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Bartko PE, Arfsten H, Heitzinger G, Pavo N, Winter MP, Toma A, Strunk G, Hengstenberg C, Hülsmann M, Goliasch G. Natural history of bivalvular functional regurgitation. Eur Heart J Cardiovasc Imaging 2020; 20:565-573. [PMID: 30508183 DOI: 10.1093/ehjci/jey178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/29/2018] [Indexed: 01/07/2023] Open
Abstract
AIMS Bivalvular functional regurgitation (BVFR) defined as concomitant mitral and tricuspid insufficiency has not been described or systematically assessed before. Therefore, this study sought to define incidence, impact and natural history of BVFR in heart failure with reduced ejection fraction (HFrEF) to provide the foundation for risk assessment and directions for potential treatment strategies. METHODS AND RESULTS We enrolled 1021 consecutive patients with HFrEF under guideline-directed medical therapy and performed comprehensive echocardiographic and neurohumoral profiling. All-cause mortality during a 5 years of follow-up served as the primary endpoint. Thirty percent of patients suffered from moderate or severe BVFR. Long-term mortality increased with the presence and severity of functional regurgitation (FR) with severe BVFR representing the highest risk-subset (P < 0.001). Severe BVFR patients were more symptomatic and displayed an adverse remodelling and neurohumoral activation pattern (all P < 0.05). Severe BVFR was associated with excess mortality independently of clinical [adjusted hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.39-1.84; P < 0.001] and echocardiographic (adjusted HR 1.31, 95% CI 1.11-1.54; P = 0.001) confounders, guideline-directed medical therapy (adjusted HR 1.55, 95% CI 1.35-1.79; P < 0.001) and neurohumoral activation (adjusted HR 1.31, 95% CI 1.07-1.59; P = 0.009). Moderate BVFR (n = 99) comprised equal baseline characteristics and similar risk as isolated severe FR (HR 0.95, 95% CI 0.69-1.30; P = 0.73). CONCLUSION This long-term outcome study shows the multi-faceted nature of FR and defines BVFR as an important clinical entity associated with impaired functional class, adverse cardiac remodelling, and excess risk of mortality. Moderate BVFR conveys similar risk as isolated severe FR reflecting the deleterious impact of the global regurgitant load on the failing heart and the need of an integrated understanding for risk-assessment.
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Affiliation(s)
- Philipp E Bartko
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A Vienna, Austria
| | - Henrike Arfsten
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A Vienna, Austria
| | - Gregor Heitzinger
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A Vienna, Austria
| | - Noemi Pavo
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A Vienna, Austria
| | - Max-Paul Winter
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A Vienna, Austria
| | - Aurel Toma
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A Vienna, Austria
| | - Guido Strunk
- FH Campus Vienna and Complexity Research, Favoritenstraße 226, A Vienna, Austria
| | - Christian Hengstenberg
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A Vienna, Austria
| | - Martin Hülsmann
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A Vienna, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A Vienna, Austria
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Gyoten T, Schenk S, Rochor K, Herwig V, Harnath A, Grimmig O, Just S, Fritzsche D, Messroghli D. Outcome comparison of mitral valve surgery and MitraClip therapy in patients with severely reduced left ventricular dysfunction. ESC Heart Fail 2020; 7:1781-1790. [PMID: 32445540 PMCID: PMC7373891 DOI: 10.1002/ehf2.12741] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 11/11/2022] Open
Abstract
AIMS The aim of this study was to compare the outcomes of surgical mitral valve repair or replacement (sMVR) and percutaneous edge-to-edge repair using MitraClip (pMVR) in patients with severe left ventricular dysfunction affected by functional mitral regurgitation (FMR). METHODS AND RESULTS We retrospectively identified 132 patients with left ventricular ejection fraction (LVEF) ≦ 30% submitted to sMVR (n = 47) or pMVR (n = 85) for FMR at our centre from January 2013 to December 2017. To adjust for baseline imbalances, we used a propensity score matching by age, logistic EuroSCORE, and left ventricular end-systolic volume. After being matched, MitraClip therapy showed lower perioperative mortality and rate of complications yet increased residual mitral regurgitation (MR) grade than did surgery (0.2 ± 0.50 in sMVR vs. 1.3 ± 0.88 in pMVR, P < 0.0001). According to stratified multivariate Cox model analysis, residual MR severity was an independent risk factor for cardiac death [hazard ratio (HR), 2.81; 95% confidence interval [CI], 1.44-5.48, P = 0.0025] and re-hospitalization for heart failure (HR, 3.07; 95% CI, 1.50-6.29, P = 0.0022) at 1 year follow-up. Stratified multivariable Cox regression analysis at 3 years identified pMVR as risk factor for cardiac death (HR, 0.19; 95% CI, 0.040-0.86, P = 0.031) and re-hospitalization for heart failure (HR, 0.28; 95% CI, 0.077-0.99, P = 0.048). CONCLUSIONS In patients with FMR and LVEF ≤ 30%, MitraClip therapy resulted in lower perioperative complications and mortality than sMVR. However, surgically treated patients who survived the perioperative stage had less residual MR and experienced lower rates of re-hospitalization for heart failure at 1 year and lower cardiac mortality at 1 and 3 years of follow-up than did patients undergoing pMVR.
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Affiliation(s)
- Takayuki Gyoten
- Department of Cardiovascular SurgerySana‐Herzzentrum CottbusLeipziger Strasse 5003048CottbusGermany
| | - Sören Schenk
- Department of Cardiovascular SurgerySana‐Herzzentrum CottbusLeipziger Strasse 5003048CottbusGermany
| | - Kristin Rochor
- Department of CardiologySana‐Herzzentrum CottbusLeipziger Strasse 5003048CottbusGermany
| | - Volker Herwig
- Department of CardiologySana‐Herzzentrum CottbusLeipziger Strasse 5003048CottbusGermany
| | - Axel Harnath
- Department of CardiologySana‐Herzzentrum CottbusLeipziger Strasse 5003048CottbusGermany
| | - Oliver Grimmig
- Department of Cardiovascular SurgerySana‐Herzzentrum CottbusLeipziger Strasse 5003048CottbusGermany
| | - Sören Just
- Department of Cardiovascular SurgerySana‐Herzzentrum CottbusLeipziger Strasse 5003048CottbusGermany
| | - Dirk Fritzsche
- Department of Cardiovascular SurgerySana‐Herzzentrum CottbusLeipziger Strasse 5003048CottbusGermany
| | - Daniel Messroghli
- Department of Internal Medicine—CardiologyDeutsches Herzzentrum BerlinBerlinGermany
- Department of Internal Medicine and Cardiology, Campus Virchow‐KlinikumCharité—Universitätsmedizin BerlinBerlinGermany
- German Center for Cardiovascular Research (DZHK), partner siteBerlinGermany
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53
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54
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Combined Tricuspid and Mitral Versus Isolated Mitral Valve Repair for Severe MR and TR. JACC Cardiovasc Interv 2020; 13:543-550. [DOI: 10.1016/j.jcin.2019.10.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/19/2019] [Accepted: 10/08/2019] [Indexed: 11/23/2022]
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55
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Nita N, Scharnbeck D, Schneider LM, Seeger J, Wöhrle J, Rottbauer W, Keßler M, Markovic S. Predictors of left ventricular reverse remodeling after percutaneous therapy for mitral regurgitation with the MitraClip system. Catheter Cardiovasc Interv 2020; 96:687-697. [PMID: 32104977 DOI: 10.1002/ccd.28779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/26/2020] [Accepted: 02/07/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate the predictors and clinical impact of left ventricular reverse remodeling (LVRR) after MitraClip (MC) therapy for degenerative (DMR) and functional mitral regurgitation (FMR). BACKGROUND MC therapy induces LVRR in patients with mitral regurgitation (MR) at high-risk for surgery. However, specific data on predictors of LVRR therapy are limited. METHODS This study included 164 patients treated by MC implantation with complete clinical and echocardiographic evaluation at baseline, 6 months, and 12 months. LVRR was defined as a decrease of ≥10% of the left ventricular end-diastolic diameter after 12 months and was found in 49% of the patients. RESULTS LVRR was associated with significantly reduced event rate 2 years after MC procedure. In the total cohort, multivariate regression analysis determined severe recurrent/residual MR after 12 months (p = .010, odds ratio [OR] = 0.26), male gender (p = .050, OR = 0.49) and left ventricular ejection fraction (LVEF) <20% (p = .046, OR = 0.24) as predictors of absence of LVRR. In the subgroup analysis according to etiology of MR, multivariate regression analysis revealed severe recurrent/residual MR after 12 months (p = .04, OR = 0.184) to inversely predict LVRR only in the DMR subgroup. In FMR, residual severe tricuspid regurgitation (TR) inversely predicts LVRR (p = .032, OR = 0.361). CONCLUSIONS LVRR occurs in half of the patients after MC and is associated with reduced MACCE rates at follow-up. Combined information on residual/recurrent MR, baseline LVEF and gender predict LVRR after MC procedure. While residual/recurrent MR is the independent predictor for the absence of LVRR in DMR, in FMR only severe residual TR independently predict LVRR.
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Affiliation(s)
- Nicoleta Nita
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | | | | | - Julia Seeger
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | - Jochen Wöhrle
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | | | - Mirjam Keßler
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | - Sinisa Markovic
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
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Orban M, Lüsebrink E, Braun D, Stocker TJ, Bagaev E, Hagl C, Näbauer M, Massberg S, Orban M, Hausleiter J. Recent advances in patient selection and devices for transcatheter edge-to-edge mitral valve repair in heart failure. Expert Rev Med Devices 2020; 17:93-102. [DOI: 10.1080/17434440.2020.1714433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Enzo Lüsebrink
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Thomas J. Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Erik Bagaev
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
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Multimodality Imaging of the Tricuspid Valve and Right Heart Anatomy. JACC Cardiovasc Imaging 2020; 12:516-531. [PMID: 30846125 DOI: 10.1016/j.jcmg.2019.01.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 01/08/2023]
Abstract
The characterization of tricuspid valve and right-heart anatomy has been gaining significant interest in the setting of new percutaneous transcatheter interventions for tricuspid regurgitation. Multimodality cardiac imaging provides a wealth of information about the anatomy and function of the tricuspid valve apparatus, right ventricle, and right atrium, which is pivotal for diagnosis and prognosis and for planning of percutaneous interventions. The present review describes the role of echocardiography, cardiac magnetic resonance, and multidetector row cardiac computed tomography for right heart and tricuspid valve assessment.
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58
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Erlebach M, Lange R. Multivalvular Disease: Percutaneous Management in 2019 and Beyond. Interv Cardiol 2019; 14:142-146. [PMID: 31867059 PMCID: PMC6918484 DOI: 10.15420/icr.2019.13.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 09/27/2019] [Indexed: 12/24/2022] Open
Abstract
Patients with multivalvular disease (MVD) are common and often present with heterogeneous valve defects. Evaluation is complicated by interactions among various valve pathologies. Trials and guidelines focus primarily on single-valve disease, providing few recommendations for the treatment of patients with MVD. This article provides an insight into percutaneous treatment possibilities for this heterogeneous patient population.
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Affiliation(s)
- Magdalena Erlebach
- Department of Cardiovascular Surgery, German Heart Centre Munich, Germany.,Institute of Translational Cardiac Surgery, Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Centre Munich, Germany.,Institute of Translational Cardiac Surgery, Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München Munich, Germany
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59
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Tricuspid Annular Diameter Measurement on Routine Chest CT Can Detect Significant Tricuspid Regurgitation. AJR Am J Roentgenol 2019; 213:W257-W263. [DOI: 10.2214/ajr.19.21602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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60
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Post-procedural tricuspid regurgitation predicts long-term survival in patients undergoing percutaneous mitral valve repair. J Cardiol 2019; 74:524-531. [DOI: 10.1016/j.jjcc.2019.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/06/2019] [Accepted: 05/13/2019] [Indexed: 12/28/2022]
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61
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Assessment and procedural guidance with echocardiography for transcatheter tricuspid regurgitation devices. Prog Cardiovasc Dis 2019; 62:452-458. [DOI: 10.1016/j.pcad.2019.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 09/18/2019] [Indexed: 11/18/2022]
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62
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Brescia AA, Ward ST, Watt TMF, Rosenbloom LM, Baker M, Khan S, Ziese E, Romano MA, Bolling SF. Outcomes of Guideline-Directed Concomitant Annuloplasty for Functional Tricuspid Regurgitation. Ann Thorac Surg 2019; 109:1227-1232. [PMID: 31479635 DOI: 10.1016/j.athoracsur.2019.07.035] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/29/2019] [Accepted: 07/08/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite guideline recommendations, rates of concomitant tricuspid valve repair are suboptimal, possibly due to fear of complications. We reviewed morbidity, mortality, recurrent tricuspid regurgitation, and right ventricular remodeling after guideline-directed concomitant tricuspid valve repair. METHODS We performed guideline-directed concomitant tricuspid valve repair on 171 consecutive patients who underwent left-sided valve surgery (degenerative mitral surgery or aortic valve replacement) between May 2012 and March 2016. Exclusion criteria included functional mitral regurgitation, rheumatic disease, active endocarditis, and concomitant coronary artery bypass grafting or complex aortic surgery. RESULTS Mean age was 68 ± 12 years, and 47% (81 of 171) were women. Preoperative atrial fibrillation was present in 57% (98 of 171), and preoperative tricuspid regurgitation was moderate or higher in 64% (108 of 171). The rate of de novo pacemaker placement was 4.1% (7 of 171), and the 30-day mortality rate was 0.6% (1 of 171). Estimated survival was 95% ± 4% at 1 year and 92% ± 5% at 5 years. Freedom from moderate or worse residual/recurrent tricuspid regurgitation was 93% ± 6% at 6 months and 89% ± 8% at 3 years. Quantitative echocardiography found no significant increase in right ventricular dimensions or area at 1 year in subgroup analysis. Mean echocardiographic follow-up was 14.1 months, and mean clinical follow-up was 33.9 months. CONCLUSIONS Guideline-directed concomitant tricuspid valve repair resulted in excellent safety end points and survival. At 14 months, freedom from moderate or worse tricuspid regurgitation was high, right ventricular performance did not worsen, and the pacemaker rate was comparable to rates after isolated mitral repair. Given these findings, adherence to current guidelines regarding functional tricuspid regurgitation should be encouraged.
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Affiliation(s)
| | - Sarah T Ward
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Tessa M F Watt
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Liza M Rosenbloom
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Megan Baker
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Shazli Khan
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Emilie Ziese
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Matthew A Romano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | -
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
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63
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Singh S. MitraClip in the Tricuspid Position: Slowly, But Surely, the March Continues. JACC Cardiovasc Interv 2019; 12:1462-1464. [PMID: 31395216 DOI: 10.1016/j.jcin.2019.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/14/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Siddharth Singh
- Echocardiography Laboratory, Cedars Sinai Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California.
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64
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Lo KB, Dayanand S, Ram P, Dayanand P, Slipczuk LN, Figueredo VM, Rangaswami J. Interrelationship Between Kidney Function and Percutaneous Mitral Valve Interventions: A Comprehensive Review. Curr Cardiol Rev 2019; 15:76-82. [PMID: 30360746 PMCID: PMC6520580 DOI: 10.2174/1573403x14666181024155247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 11/22/2022] Open
Abstract
Percutaneous mitral valve repair is emerging as a reasonable alternative especially in those with an unfavorable surgical risk profile in the repair of mitral regurgitation. At this time, our understanding of the effects of underlying renal dysfunction on outcomes with percutaneous mitral valve repair and the effects of this procedure itself on renal function is evolving, as more data emerges in this field. The current evidence suggests that the correction of mitral regurgitation via percutaneous mitral valve repair is associated with some degree of improvement in cardiac function, hemodynamics and renal function. The improvement in renal function was more significant for those with greater renal dysfunction at baseline. The presence of Chronic Kidney Disease (CKD) in turn has been associated with poor long-term outcomes including increased mortality and hospitalization among patients who undergo percutaneous mitral valve repair. This was true regardless of the degree of improvement in GFR post repair advanced CKD. The adverse impact of CKD on long-term outcomes was consistent across all studies and was more prominent in those with GFR<30 mL/min/1.73 m². It is clear that from these contrasting evidences of improved renal function post mitral valve repair but poor long-term outcomes including increased mortality in patients with CKD, that proper patient selection for percutaneous mitral valve repair is key. There is a need to have better-standardized criteria for patients who should qualify to have percutaneous mitral valve replacement with Mitraclip. In this new era of percutaneous mitral valve repair, much work needs to be done to optimize long-term patient outcomes.
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Affiliation(s)
- Kevin Bryan Lo
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States
| | - Sandeep Dayanand
- Department of Cardiology, Einstein Medical Center, Philadelphia, PA, United States
| | - Pradhum Ram
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States
| | - Pradeep Dayanand
- University of Miami - JFK Miller School of Medicine GME Consortium, Florida, FL, United States
| | - Leandro N Slipczuk
- Department of Cardiology, Einstein Medical Center, Philadelphia, PA, United States
| | - Vincent M Figueredo
- Department of Cardiology, Einstein Medical Center, Philadelphia, PA, United States.,Sidney Kimmel College of Thomas Jefferson University, Philadelphia, PA, United States
| | - Janani Rangaswami
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States.,Sidney Kimmel College of Thomas Jefferson University, Philadelphia, PA, United States
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65
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66
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6-Month Outcomes of Tricuspid Valve Reconstruction for Patients With Severe Tricuspid Regurgitation. J Am Coll Cardiol 2019; 73:1905-1915. [DOI: 10.1016/j.jacc.2019.01.062] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/14/2019] [Accepted: 01/21/2019] [Indexed: 01/08/2023]
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67
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Zoghbi WA, Asch FM, Bruce C, Gillam LD, Grayburn PA, Hahn RT, Inglessis I, Islam AM, Lerakis S, Little SH, Siegel RJ, Skubas N, Slesnick TC, Stewart WJ, Thavendiranathan P, Weissman NJ, Yasukochi S, Zimmerman KG. Guidelines for the Evaluation of Valvular Regurgitation After Percutaneous Valve Repair or Replacement. J Am Soc Echocardiogr 2019; 32:431-475. [DOI: 10.1016/j.echo.2019.01.003] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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68
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Hahn RT, Nabauer M, Zuber M, Nazif TM, Hausleiter J, Taramasso M, Pozzoli A, George I, Kodali S, Bapat V, Maisano F. Intraprocedural Imaging of Transcatheter Tricuspid Valve Interventions. JACC Cardiovasc Imaging 2019; 12:532-553. [DOI: 10.1016/j.jcmg.2018.07.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 01/12/2023]
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69
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Prihadi EA, Delgado V, Leon MB, Enriquez-Sarano M, Topilsky Y, Bax JJ. Morphologic Types of Tricuspid Regurgitation. JACC Cardiovasc Imaging 2019; 12:491-499. [DOI: 10.1016/j.jcmg.2018.09.027] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/17/2018] [Accepted: 09/20/2018] [Indexed: 12/18/2022]
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70
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Pavasini R, Ruggerini S, Grapsa J, Biscaglia S, Tumscitz C, Serenelli M, Boriani G, Squeri A, Campo G. Role of the tricuspid regurgitation after mitraclip and transcatheter aortic valve implantation: a systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging 2019; 19:654-659. [PMID: 28586413 DOI: 10.1093/ehjci/jex143] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/06/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Treatment of tricuspid regurgitation (TR) is common after surgery for mitral and/or aortic valves. The prognostic role of moderate to severe TR in patients undergoing mitraclip or transcatheter aortic valve implantation (TAVI) is not well-defined. Thus, the aim of this article is to perform a systematic review and meta-analysis of articles valuing the prognostic role of TR for patients undergoing mitraclip and TAVI. Methods and results Articles were searched in Pubmed, Cochrane Library, Google Scholar and Biomed Central in September 2016. Inclusion criteria: observational or randomized clinical trials with data on the prognostic role of TR in patients undergoing mitraclip or TAVI. Primary outcome was all-cause mortality expressed as hazard ratio (HR). Six articles fulfilled inclusion criteria, three were on mitraclip and three on TAVI. A total of 2329 patients were analysed (mean age was 78.38 (3.09), 63% male): 1328 treated with TAVI and 1001 with mitraclip. The HR for all-cause mortality of moderate to severe TR was 2.0 (95% CI 1.57-2.55, I2 = 0%). Data were confirmed also after subgroup analysis for mitraclip vs. TAVI. None of the factor considered in meta-regression analyses was affecting the primary outcome. Conclusions The current meta-analysis suggests that the presence of moderate to severe TR in patients undergoing mitraclip or TAVI might be a major determinant of all-cause mortality. New studies are needed to confirm it and to plan possible intervention in order to reduce its impact.
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Affiliation(s)
- Rita Pavasini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Cona, (FE), Italy
| | - Sara Ruggerini
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico d Modena, Italy
| | - Julia Grapsa
- Heart and vascular institute, Cleaveland Clinic, Cleaveland, USA
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Cona, (FE), Italy
| | - Carlo Tumscitz
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Cona, (FE), Italy
| | - Matteo Serenelli
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Cona, (FE), Italy
| | - Giuseppe Boriani
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico d Modena, Italy
| | - Angelo Squeri
- Cardiology Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Cona, (FE), Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S.: Health Science Foundation, Cotignola, Italy
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71
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Keßler M, Pott A, Mammadova E, Seeger J, Wöhrle J, Rottbauer W, Markovic S. Atrial Fibrillation Predicts Long-Term Outcome after Transcatheter Edge-to-Edge Mitral Valve Repair by MitraClip Implantation. Biomolecules 2018; 8:biom8040152. [PMID: 30463247 PMCID: PMC6316291 DOI: 10.3390/biom8040152] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/04/2018] [Accepted: 11/08/2018] [Indexed: 11/29/2022] Open
Abstract
Background: Atrial fibrillation is common in patients with mitral regurgitation (MR) and has a negative impact on the clinical outcome of patients with valvular heart disease. We aimed to evaluate the impact of pre-procedural atrial fibrillation on the long-term clinical outcomes of patients with MR undergoing transcatheter mitral valve repair by MitraClip implantation. Methods: We analysed 355 consecutive patients with and without atrial fibrillation with symptomatic, severe MR and inoperability or high surgical risk undergoing MitraClip implantation in a three-year follow-up. Results: In patients with pre-procedural atrial fibrillation undergoing MitraClip implantation, we found advanced age, higher baseline NT-pro-BNP levels, increased left atrial diameter, and higher rate of severe tricuspid regurgitation, compared to patients with sinus rhythm. In the three-year follow-up after MitraClip implantation, mortality and major adverse cardiovascular and cerebral events (MACCE) occur significantly more often in patients with atrial fibrillation, compared to patients without atrial fibrillation. Multivariate regression analysis confirmed atrial fibrillation (hazard ratio 2.39, 95%-confidence interval 1.06–5.41, p = 0.036) as an independent predictor for three-year-mortality after MitraClip implantation. Conclusions: Atrial fibrillation is an independent predictor for long-term mortality after MitraClip implantation. We demonstrate the association of atrial fibrillation with mortality and MACCE in the long-term follow-up of patients undergoing MitraClip implantation.
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Affiliation(s)
- Mirjam Keßler
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
| | - Alexander Pott
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
| | - Elnura Mammadova
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
| | - Julia Seeger
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
| | - Jochen Wöhrle
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
| | - Sinisa Markovic
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
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72
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De Rosa R, Silverio A, Baldi C, Di Maio M, Prota C, Radano I, Rey J, Herrmann E, Citro R, Piscione F, Galasso G. Transcatheter Repair of Functional Mitral Regurgitation in Heart Failure Patients ― A Meta-Analysis of 23 Studies on MitraClip Implantation ―. Circ J 2018; 82:2800-2810. [DOI: 10.1253/circj.cj-18-0571] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Roberta De Rosa
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Angelo Silverio
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Cesare Baldi
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Marco Di Maio
- Division of Cardiology, Department of Cardiothoracic and Respiratory Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, AORN “Ospedali dei Colli”
| | - Costantina Prota
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Ilaria Radano
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Julia Rey
- Department of Medicine, Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt
| | - Eva Herrmann
- Department of Medicine, Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt
| | - Rodolfo Citro
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Federico Piscione
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Gennaro Galasso
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
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73
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Megaly M, Abraham B, Saad M, Omer M, Elbadawi A, Tawadros M, Khalil C, Nairoz R, Almomani A, Sengupta J, Kalra A, Brilakis E, Gafoor S. Impact of Atrial Fibrillation on the Outcomes after MitraClip®: A Meta-Analysis. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2018. [DOI: 10.1080/24748706.2018.1517952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Michael Megaly
- Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, Minnesota, USA
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center , Minneapolis, Minnesota, USA
| | - Bishoy Abraham
- Department of Medicine, St. John Providence Hospital , Detroit, Michigan, USA
| | - Marwan Saad
- Department of Cardiovascular Medicine, University of Arkansas , Little Rock, Arkansas, USA
- Division of Cardiology, Ain Shams University , Cairo, Egypt
| | - Mohamed Omer
- Cardiology Division, Saint Luke’s Hospital , Kansas City, Missouri, USA
| | - Ayman Elbadawi
- Division of Cardiology, Rochester General Hospital , Rochester, New York, USA
| | - Mariam Tawadros
- Department of Cardiology, Ain Shams University Medical School , Cairo, Egypt
| | - Charl Khalil
- Department of Internal Medicine, University of Buffalo , Buffalo, New York, USA
| | - Ramez Nairoz
- Division of Cardiology, University of South California , Los Angeles, California, USA
| | - Ahmed Almomani
- Department of Cardiovascular Medicine, University of Arkansas , Little Rock, Arkansas, USA
| | - Jay Sengupta
- Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, Minnesota, USA
| | - Ankur Kalra
- Division of Cardiology, Case Western Reserve University School of Medicine , Cleveland, Ohio, USA
| | - Emmanouil Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, Minnesota, USA
| | - Sameer Gafoor
- Division of Cardiology, Swedish Medical Center , Seattle, Washington, USA
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74
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Transcatheter Tricuspid and Mitral Valve Edge-to-Edge Repair: The Double Double Orifice. CASE 2018; 2:164-173. [PMID: 30370377 PMCID: PMC6200677 DOI: 10.1016/j.case.2018.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Tricuspid regurgitation with mitral valve disease is associated with poor outcomes. Transcatheter edge-to-edge repair of the tricuspid valve can be done successfully. Intraprocedural echocardiography is essential for transcatheter tricuspid therapies.
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75
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Murray CSG, Salama AY, Akdogan RE, Harb S, Nahar T, Nanda NC. Assessment of tricuspid valve by two- and three-dimensional echocardiography with special reference to percutaneous repair and prosthetic valve implantation procedures. Echocardiography 2018; 35:1419-1438. [PMID: 30209853 DOI: 10.1111/echo.14130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 07/28/2018] [Accepted: 08/06/2018] [Indexed: 11/28/2022] Open
Abstract
Moderate-to-severe tricuspid regurgitation affects approximately 1.6 million people in the United States. An estimated 8000 patients will undergo tricuspid surgery annually, leaving a large number of patients with this condition untreated. Many of these individuals who are not referred for surgery engender a large unmet clinical need; this may be primarily due to the surgical risk involved. In persons who are categorized as high-risk surgical candidates, percutaneous procedures present a viable alternative. The majority of developmental attention as regards percutaneous approaches has been focused on the aortic and mitral valves recently, but few data are available about the feasibility and efficacy of minimally invasive tricuspid valve treatment. We review the usefulness of two- and three-dimensional echocardiography in the assessment of the tricuspid valve with special reference to recent interest in percutaneous repair and prosthetic valve implantation procedures for severe functional tricuspid regurgitation.
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Affiliation(s)
- Christopher S G Murray
- Department of Internal Medicine, Harlem Hospital Center/Columbia University, New York, New York
| | - Ahmed Y Salama
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Raziye E Akdogan
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Serge Harb
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Tamanna Nahar
- Section of Cardiology, Department of Internal Medicine, Harlem Hospital Center/Columbia University, New York, New York
| | - Navin C Nanda
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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76
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Abstract
PURPOSE OF REVIEW This report aims to define the clinical and anatomic variables key in determining patient suitability for transcatheter mitral valve therapies. RECENT FINDINGS Candidacy for transcatheter mitral valve repair requires weighing the clinical variables that may impact the ability to improve patient symptoms and prolong survival that include left ventricular ejection fraction, symptom severity, pulmonary hypertension, and magnitude of residual regurgitation or stenosis. Individualized selection of transcatheter repair or replacement based on patho-anatomy is being explored. The primary goal is achieving significant reduction in mitral regurgitation. Transcatheter mitral valve replacement requires rigorous anatomic screening using computed tomography and candidates should be able to take oral anticoagulation. Selection of patients for transcatheter mitral valve repair is complex and requires intimate knowledge of clinical variables and specific device limitations.
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77
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Grasso C, Popolo Rubbio A, Braun D, Hausleiter J, Nickenig G. Transcatheter treatment of tricuspid regurgitation (focusing on current technologies). EUROINTERVENTION 2018; 14:AB112-AB120. [DOI: 10.4244/eij-d-18-00520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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78
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Hausleiter J, Braun D, Orban M, Latib A, Lurz P, Boekstegers P, von Bardeleben RS, Kowalski M, Hahn RT, Maisano F, Hagl C, Massberg S, Nabauer M. Patient selection, echocardiographic screening and treatment strategies for interventional tricuspid repair using the edge-to-edge repair technique. EUROINTERVENTION 2018; 14:645-653. [DOI: 10.4244/eij-d-17-01136] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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79
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Prihadi EA, van der Bijl P, Gursoy E, Abou R, Mara Vollema E, Hahn RT, Stone GW, Leon MB, Ajmone Marsan N, Delgado V, Bax JJ. Development of significant tricuspid regurgitation over time and prognostic implications: new insights into natural history. Eur Heart J 2018; 39:3574-3581. [PMID: 30010848 DOI: 10.1093/eurheartj/ehy352] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 06/01/2018] [Indexed: 01/12/2023] Open
Affiliation(s)
- Edgard A Prihadi
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
- Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium
| | - Pieter van der Bijl
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
| | - Erhan Gursoy
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
| | - Rachid Abou
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
| | - E Mara Vollema
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
| | - Rebecca T Hahn
- New York Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, 630 West 168th Street, New York, NY, USA
| | - Gregg W Stone
- New York Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, 630 West 168th Street, New York, NY, USA
| | - Martin B Leon
- New York Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, 630 West 168th Street, New York, NY, USA
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
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80
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Besler C, Orban M, Rommel KP, Braun D, Patel M, Hagl C, Borger M, Nabauer M, Massberg S, Thiele H, Hausleiter J, Lurz P. Predictors of Procedural and Clinical Outcomes in Patients With Symptomatic Tricuspid Regurgitation Undergoing Transcatheter Edge-to-Edge Repair. JACC Cardiovasc Interv 2018; 11:1119-1128. [DOI: 10.1016/j.jcin.2018.05.002] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/23/2018] [Accepted: 05/01/2018] [Indexed: 11/28/2022]
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81
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Combined Mitral and Tricuspid Versus Isolated Mitral Valve Transcatheter Edge-to-Edge Repair in Patients With Symptomatic Valve Regurgitation at High Surgical Risk. JACC Cardiovasc Interv 2018; 11:1142-1151. [DOI: 10.1016/j.jcin.2018.04.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/03/2018] [Indexed: 12/13/2022]
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82
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Lausberg HF, Gryszkiewicz R, Kuetting M, Baumgaertner M, Centola M, Wendel HP, Nowak-Machen M, Schibilsky D, Kruger T, Schlensak C. Catheter-based tricuspid valve replacement: first experimental data of a newly designed bileaflet stent graft prosthesis. Eur J Cardiothorac Surg 2018; 52:189-196. [PMID: 28430904 DOI: 10.1093/ejcts/ezx084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/03/2017] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Moderate or severe degree tricuspid valve regurgitation (TVR) is associated with high rates of morbidity and mortality. Surgical correction as the only therapeutic option offers unsatisfactory results. Recently, several interventional procedures have been introduced clinically in a limited cohort. We present our initial experiments with an innovative interventional valved stent graft for treatment of TVR. METHODS A newly designed porcine pericardium-covered nitinol stent graft with a lateral bicuspid valve was adapted to size in a cadaver study. After haemodynamic testing in an ex vivo perfusion setup, vascular access, valve delivery and function were investigated in an ovine animal model ( n = 7). RESULTS The device was implanted successfully in all animals. Vascular access was established surgically via the femoral vein without any vascular complications. Angiography demonstrated the correct position of the device with proper sealing of both venae cavae in 6 animals. In 1 extremely large animal, the position of the device was considered too cranial but still acceptable. Correct valve function was verified in all animals by both angiography and echocardiography. There were no persistent arrhythmias other than during valve implant. All animals survived the implant procedure and were sacrificed electively. CONCLUSIONS This study demonstrated that this new valved stent graft could be delivered safely with correct positioning and valve function in this ovine model. Further long-term studies in animals implanted with the device after creation of tricuspid regurgitation are necessary to prove the haemodynamic benefit of this procedure.
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Affiliation(s)
- Henning F Lausberg
- Department of Thoracic and Cardiovascular Surgery, German Heart Competence Centre, Tuebingen University Medical Center, Tuebingen, Germany
| | - Rafal Gryszkiewicz
- Department of Thoracic and Cardiovascular Surgery, German Heart Competence Centre, Tuebingen University Medical Center, Tuebingen, Germany
| | | | | | | | - Hans-Peter Wendel
- Department of Thoracic and Cardiovascular Surgery, German Heart Competence Centre, Tuebingen University Medical Center, Tuebingen, Germany
| | - Martina Nowak-Machen
- Department of Anaesthesiology and Intensive Care Medicine, Tuebingen University Medical Center, Tuebingen, Germany
| | - David Schibilsky
- Department of Thoracic and Cardiovascular Surgery, German Heart Competence Centre, Tuebingen University Medical Center, Tuebingen, Germany
| | - Tobias Kruger
- Department of Thoracic and Cardiovascular Surgery, German Heart Competence Centre, Tuebingen University Medical Center, Tuebingen, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, German Heart Competence Centre, Tuebingen University Medical Center, Tuebingen, Germany
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83
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Orban M, Besler C, Braun D, Nabauer M, Zimmer M, Orban M, Noack T, Mehilli J, Hagl C, Seeburger J, Borger M, Linke A, Thiele H, Massberg S, Ender J, Lurz P, Hausleiter J. Six-month outcome after transcatheter edge-to-edge repair of severe tricuspid regurgitation in patients with heart failure. Eur J Heart Fail 2018; 20:1055-1062. [PMID: 29405554 DOI: 10.1002/ejhf.1147] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 11/10/2022] Open
Abstract
AIMS Severe tricuspid regurgitation (TR) is common in patients with right-sided heart failure (HF) and causes substantial morbidity and mortality. Treatment options beyond medical therapy are limited for high-risk patients. Transcatheter edge-to-edge tricuspid valve (TV) repair showed procedural safety and short-term efficacy. Impact on mid-term outcome is unclear. This dual-centre observational study evaluates the mid-term safety, efficacy and clinical outcome after edge-to-edge TV repair for severe TR in patients with HF. METHODS AND RESULTS Overall, 50 patients with right-sided HF and severe TR were treated with the transcatheter edge-to-edge repair technique; 14 patients were treated for isolated TR and 36 patients for combined mitral regurgitation (MR) and TR. At 6-month follow-up (available for 98% of patients), a persistent reduction of at least one echocardiographic TR grade was achieved in 90% of patients and New York Heart Association class improved in 79% of patients. The 6-minute walk distance increased by 44% (+84 m, P < 0.001), the median N-terminal pro-B-type natriuretic peptide decreased by 30% (from 3625 to 2526 pg/mL, P = 0.002), and the quality of life score improved by 16% (decrease of 6 points in the Minnesota Living with Heart Failure Questionnaire score, P = 0.056). The improvements were comparable in patients undergoing isolated TR or combined MR and TR treatment. During follow-up, 8 patients died, 14 were hospitalized for worsening of HF, 2 underwent TV surgery, and 2 received a second TV clip procedure. CONCLUSIONS Transcatheter edge-to-edge TV repair for severe TR is safe and effective in reducing TR. It appears to be associated with improved clinical outcome in the majority of patients.
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Affiliation(s)
- Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Christian Besler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Michael Nabauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Marion Zimmer
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Thilo Noack
- Department of Heart Surgery, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Julinda Mehilli
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Joerg Seeburger
- Department of Heart Surgery, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Michael Borger
- Department of Heart Surgery, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Axel Linke
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Joerg Ender
- Department of Anaesthesiology and Intensive Care Medicine, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
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84
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Tratamientos percutáneos de la valvulopatía tricuspídea: una nueva esperanza para la válvula «olvidada». Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2017.04.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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85
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Toyama K, Ayabe K, Kar S, Kubo S, Minamishima T, Rader F, Shiota T, Nishioka T, Siegel RJ. Postprocedural Changes of Tricuspid Regurgitation After MitraClip Therapy for Mitral Regurgitation. Am J Cardiol 2017; 120:857-861. [PMID: 28689751 DOI: 10.1016/j.amjcard.2017.05.044] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/13/2017] [Accepted: 05/26/2017] [Indexed: 10/19/2022]
Abstract
The effect of percutaneous mitral valve repair using the MitraClip system on tricuspid regurgitation (TR) has not been well investigated. We retrospectively analyzed 102 consecutive patients who underwent the successful MitraClip procedure, and who also had a preprocedural and 1-year follow-up transthoracic echocardiography. TR severity was graded by standard guideline-recommended criteria. At 1 year after the MitraClip procedure, the degree of TR regressed (at least 1 grade) in 23% of the patients, was unchanged in 62% of the patients, and progressed in 16% of the patients. Compared with patients in the other groups, the patients with TR regression had a greater severity of TR at baseline. The TR regression group showed a significant reduction in the systolic pulmonary artery pressure (sPAP) (49 ± 13 to 37 ± 11 mm Hg, p <0.05), a right-sided cardiac reverse remodeling (right ventricular diameter: 41 ± 7 to 39 ± 7 mm, tricuspid annular diameter: 48 ± 8 to 46 ± 9 mm, both p <0.05), and an increase in the right ventricular fractional area change (38 ± 7 to 40 ± 7%, p <0.05). In the multivariate analysis, the decrease in sPAP was the only independent parameter change associated with TR regression. In conclusion, TR regression was observed in 23% of the patients after the successful MitraClip procedures, and favorable echocardiographic parameter changes were detected in this group. Only a reduction in sPAP was independently associated with TR regression.
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Antunes MJ, Rodríguez-Palomares J, Prendergast B, De Bonis M, Rosenhek R, Al-Attar N, Barili F, Casselman F, Folliguet T, Iung B, Lancellotti P, Muneretto C, Obadia JF, Pierard L, Suwalski P, Zamorano P. Management of tricuspid valve regurgitation. Eur J Cardiothorac Surg 2017; 52:1022-1030. [DOI: 10.1093/ejcts/ezx279] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/27/2017] [Indexed: 12/18/2022] Open
Affiliation(s)
- Manuel J Antunes
- Department of Cardiothoracic Surgery and Transplantation of Thoracic Organs, University Hospital and Faculty of Medicine of Coimbra, Coimbra, Portugal
| | - José Rodríguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - Michele De Bonis
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Raphael Rosenhek
- Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Nawwar Al-Attar
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK
| | - Fabio Barili
- Department of Cardiovascular Surgery, S. Croce Hospital, Cuneo, Italy
| | - Filip Casselman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Thierry Folliguet
- Department of Cardiothoracic Surgery and Transplantation, University of Lorraine, Centre Hospitalier Universitaire Brabois, Vandoeuvre les Nancy, France
| | - Bernard Iung
- Department of Cardiology, Bichat Hospital, APHP, Paris Diderot University, DHU Fire, Paris, France
| | - Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, University of Liège Hospital, Liège, Belgium
- Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Claudio Muneretto
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Jean-François Obadia
- Chirurgie Cardiothoracique et Transplantation Cardiaque, Hôpital Louis Pradel, Lyon, France
| | - Luc Pierard
- Department of Cardiology, University Hospital Sart Tilman, Liège, Belgium
| | - Piotr Suwalski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
- Pulaski University of Technology and Humanities, Radom, Poland
| | - Pepe Zamorano
- University Alcala, Hospital Ramon y Cajal, Madrid, Spain
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Hahn RT, Zamorano JL. The need for a new tricuspid regurgitation grading scheme. Eur Heart J Cardiovasc Imaging 2017; 18:1342-1343. [DOI: 10.1093/ehjci/jex139] [Citation(s) in RCA: 250] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mangieri A, Montalto C, Pagnesi M, Jabbour RJ, Rodés-Cabau J, Moat N, Colombo A, Latib A. Mechanism and Implications of the Tricuspid Regurgitation. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005043. [DOI: 10.1161/circinterventions.117.005043] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/15/2017] [Indexed: 01/28/2023]
Abstract
The tricuspid valve was virtually ignored for a long time in the past. However, significant tricuspid regurgitation (TR) often accompanies left-side heart valve pathology and does not always reverse with its correction. If left untreated, TR can progress and result in progressive right ventricular failure. Current guideline recommendations still hold minor differences. Nevertheless, there is a consensus to operate on patients with severe TR undergoing left-sided valve surgery (class I) or those with mild to moderate TR with a dilated annulus (≥40 or ≥21 mm
2
, Class IIa). However, in case of the primary TR, surgical options is limited by a relatively high risk of mortality and morbidity. For these patients, new percutaneous approaches are becoming available but no long-term data are still available. In this review, we provide a comprehensive overview of the epidemiological and pathophysiological aspects of TR, and the current and future directions of therapy.
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Affiliation(s)
- Antonio Mangieri
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Claudio Montalto
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Matteo Pagnesi
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Richard J. Jabbour
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Josep Rodés-Cabau
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Neil Moat
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Antonio Colombo
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Azeem Latib
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
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Campelo-Parada F, Lairez O, Carrié D. Percutaneous Treatment of the Tricuspid Valve Disease: New Hope for the "Forgotten" Valve. ACTA ACUST UNITED AC 2017. [PMID: 28645836 DOI: 10.1016/j.rec.2017.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tricuspid valve disease is a frequent condition but is currently undertreated. A limited number of patients undergo an isolated surgical tricuspid repair, and this intervention is associated with poor outcomes, especially in patients with previous cardiac surgery. Most patients are only medically treated, despite the impact of severe tricuspid regurgitation on functional status and long-term survival. Transcatheter therapies represent a promising alternative for patients with severe tricuspid regurgitation and high surgical risk. In the last few years, several percutaneous alternatives have been developed for the treatment of functional tricuspid regurgitation. Imaging techniques play an indispensable role in patient selection, procedural guidance and follow-up. The current available transcatheter options for native tricuspid valve disease can be divided into 3 main groups: heterotopic caval valve implantation, annuloplasty devices, and coaptation devices. In patients with previous tricuspid valve surgery, transcatheter valve-in-valve and valve-in-ring procedures have been reported. This review provides a detailed analysis of the novel transcatheter alternatives for the treatment of tricuspid valve disease that have already been successfully implanted in humans, as well as the most important aspects of tricuspid valve anatomy and imaging assessment.
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Affiliation(s)
| | - Olivier Lairez
- Department of Cardiology, Rangueil University Hospital, CHU Toulouse, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, Rangueil University Hospital, CHU Toulouse, Toulouse, France
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90
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Braun D, Nabauer M, Orban M, Orban M, Gross L, Englmaier A, Rösler D, Mehilli J, Bauer A, Hagl C, Massberg S, Hausleiter J. Transcatheter treatment of severe tricuspid regurgitation using the edge-to-edge repair technique. EUROINTERVENTION 2017; 12:e1837-e1844. [PMID: 28089953 DOI: 10.4244/eij-d-16-00949] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to investigate the procedural feasibility and short-term durability of the transcatheter tricuspid valve edge-to-edge repair technique in highly symptomatic patients with severe tricuspid regurgitation (TR). METHODS AND RESULTS Eighteen consecutive patients suffering from severe right-sided heart failure (NYHA Class III-IV), primarily due to moderate to severe tricuspid regurgitation, were included in the study. Applying a modified steering technique for the clip delivery system, six patients were treated for isolated severe TR, while 12 patients were treated for moderate to severe TR and concomitant severe mitral regurgitation. The primary objectives were procedural success, defined as reduction of at least one TR grade, and 30-day echocardiographic and clinical outcomes. A total of 41 clips (2.3±0.7 per patient) were placed into the tricuspid valve of high surgical risk patients (EuroSCORE II: 10±8%). Procedural success was achieved in all patients; no MACCE occurred in hospital. The presence of a TR grade ≥3 was reduced from 94% (17 patients) before the procedure to 33% (six patients) at 30-day follow-up (p<0.001). Sixteen patients (89%) reported an improvement in NYHA functional class at 30 days. CONCLUSIONS Applying a modified steering technique, the edge-to-edge repair technique can be successfully used for the treatment of TR. At 30-day follow-up, the short-term durability of TR reduction appeared promising and the majority of patients improved clinically. Further studies with larger patient populations and longer follow-up have to define the role of this novel treatment option for patients with right-sided heart failure and severe TR.
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Affiliation(s)
- Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
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Hahn RT. Current transcatheter devices to treat functional tricuspid regurgitation with discussion of issues relevant to clinical trial design. Ann Cardiothorac Surg 2017; 6:240-247. [PMID: 28706866 DOI: 10.21037/acs.2017.03.10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Functional or secondary tricuspid regurgitation (TR) has seen increased attention in recent times as relationships with clinically-relevant outcomes have come to light. Despite the association of increased mortality with significant TR, the disease remains under-recognized and thus relatively untreated. In addition, the disease itself has not been extensively studied and the interactions between annular dilatation, right heart disease and pulmonary hypertension are poorly understood. However, the high mortality and recurrence rate with current surgical replacement or repair techniques is well recognised, opening the door to transcatheter therapies for functional TR. The current perspective reviews the rationale for transcatheter solutions, describes some of the current approaches and discusses the ongoing questions of a poorly-studied condition which may limit the design of clinical trials for this disease.
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Affiliation(s)
- Rebecca T Hahn
- Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
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93
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Hahn RT, Meduri CU, Davidson CJ, Lim S, Nazif TM, Ricciardi MJ, Rajagopal V, Ailawadi G, Vannan MA, Thomas JD, Fowler D, Rich S, Martin R, Ong G, Groothuis A, Kodali S. Early Feasibility Study of a Transcatheter Tricuspid Valve Annuloplasty. J Am Coll Cardiol 2017; 69:1795-1806. [DOI: 10.1016/j.jacc.2017.01.054] [Citation(s) in RCA: 188] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
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Alozie A, Paranskaya L, Westphal B, Kaminski A, Sherif M, Sindt M, Kische S, Schubert J, Diedrich D, Ince H, Steinhoff G, Öner A. Clinical outcomes of conventional surgery versus MitraClip® therapy for moderate to severe symptomatic mitral valve regurgitation in the elderly population: an institutional experience. BMC Cardiovasc Disord 2017; 17:85. [PMID: 28320316 PMCID: PMC5360063 DOI: 10.1186/s12872-017-0523-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 03/11/2017] [Indexed: 01/27/2023] Open
Abstract
Background The aim of this study was to compare treatment of moderate to severe symptomatic mitral regurgitation (MR) with either conventional surgery or the mitral valve edge-to-edge device (MitraClip®) in very elderly patients. The newly introduced MitraClip device has demonstrated promising acute results in treating this patient cohort. Also noteworthy is the fact that patients who otherwise would have been denied surgery are increasingly referred for treatment with the MitraClip device. We sought to review our institutional experience, comparing outcomes in both surgical and MitraClip arms of treatment in the elderly population with symptomatic MR. Methods From October 2008 through October 2014, 136 consecutive patients aged ≥ 80 with moderate to severe symptomatic MR were scheduled for either conventional surgery or MitraClip intervention. 56 patients ≥ 80 were operated for symptomatic MR and 80 patients ≥ 80 were treated with the mitraClip device. Patients suitable for this study were identified from our hospital database. Patients ≥80 with moderate/severe symptomatic MR treated with either conventional surgery or the MitraClip device were eligible for our analysis. We compared the surgical patient cohort with the mitraClip patient cohort after eliminating patients that did not meet our inclusion criteria. Forty-two patients were identified from the conventional cohort who were then compared with 42 patients from the mitraClip cohort. Forty-two patients (50%) underwent mitral valve repair or replacement (40.5% functional MR, 59.5% organic/mixed MR) and 42 patients (50%) underwent MitraClip intervention (50% functional MR, 50% organic/mixed MR). Associated procedures in the conventional surgical group were myocardial revascularization 38%, pulmonary vein ablation 23.8%, left atrial appendage resection 52.4% and PFO occlusion 11.9%. Results Patients who underwent MitraClip treatment were though slightly older but the differences did not attain statistical significance (mean, 82.2 ± 1.65 vs 81.7 ± 1.35 years, p = 0,100), had lower LVEF (mean, 47.6 ± 14.2 vs 53.4 ± 14.3, p = 0.072), lower logistic EuroScore II (mean, 11.3 ± 5.63 vs 12.1 ± 10.6, p = 0.655) but higher STS risk score (mean, 11.8 ± 6.7 vs 8.1 ± 5.6, p = 0.008) respectively compared to surgical patients. Procedural success was 100% vs 96% in surgery and MitraClip groups respectively. Thirty -day mortality was 7.1% vs 4.8% (p = 1.000) in surgery and MitraClip group respectively. Residual postoperative MR ≥2 at discharge was present in none of the patients treated surgically, whereas this was the case in 10 (23.8%) patients treated with the MitraClip device. At 1 year a cumulative number of four (9.52%) patients died in the surgical group vs 9 (21.4%) patients who died in the MitraClip group. Conclusions Elderly patients presenting with moderate to severe symptomatic MR may either be treated by conventional surgery or with the MitraClip device with acceptable acute outcomes. The decision for treatment with the MitraClip device should not depend on age alone rather on cumulative risk of conventional surgery. Concomitant cardiac pathologies, often times treated simultaneously during surgery for symptomatic MR may be omitted, if patients are scheduled outright to MitraClip treatment. The effect of concomitant cardiac pathologies left untreated at the time of interventional mitral valve repair on outcome after MitraClip therapy remain widely unknown.
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Affiliation(s)
- Anthony Alozie
- Department of Cardiac Surgery, Heart Center Rostock, Schillingallee 35, 18057, Rostock, Germany.
| | - Liliya Paranskaya
- Department of Cardiology, Heart Center Rostock, Ernst-Heydemannstrasse 6, 18057, Rostock, Germany
| | - Bernd Westphal
- Department of Cardiac Surgery, Heart Center Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Alexander Kaminski
- Department of Cardiac Surgery, Heart Center Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Mohammad Sherif
- Department of Cardiology, Heart Center Rostock, Ernst-Heydemannstrasse 6, 18057, Rostock, Germany
| | - Magnus Sindt
- Department of Cardiac Surgery, Heart Center Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Stephan Kische
- Kardiologie und Konservative Intensivmedizin, Landsbergerallee 49, 10249, Berlin, Germany
| | - Jochen Schubert
- Department of Anesthesiology and Intensive Care Medicine, Heart Center Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Doreen Diedrich
- Institute For Biostatistics and Informatics in Medicine And Ageing Research, Ernst Heydemanstr. 8, 18057, Rostock, Germany
| | - Hüseyin Ince
- Department of Cardiology, Heart Center Rostock, Ernst-Heydemannstrasse 6, 18057, Rostock, Germany
| | - Gustav Steinhoff
- Department of Cardiac Surgery, Heart Center Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Alper Öner
- Department of Cardiology, Heart Center Rostock, Ernst-Heydemannstrasse 6, 18057, Rostock, Germany
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Yzeiraj E, Bijuklic K, Tiburtius C, Witt J, Krause K, Steude J, Hansen L, Rieß FC, Schofer J. Tricuspid regurgitation is a predictor of mortality after percutaneous mitral valve edge-to-edge repair. EUROINTERVENTION 2017; 12:e1817-e1824. [DOI: 10.4244/eij-d-16-00909] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kaneko H, Neuss M, Schau T, Weissenborn J, Butter C. Interaction between renal function and percutaneous edge-to-edge mitral valve repair using MitraClip. J Cardiol 2017; 69:476-482. [DOI: 10.1016/j.jjcc.2016.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 02/16/2016] [Accepted: 03/04/2016] [Indexed: 11/26/2022]
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Besler C, Meduri CU, Lurz P. Transcatheter Treatment of Functional Tricuspid Regurgitation Using the Trialign Device. Interv Cardiol 2017; 13:8-13. [PMID: 29593830 DOI: 10.15420/icr.2017:21:1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Functional tricuspid regurgitation (TR) represents an important unmet need in clinical cardiology given its prevalence, adverse prognostic impact and symptom burden associated with progressive right heart failure. Several transcatheter techniques are currently in early clinical testing to provide alternative treatment options for patients deemed unsuitable for tricuspid valve surgery. Amongst them, the TrialignTM device (Mitralign, Inc.) represents a novel percutaneous tricuspid valve annuloplasty technique, which aims to reduce tricuspid annular dilatation in functional TR by delivering and cinching two pledgeted sutures to the posterior portion of the tricuspid annulus via transjugular access. Early clinical data suggest the Trialign technique is safe and feasible, and associated with an improvement in quality-of-life measures. However, further studies are needed to confirm these data in larger cohorts of patients with longer follow up. In addition, future trials need to address the question whether TR reduction with the Trialign and other devices leads to an improvement in the patient`s functional status and prognosis, over and above medical treatment alone.
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Affiliation(s)
- Christian Besler
- Department of Cardiology, University of Leipzig - Heart CenterLeipzig, Germany
| | | | - Philipp Lurz
- Department of Cardiology, University of Leipzig - Heart CenterLeipzig, Germany
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98
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Schueler R, Öztürk C, Sinning JM, Werner N, Welz A, Hammerstingl C, Nickenig G. Impact of baseline tricuspid regurgitation on long-term clinical outcomes and survival after interventional edge-to-edge repair for mitral regurgitation. Clin Res Cardiol 2016; 106:350-358. [PMID: 27999930 DOI: 10.1007/s00392-016-1062-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/08/2016] [Indexed: 12/20/2022]
Abstract
AIMS Tricuspid regurgitation (TR) in patients with mitral valve disease is associated with poor outcome and mortality. Only limited data on the impact of TR on functional outcome and survival in patients undergoing MitraClip procedures are available. METHODS AND RESULTS 261 patients (mean age 76.6 ± 10, EuroScore 15.9 ± 15.1%) with symptomatic mitral regurgitation (MR) (75.2% functional MR) undergoing MitraClip procedure were included and followed for 721 ± 19.4 days. At baseline 54.7% presented with TR grade 0/I, 29.5% with grade II, 13.4% with grade III and 2.3% with grade IV. When dividing groups according to baseline TR grades, follow-up (FU)-NYHA class was significantly improved only in patients with TR ≤ II (p = 0.05). FU-6-min walking distance increased significantly in the overall cohort (p = 0.05), in patients with TR ≤ II (p = 0.007), but not in patients with TR > II (p = 0.4). Moreover, FU-NT-pro-BNP levels were higher in patients with TR > II (p = 0.05), compared to patients with TR ≤ II. There was a higher mortality according to baseline TR > II and multivariate Cox regression revealed TR > II as the strongest independent predictor for mortality (hazard ratio 2.04). CONCLUSIONS Concomitant TR at baseline negatively influences functional outcome and mortality in patients undergoing MitraClip procedures. Our results underline the need for dedicated interventional strategies for the treatment of TR in patients with symptomatic MR.
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Affiliation(s)
- Robert Schueler
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
| | - Can Öztürk
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Jan-Malte Sinning
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Nikos Werner
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Armin Welz
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Christoph Hammerstingl
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Georg Nickenig
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
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Hahn RT. State-of-the-Art Review of Echocardiographic Imaging in the Evaluation and Treatment of Functional Tricuspid Regurgitation. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.005332. [DOI: 10.1161/circimaging.116.005332] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Functional or secondary tricuspid regurgitation (TR) is the most common cause of severe TR in the Western world. The presence of functional TR, either isolated or in combination with left heart disease, is associated with unfavorable natural history. Surgical mortality for isolated tricuspid valve interventions remains higher than for any other single valve surgery, and surgical options for repair do not have consistent long-term durability. In addition, as more patients undergo transcatheter left valve interventions, developing transcatheter solutions for functional TR has gained greater momentum. Numerous transcatheter devices are currently in early clinical trials. All patients require an assessment of valve morphology and function, and transcatheter devices typically require intraprocedural guidance by echocardiography. The following review will describe tricuspid anatomy, define echocardiographic views for evaluating tricuspid valve morphology and function, and discuss imaging requirements for the current transcatheter devices under development for the treatment of functional TR.
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Affiliation(s)
- Rebecca T. Hahn
- From the Columbia University Medical Center, Department of Medicine, New York Presbyterian Hospital, NY
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Inderbitzin DT, Taramasso M, Nietlispach F, Maisano F. Percutaneous Mitral Valve Repair with MitraClip: Patient and Valve Selection for Optimal Outcome. Curr Cardiol Rep 2016; 18:129. [PMID: 27796866 DOI: 10.1007/s11886-016-0809-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the real world of mitral regurgitation, the patient selection process for MitraClip (Abbott, Abbott Park, IL, USA) to achieve optimal outcome has become a challenge. With the opening of the Endovascular Valve Edge-to-Edge Repair Study criteria, the implant experience was extended towards functional mitral regurgitation and anatomically more complex mitral pathologies in many centers worldwide. We provide a review of the current literature to identify an appropriate patient selection process for MitraClip therapy and suggest a simple two-dimensional decision-making algorithm.
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Affiliation(s)
- Devdas T Inderbitzin
- Department of Cardiovascular Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
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