflet and 4-leaflet configuration groups. However, compared with patients with a 3-leaflet configuration, patients with 4-leaflet configuration more frequently had residual TR ≥3+ (18.4% vs 38.1%; P = 0.018). In the multivariable model, the 4-leaflet configuration was associated with an increased risk of residual TR ≥3+ (odds ratio: 2.65; 95% CI 1.15-6.10; P = 0.022), independent of baseline TR grade, coaptation gap width, and TR jet location. After 1-year follow-up, compared with patients with residual TR <3+, patients with residual TR ≥3+ had a significantly higher incidence of the composite of all-cause mortality or heart failure hospitalization (27.7% vs 56.1%; P = 0.016). CONCLUSIONS A 4-leaflet configuration of the tricuspid valve is observed in approximately one-third of patients undergoing transcatheter edge-to-edge tricuspid repair, which is associated with an increased risk of residual TR after the procedure.
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Affiliation(s)
- Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Tetsu Tanaka
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Refik Kavsur
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Johanna Vogelhuber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Nihal Wilde
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
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88
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Bartorelli AL, Ferrari C, Olivares P, Monizzi G, Grancini L. Revival of a forgotten valve: use of the percutaneous clip for the treatment of tricuspid regurgitation. Eur Heart J Suppl 2021; 23:E19-E24. [PMID: 35233210 PMCID: PMC8876298 DOI: 10.1093/eurheartj/suab081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tricuspid regurgitation (TR) is common in patients with left-sided valvular heart disease and is independently associated with increased mortality and morbidity because it leads to right-sided heart failure and recurrent hospitalization. The prognostic benefit of isolated TR surgical repair or replacement is unclear and medical treatment of decompensated right heart failure alone does not prevent the progression of the disease. Recently, minimal invasive catheter-based techniques have emerged as a feasible and effective option for TR treatment in selected high-risk patients who would clinically benefit from tricuspid valve repair. We provide an overview of the current state of transcatheter TR treatment using the edge-to-edge technique.
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Affiliation(s)
- Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy
- Department of Biomedical and Clinical Sciences, ‘Luigi Sacco’, University of Milan, Milan, Italy
| | - Cristina Ferrari
- Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Paolo Olivares
- Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Giovanni Monizzi
- Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Luca Grancini
- Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy
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89
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Caravita S, Figliozzi S, Florescu DR, Volpato V, Oliverio G, Tomaselli M, Torlasco C, Muscogiuri G, Cernigliaro F, Parati G, Badano L, Muraru D. Recent advances in multimodality imaging of the tricuspid valve. Expert Rev Med Devices 2021; 18:1069-1081. [PMID: 34617481 DOI: 10.1080/17434440.2021.1990753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The tricuspid valve (TV) and the right heart chambers are complex three-dimensional structures that are difficult to assess using tomographic imaging techniques. The progressive aging of the general population and the advancements in treating left-sided heart diseases by transcatheter procedures have contributed to the tricuspid regurgitation (TR) becoming a major public health problem associated with progression to refractory heart failure and poor outcome. Recent advances in multimodality cardiac imaging allow a better understanding of the pathophysiology of TR that may translate in better management of patients. AREAS COVERED Three-dimensional echocardiography, cardiac magnetic resonance, and computed tomography provide complementary information to i. assess the TV complex; ii. identify the etiology and the mechanisms of TR; iii. evaluate its severity and hemodynamic consequences; iv. explore the remodeling of the right heart chambers; and v. properly plan, guide, and monitor the transcatheter interventions aimed to reduce the severity of TR. EXPERT OPINION We need thorough understanding of both the TV and the right heart chamber geometry and function to understand the pathophysiology of TR. The integrated use of multimodality cardiac imaging is pivotal to assess patients with TR and to identify tailored and timely treatment of TR in properly selected patients.
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Affiliation(s)
- Sergio Caravita
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Management, Information and Production Engineering, University of Bergamo, Dalmine (BG), Italy
| | - Stefano Figliozzi
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Diana-Ruxandra Florescu
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Valentina Volpato
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Giorgio Oliverio
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Michele Tomaselli
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Camilla Torlasco
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Giuseppe Muscogiuri
- Department of Radiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Franco Cernigliaro
- Department of Radiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Luigi Badano
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Denisa Muraru
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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90
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Transcatheter Tricuspid Valve-in-Valve Procedure-An Illustrative Case Report and Review. J Clin Med 2021; 10:jcm10174004. [PMID: 34501452 PMCID: PMC8432540 DOI: 10.3390/jcm10174004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/21/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022] Open
Abstract
Severe tricuspid commitment is no longer understood as merely a marker of disease but is now widely thought of as a significant contributor to cardiac morbidity and mortality. However, isolated tricuspid valve surgery remains rare and to this day continues to be associated with the highest surgical risk among all valve procedures and high operative mortality rates, especially in reoperations. Therefore, the development of tricuspid transcatheter procedures is as necessary as it was for the other valves a couple of years ago. Recently, multiple percutaneous therapies have been developed for the management of severe tricuspid disease, initially only repair and more recently replacement, thus creating a new branch for the management of patients who have already undergone surgery and who present with dysfunctional bioprostheses. The purpose of this review and report is to demonstrate current and possible future challenges, and to show that the valve-in-valve procedure of the tricuspid valve is feasible and safe, and now can be performed in all its range, in the smallest to the largest sizes of presentation, without incurring the untoward risks of conventional surgery.
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91
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Parody-Cuerda G, Rodríguez-Caulo E, Barquero-Aroca JM. Tratamiento endovascular de la válvula tricúspide: estado actual. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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92
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Volpato V, Badano LP, Figliozzi S, Florescu DR, Parati G, Muraru D. Multimodality cardiac imaging and new display options to broaden our understanding of the tricuspid valve. Curr Opin Cardiol 2021; 36:513-524. [PMID: 34292179 PMCID: PMC9904443 DOI: 10.1097/hco.0000000000000890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The prognostic impact of tricuspid regurgitation (TR) and the subsequent development of percutaneous procedures targeting the tricuspid valve (TV), has brought to the forefront the role of imaging for the assessment of the forgotten valve. As illustrated in several studies and summarized in this review, currently a multimodality imaging approach is required to understand the pathophysiology of TR, due to the complex TV anatomy and the close relationship between the severity of TR and the extent of the remodeling of the right heart chambers. RECENT FINDINGS Recently, the advance in the tranhscatheter treatment of the TV has led to a growing interest in the development of dedicated software packages and new display modalities to increase our understanding of the TV. As a consequence, a transversal knowledge of the different imaging modalities is required for contemporary cardiac-imaging physicians. SUMMARY This review highlights the main features, and the pros and cons of echocardiography, cardiac computed tomography, cardiac magnetic resonance and emerging technologies, as 3D printing and virtual reality, in the assessment of patients with TR.
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Affiliation(s)
- Valentina Volpato
- Department of Medicine and Surgery, University of Milano-Bicocca
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Luigi P. Badano
- Department of Medicine and Surgery, University of Milano-Bicocca
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Stefano Figliozzi
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Diana R. Florescu
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
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93
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Meijerink F, Koch KT, de Winter RJ, Holierook M, Rensing BJWM, Timmers L, Eefting FD, Swaans MJ, Bouma BJ, Baan J. Transcatheter tricuspid valve repair: early experience in the Netherlands. Neth Heart J 2021; 29:595-603. [PMID: 34415550 PMCID: PMC8556435 DOI: 10.1007/s12471-021-01613-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background Symptomatic tricuspid regurgitation (TR) is increasingly prevalent and impairs quality of life and survival, despite medical treatment. Transcatheter tricuspid valve repair (TTVR) has recently become available as a treatment option for patients not eligible for tricuspid valve surgery. In this study we describe the early experience with TTVR in the Netherlands. Methods All consecutive patients scheduled for TTVR in two tertiary hospitals were included in the current study. Patients were symptomatic and had severe functional TR. TTVR was performed either with the MitraClip (off-label use) or dedicated TriClip delivery system and device. Procedural success was defined as achievement of clip implantation, TR reduction ≥ 1 grade and no need for re-do surgical or transcatheter intervention. Clinical improvement was evaluated after 4 weeks. Results Twenty-one patients (median age 78 years, 33% male, 95% New York Heart Association class ≥ 3, 100% history of atrial fibrillation) underwent TTVR. Procedural success was achieved in 16 patients, of whom 15 reported symptomatic improvement (New York Heart Association class 1 or 2). There was no in-hospital mortality and no major complications occurred. Baseline glomerular filtration rate and TR coaptation gap size were associated with procedural success. Conclusion The current study showed that TTVR seems a promising treatment option for patients with severe functional TR deemed high risk for surgery. Successful TR reduction is most likely in patients with limited coaptation gap size and strongly determines clinical benefit. Adequate patient selection and timing of treatment seem essential for an optimal patient outcome. Supplementary Information The online version of this article (10.1007/s12471-021-01613-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F Meijerink
- Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - K T Koch
- Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - R J de Winter
- Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - M Holierook
- Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - B J W M Rensing
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - L Timmers
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - F D Eefting
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - M J Swaans
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - B J Bouma
- Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - J Baan
- Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.
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94
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Lurz P, Stephan von Bardeleben R, Weber M, Sitges M, Sorajja P, Hausleiter J, Denti P, Trochu JN, Nabauer M, Tang GHL, Biaggi P, Ying SW, Trusty PM, Dahou A, Hahn RT, Nickenig G. Transcatheter Edge-to-Edge Repair for Treatment of Tricuspid Regurgitation. J Am Coll Cardiol 2021; 77:229-239. [PMID: 33478646 DOI: 10.1016/j.jacc.2020.11.038] [Citation(s) in RCA: 247] [Impact Index Per Article: 82.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Tricuspid regurgitation (TR) is a frequent disease with a progressive increase in mortality as disease severity increases. Transcatheter therapies for treatment of TR may offer a safe and effective alternative to surgery in this high-risk population. OBJECTIVES The purpose of this report was to study the 1-year outcomes with the TriClip transcatheter tricuspid valve repair system, including repair durability, clinical benefit and safety. METHODS The TRILUMINATE trial (n = 85) is an international, prospective, single arm, multicenter study investigating safety and performance of the TriClip Tricuspid Valve Repair System in patients with moderate or greater TR. Echocardiographic assessment was performed by a core laboratory. RESULTS At 1 year, TR was reduced to moderate or less in 71% of subjects compared with 8% at baseline (p < 0.0001). Patients experienced significant clinical improvements in New York Heart Association (NYHA) functional class I/II (31% to 83%, p < 0.0001), 6-minute walk test (272.3 ± 15.6 to 303.2 ± 15.6 meters, p = 0.0023) and Kansas City Cardiomyopathy Questionnaire (KCCQ) score (improvement of 20 ± 2.61 points, p < 0.0001). Significant reverse right ventricular remodeling was observed in terms of size and function. The overall major adverse event rate and all-cause mortality were both 7.1% at 1 year. CONCLUSION Transcatheter tricuspid valve repair using the TriClip device was found to be safe and effective in patients with moderate or greater TR. The repair itself was durable at reducing TR at 1 year and was associated with a sustained and marked clinical benefit with low mortality after 1 year in a fragile population that was at high surgical risk. (TRILUMINATE Study With Abbott Transcatheter Clip Repair System in Patients With Moderate or Greater TR; NCT03227757).
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Affiliation(s)
- Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
| | | | | | - Marta Sitges
- Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Centro de investigación Biomedica en Red Enfermedades Cardiovasculares, Spain
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I der Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Jean-Noël Trochu
- Université Nantes, CHU Nantes, CNRS, INSERM, l'institut du Thorax, Nantes, France
| | - Michael Nabauer
- Medizinische Klinik und Poliklinik I der Ludwig-Maximilians-Universität München, Munich, Germany
| | | | | | - Shih-Wa Ying
- Abbott Structural Heart, Santa Clara, California, USA
| | | | | | - Rebecca T Hahn
- The Cardiovascular Research Foundation, New York, New York, USA; New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA
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95
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Kodali S, Hahn RT, Eleid MF, Kipperman R, Smith R, Lim DS, Gray WA, Narang A, Pislaru SV, Koulogiannis K, Grayburn P, Fowler D, Hawthorne K, Dahou A, Deo SH, Vandrangi P, Deuschl F, Mack MJ, Leon MB, Feldman T, Davidson CJ. Feasibility Study of the Transcatheter Valve Repair System for Severe Tricuspid Regurgitation. J Am Coll Cardiol 2021; 77:345-356. [PMID: 33509390 DOI: 10.1016/j.jacc.2020.11.047] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tricuspid regurgitation (TR) is a prevalent disease with limited treatment options. OBJECTIVES This is the first 30-day report of the U.S. single-arm, multicenter, prospective CLASP TR early feasibility study of the PASCAL transcatheter valve repair system in the treatment of TR. METHODS Patients with symptomatic TR despite optimal medical therapy, reviewed by the local heart team and central screening committee, were eligible for the study. Data were collected at baseline, discharge, and the 30-day follow-up and were reviewed by an independent clinical events committee and echocardiographic core laboratory. Feasibility endpoints included safety (composite major adverse event [MAE] rate), echocardiographic, clinical, and functional endpoints. RESULTS Of the 34 patients enrolled in the study, the mean age was 76 years, 53% were women, the mean Society of Thoracic Surgeons score was 7.3%, 88% had atrial fibrillation/flutter, 97% had severe or greater TR, and 79% had New York Heart Association (NYHA) functional class III/IV symptoms. Twenty-nine patients (85%) received implants; at 30 days, 85% of them achieved a TR severity reduction of at least 1 grade, with 52% with moderate or less TR (p < 0.001). The MAE rate was 5.9%, and none of the patients experienced cardiovascular mortality, stroke, myocardial infarction, renal complication, or reintervention. Eighty-nine percent of the patients improved to NYHA functional class I/II (p < 0.001), the mean 6-min walk distance improved by 71 m (p < 0.001), and the mean Kansas City Cardiomyopathy Questionnaire score improved by 15 points (p < 0.001). CONCLUSIONS In this early experience, the repair system performed as intended, with substantial TR reduction, favorable safety results with a low MAE rate, no mortality or reintervention, and significant improvements in functional status, exercise capacity, and quality of life. (Edwards CLASP TR EFS [CLASP TR EFS]; NCT03745313).
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Affiliation(s)
- Susheel Kodali
- Columbia University Medical Center, New York, New York, USA.
| | - Rebecca T Hahn
- Columbia University Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | | | - Robert Kipperman
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Robert Smith
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - D Scott Lim
- University of Virginia Health System, Charlottesville, Virginia, USA
| | | | - Akhil Narang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | - Paul Grayburn
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Dale Fowler
- University of Virginia Health System, Charlottesville, Virginia, USA
| | | | | | | | | | | | - Michael J Mack
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- Columbia University Medical Center, New York, New York, USA
| | - Ted Feldman
- Edwards Lifesciences, Irvine, California, USA
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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96
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Vieitez JM, Monteagudo JM, Mahia P, Perez L, Lopez T, Marco I, Perone F, González T, Sitges M, Bouzas A, González-Salvado V, Li CH, Alonso D, Carrasco F, Adeba A, de la Hera JM, Fernandez-Golfin C, Zamorano JL. New insights of tricuspid regurgitation: a large-scale prospective cohort study. Eur Heart J Cardiovasc Imaging 2021; 22:196-202. [PMID: 32783057 DOI: 10.1093/ehjci/jeaa205] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/01/2020] [Indexed: 01/01/2023] Open
Abstract
AIMS To evaluate the burden of tricuspid regurgitation (TR) in a large cohort, determine the right ventricle involvement of patients with TR and determine the characteristics of isolated TR. METHODS AND RESULTS Prospective study where consecutive patients undergoing an echocardiographic study in 10 centres were included. All studies with significant TR (at least moderate) were selected. We considered that patients with one of pulmonary systolic hypertension >50 mmHg, left ventricular ejection fraction <35%, New York Heart Association III-IV, or older than 85 years, had a high surgical risk. A total of 35 088 echocardiograms were performed. Significant TR was detected in 6% of studies. Moderate TR was found in 69.6%, severe in 25.5%, massive in 3.9%, and torrential in 1.0% of patients. Right ventricle was dilated in 81.7% of patients with massive/torrential TR, in 55.9% with severe TR, and in 29.3% with moderate TR (P < 0.001). Primary TR was present in 7.4% of patients whereas secondary TR was present in 92.6%. Mitral or aortic valve disease was the most common aetiology (54.6%), following by isolated TR (16%). Up to 51.9% of patients with severe, massive, or torrential primary TR and 57% of patients with severe, massive, or torrential secondary TR had a high surgical risk. CONCLUSION Significant TR is a prevalent condition and a high proportion of these patients have an indication for valve intervention. More than a half of patients with severe, massive, or torrential TR had a high surgical risk. Massive/torrential TR may have implications regarding selection and monitoring patients for percutaneous treatment.
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Affiliation(s)
- José María Vieitez
- Department of Cardiology, CIBERCV University Hospital Ramon y Cajal, Carretera de Colmenar Km 9.100, Madrid 28034, Spain
| | - Juan Manuel Monteagudo
- Department of Cardiology, CIBERCV University Hospital Ramon y Cajal, Carretera de Colmenar Km 9.100, Madrid 28034, Spain
| | - Patricia Mahia
- Department of Cardiology, Hospital Clinic San Carlos, calle Prof Martín Lagos, Madrid 28040, Spain
| | - Leopoldo Perez
- Department of Cardiology, Hospital Clinic San Carlos, calle Prof Martín Lagos, Madrid 28040, Spain
| | - Teresa Lopez
- Department of Cardiology, University Hospital La Paz, Paseo de la Castellana, 261, Madrid 28046, Spain
| | - Irene Marco
- Department of Cardiology, University Hospital La Paz, Paseo de la Castellana, 261, Madrid 28046, Spain
| | - Francesco Perone
- Department of Cardiology, University Hospital La Paz, Paseo de la Castellana, 261, Madrid 28046, Spain
| | - Teresa González
- Department of Cardiology, Hospital Vall d`Hebron, Passeig de la Vall d'Hebron, 119, 129, Barcelona, Spain
| | - Marta Sitges
- Barcelona Hospital Clinic de Barcelona, Carrer de Villarroel 170, Barcelona 08036, Spain
| | - Alberto Bouzas
- Department of Cardiology, University Hospital Complex A Coruña, As Xubias 84, A Coruña 15006, Spain
| | | | - Chi-Hion Li
- Department of Cardiology, Hospital of Santa Creu I Sant Pau, Carrer de Sant Quintí, 89, Barcelona 08041, Spain
| | - David Alonso
- Department of Cardiology, Hospital of Leon, Altos de Nava, León 24008, Spain
| | - Fernando Carrasco
- Department of Cardiology, University Hospital Virgen de la Victoria, Campus de Teatinos, Málaga 29010, Spain
| | - Antonio Adeba
- Department of Cardiology, University Hospital Central de Asturias, Avenida de Roma s/n, Oviedo 33011, Spain
| | - Jesus Maria de la Hera
- Department of Cardiology, University Hospital Central de Asturias, Avenida de Roma s/n, Oviedo 33011, Spain
| | - Covadonga Fernandez-Golfin
- Department of Cardiology, CIBERCV University Hospital Ramon y Cajal, Carretera de Colmenar Km 9.100, Madrid 28034, Spain
| | - José Luis Zamorano
- Department of Cardiology, CIBERCV University Hospital Ramon y Cajal, Carretera de Colmenar Km 9.100, Madrid 28034, Spain
- Department of Cardiology, La Zarzuela Hospital, Calle de Pleyades, 25, Madrid 28023, Spain
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97
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Körber MI, Landendinger M, Gerçek M, Beuthner BE, Friedrichs KP, Puls M, Baldus S, Rudolph V, Jacobshagen C, Arnold M, Pfister R. Transcatheter Treatment of Secondary Tricuspid Regurgitation With Direct Annuloplasty: Results From a Multicenter Real-World Experience. Circ Cardiovasc Interv 2021; 14:e010019. [PMID: 34325531 DOI: 10.1161/circinterventions.120.010019] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Maria I Körber
- Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology and Intensive Care, University of Cologne, Germany (M.I.K., S.B., R.P.)
| | - Melanie Landendinger
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Germany (M.L., M.A.)
| | - Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Ruhr-University Bochum, Bad Oeynhausen, Germany (M.G., K.P.F., V.R.)
| | - Bo E Beuthner
- Department of Cardiology and Pneumology, Heart Center, Georg-August-University Goettingen, Germany (B.E.B.)
| | - Kai P Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Ruhr-University Bochum, Bad Oeynhausen, Germany (M.G., K.P.F., V.R.)
| | - Miriam Puls
- Department of Cardiology, Angiology and Intensive Care, Vincentius-Diakonissen Hospital Karlsruhe, Germany (M.P., C.J.)
| | - Stephan Baldus
- Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology and Intensive Care, University of Cologne, Germany (M.I.K., S.B., R.P.)
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Ruhr-University Bochum, Bad Oeynhausen, Germany (M.G., K.P.F., V.R.)
| | - Claudius Jacobshagen
- Department of Cardiology, Angiology and Intensive Care, Vincentius-Diakonissen Hospital Karlsruhe, Germany (M.P., C.J.)
| | - Martin Arnold
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Germany (M.L., M.A.)
| | - Roman Pfister
- Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology and Intensive Care, University of Cologne, Germany (M.I.K., S.B., R.P.)
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98
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Unterhuber M, Kresoja KP, Besler C, Rommel KP, Orban M, von Roeder M, Braun D, Stolz L, Massberg S, Trebicka J, Zachäus M, Hausleiter J, Thiele H, Lurz P. Cardiac output states in patients with severe functional tricuspid regurgitation: impact on treatment success and prognosis. Eur J Heart Fail 2021; 23:1784-1794. [PMID: 34272792 DOI: 10.1002/ejhf.2307] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 12/16/2022] Open
Abstract
AIMS To investigate whether there is evidence for distinct cardiac output (CO) based phenotypes in patients with chronic right heart failure associated with severe tricuspid regurgitation (TR) and to characterize their impact on TR treatment and outcome. METHODS AND RESULTS A total of 132 patients underwent isolated transcatheter tricuspid valve repair (TTVR) for functional TR at two centres. Patients were clustered according to k-means clustering into low [cardiac index (CI) < 1.7 L/min/m2 ], intermediate (CI 1.7-2.6 L/min/m2 ) and high CO (CI > 2.6 L/min/m2 ) clusters. All-cause mortality and clinical characteristics during follow-up were compared among different CO clusters. Mortality rates were highest for patients in a low (24%) and high CO state (42%, log-rank P < 0.001). High CO state patients were characterized by larger inferior vena cava diameters (P = 0.003), reduced liver function, higher incidence of ascites (P = 0.006) and markedly reduced systemic vascular resistance (P < 0.001) as compared to TTVR patients in other CO states. Despite comparable procedural success rates, the extent of changes in right atrial pressures (P = 0.01) and right ventricular dimensions (P < 0.001) per decrease in regurgitant volume following TTVR was less pronounced in high CO state patients as compared to other CO states. Successful TTVR was associated with the smallest prognostic benefit among low and high CO state patients. CONCLUSIONS Patients with chronic right heart failure and severe TR display distinct CO states. The high CO state is characterized by advanced congestive hepatopathy, a substantial decrease in peripheral vascular tone, a lack of response of central venous pressures to TR reduction, and worse prognosis. These data are relevant to the pathophysiological understanding and management of this important clinical syndrome.
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Affiliation(s)
- Matthias Unterhuber
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Karl-Patrik Kresoja
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Karl-Philipp Rommel
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner site German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Maximilian von Roeder
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner site German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner site German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner site German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Jonel Trebicka
- Translational Hepatology, Department of Internal Medicine I, Goethe University Clinic Frankfurt, Frankfurt, Germany
| | - Markus Zachäus
- Department of Gastroenterology, Hepatology, Hematology and Oncology, Helios Park-Klinikum Leipzig, Leipzig, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner site German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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99
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Kresoja KP, Rommel KP, Lücke C, Unterhuber M, Besler C, von Roeder M, Schöber AR, Noack T, Gutberlet M, Thiele H, Lurz P. Right Ventricular Contraction Patterns in Patients Undergoing Transcatheter Tricuspid Valve Repair for Severe Tricuspid Regurgitation. JACC Cardiovasc Interv 2021; 14:1551-1561. [PMID: 34294396 DOI: 10.1016/j.jcin.2021.05.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study investigated patterns of right ventricular (RV) contraction by using cardiac magnetic resonance (CMR) imaging in patients undergoing transcatheter tricuspid valve repair (TTVR). BACKGROUND The role of RV function in patients with severe tricuspid regurgitation undergoing TTVR is poorly understood. METHODS Global RV dysfunction was defined as CMR-derived RV ejection fraction (RVEF) ≤45% and longitudinal RV dysfunction was defined as tricuspid annular plane systolic excursion (TAPSE) <17 mm on echocardiography. Patients were stratified into 3 types of RV contraction: type I, TAPSE ≥17 and RVEF >45%; type II, TAPSE <17 and RVEF >45%; and type III, TAPSE <17 and RVEF ≤45%. CMR feature tracking was performed to assess longitudinal and circumferential RV strain. The primary outcome was a composite of all-cause mortality or first heart failure hospitalization. RESULTS Of 79 patients (median age 79 years, 51% female), 18 (23%) presented with global and 40 (51%) presented with longitudinal RV dysfunction. The composite outcome occurred in 22 patients (median follow-up 362 days). Global RV dysfunction but not longitudinal RV dysfunction (hazard ratio: 6.62; 95% confidence interval: 2.77-15.77; and hazard ratio: 1.30; 95% confidence interval: 0.55-3.08, respectively) was associated with the composite outcome. Compared with type I RV contraction, patients with type II RV contraction exhibited increased circumferential strain, with a preservation of RVEF despite diminished longitudinal strain. Patients with type III RV contraction exhibited both diminished longitudinal and circumferential strain, resulting in an impaired RVEF. Patients with type III RV contraction showed the worst survival (P < 0.001). CONCLUSIONS Global RV dysfunction is a predictor of outcomes among TTVR patients. Tricuspid regurgitation patients can be stratified into 3 types of RV contraction, in which a loss of longitudinal function can be compensated by increasing circumferential function, preserving RVEF and favorable outcomes.
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Affiliation(s)
- Karl-Patrik Kresoja
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Christian Lücke
- Institute of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Matthias Unterhuber
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Christian Besler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Maximilian von Roeder
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Anne Rebecca Schöber
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Thilo Noack
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Matthias Gutberlet
- Institute of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany.
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100
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Ruf TF, Hahn RT, Kreidel F, Beiras-Fernandez A, Hell M, Gerdes P, da Roche E Silva JG, Vosseler M, Geyer M, Tamm A, Münzel T, von Bardeleben RS. Short-Term Clinical Outcomes of Transcatheter Tricuspid Valve Repair With the Third-Generation MitraClip XTR System. JACC Cardiovasc Interv 2021; 14:1231-1240. [PMID: 34112460 DOI: 10.1016/j.jcin.2021.03.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The aim of this study was to assess 30-day outcomes of transcatheter edge-to-edge repair with the MitraClip XTR for significant tricuspid regurgitation (TR), relative to baseline coaptation gap sizes (CGS). BACKGROUND Transcatheter edge-to-edge repair using the MitraClip NT for patients with significant TR is safe and efficacious; the utility of the MitraClip XTR is unknown. METHODS Patients with significant, symptomatic TR treated at a single site between April 2018 and December 2019, with consent and with complete data, were included (n = 50). Baseline and 30-day echocardiograms were assessed by an echocardiography core laboratory. Patients were divided into 3 subgroups on the basis of site-assessed CGS: subgroup I (< 7 mm), subgroup II (7 to 10 mm), and subgroup III (>10 mm). RESULTS Technical success of the MitraClip XTR implantation was 100% (88% in the septal-anterior position) using a median of 2 clips (interquartile range: 1 to 2). At 30 days, single-leaflet detachment was noted in 3 patients (6%), with no instances of device embolization. TR was reduced by 1 grade in subgroup I and by 2 grades in subgroups II and III. New York Heart Association functional class was reduced by 1 class in all 3 subgroups. The 6-min walk distance increased in subgroup I (+115 m; p = 0.014) and subgroup II (+31.5 m; p = 0.028) but not subgroup III (+50 m; p = 0.999). A CGS of ≤8.4 mm was predictive of a reduction to moderate or less TR. CONCLUSIONS MitraClip XTR implantation is a safe, effective treatment for a wider range of CGS in patients with symptomatic, significant TR than prior device iterations. All patients showed improvement in New York Heart Association functional class, and those with CGS <10 mm also experienced improved functional capacity.
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Affiliation(s)
- Tobias Friedrich Ruf
- Department of Cardiology, Heart Valve Center, University Medical Center Mainz, Mainz, Germany
| | - Rebecca T Hahn
- Cardiology Department, NewYork-Presbyterian/Columbia University Medical Center, New York, New York, USA.
| | - Felix Kreidel
- Department of Cardiology, Heart Valve Center, University Medical Center Mainz, Mainz, Germany
| | - Andres Beiras-Fernandez
- Department of Heart and Vascular Surgery, Heart Valve Center University Medical Center Mainz, Mainz, Germany
| | - Michaela Hell
- Department of Cardiology, Heart Valve Center, University Medical Center Mainz, Mainz, Germany
| | - Patrick Gerdes
- Department of Cardiology, Heart Valve Center, University Medical Center Mainz, Mainz, Germany
| | | | - Markus Vosseler
- Department of Cardiology, Heart Valve Center, University Medical Center Mainz, Mainz, Germany
| | - Martin Geyer
- Department of Cardiology, Heart Valve Center, University Medical Center Mainz, Mainz, Germany
| | - Alexander Tamm
- Department of Cardiology, Heart Valve Center, University Medical Center Mainz, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Heart Valve Center, University Medical Center Mainz, Mainz, Germany
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