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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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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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Lurz P, Kresoja KP. Tricuspid Valve Therapies: Closing the Gap. JACC Cardiovasc Interv 2021; 14:1241-1242. [PMID: 34112461 DOI: 10.1016/j.jcin.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany.
| | - Karl-Patrik Kresoja
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
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104
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Otto S, Velichkov M, Hamadanchi A, Schulze PC, Moebius-Winkler S. The impact of tricuspid annular geometry on outcome after percutaneous edge-to-edge repair for severe tricuspid regurgitation. Cardiol J 2021; 28:579-588. [PMID: 33942279 DOI: 10.5603/cj.a2021.0046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/19/2021] [Accepted: 02/25/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Percutaneous tricuspid repair using the edge-to-edge technique is a novel treatment option. More data are needed to better understand which aspects predict a favorable outcome. METHODS Twenty high-risk patients (78.6 ± 8.3 years, EuroScore II 9.1 ± 7.7%, STS score 8.8 ± 4.3) with severe symptomatic tricuspid regurgitation (TR) were treated with the MitraClip® system. All patients underwent standardized pre-, peri-, and post-procedural evaluation. Acute success was defined as successful edge-to-edge repair with TR reduction of ≥ 1 grade and survival until hospital discharge. RESULTS Fifteen (75%) patients showed acute success until discharge and 12 (60%) at 30-day followup. In 5 (25%) patients repair failed due to either unsuccessful clip implantation (n = 2), single leaflet device attachment (n = 1), TR reduction < 1 grade (n = 1), or in-hospital death (n = 1). Comparing patients with successful procedure versus those with failed repair revealed similar comorbidities but more severe right heart failure, lower left ventricular ejection fraction, worse renal function, and higher diuretic equivalent doses in the failed repair group. No differences in conventional echocardiographic parameters for TR severity but more dilated tricuspid annulus geometry (tricuspid valve annulus, coaptation depth, tenting area) in the failed repair group were observed. The success rate of non-central/non-anteroseptal jet location was only 25%. CONCLUSIONS Tricuspid annulus geometry assessment may be of crucial importance and seems to impact procedural outcomes in patients undergoing edge-to-edge tricuspid valve repair. Further investigations including advanced imaging are needed to better understand and treat this complex valve disease.
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Affiliation(s)
- Sylvia Otto
- Department of Internal Medicine I, Division of Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany.
| | - Marija Velichkov
- Department of Internal Medicine I, Division of Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany
| | - Ali Hamadanchi
- Department of Internal Medicine I, Division of Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany
| | - Sven Moebius-Winkler
- Department of Internal Medicine I, Division of Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany
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105
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Geyer M, Keller K, Bachmann K, Born S, Tamm AR, Ruf TF, Kreidel F, Hahad O, Petrescu A, Hell M, Beiras-Fernandez A, Kornberger A, Schulz E, Münzel T, von Bardeleben RS. Concomitant tricuspid regurgitation severity and its secondary reduction determine long-term prognosis after transcatheter mitral valve edge-to-edge repair. Clin Res Cardiol 2021; 110:676-688. [PMID: 33433670 PMCID: PMC8099767 DOI: 10.1007/s00392-020-01798-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/16/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Concomitant tricuspid regurgitation (TR) is a common finding in mitral regurgitation (MR). Transcatheter repair (TMVR) is a favorable treatment option in patients at elevated surgical risk. To date, evidence on long-term prognosis and the prognostic impact of TR after TMVR is limited. METHODS Long-term survival data of patients undergoing isolated edge-to-edge repair from June 2010 to March 2018 (combinations with other forms of TMVR or tricuspid valve therapy excluded) were analyzed in a retrospective monocentric study. TR severity was categorized and the impact of TR on survival was analysed. RESULTS Overall, 606 patients [46.5% female, 56.4% functional MR (FMR)] were enrolled in this study. TR at baseline was categorized severe/medium/mild/no or trace in 23.2/34.3/36.3/6.3% of the cases. At 30-day follow-up, improvement of at least one TR-grade was documented in 34.9%. Severe TR at baseline was identified as predictor of 1-year survival [65.2% vs. 77.0%, p = 0.030; HR for death 1.68 (95% CI 1.12-2.54), p = 0.013] and in FMR-patients also regarding long-term prognosis [adjusted HR for long-term mortality 1.57 (95% CI 1.00-2.45), p = 0.049]. Missing post-interventional reduction of TR severity was predictive for poor prognosis, especially in the FMR-subgroup [1-year survival: 92.9% vs. 78.3%, p = 0.025; HR for death at 1-year follow-up 3.31 (95% CI 1.15-9.58), p = 0.027]. While BNP levels decreased in both subgroups, TR reduction was associated with improved symptomatic benefit (NYHA-class-reduction 78.6 vs. 65.9%, p = 0.021). CONCLUSION In this large study, both, severe TR at baseline as well as missing secondary reduction were predictive for impaired long-term prognosis, especially in patients with FMR etiology. TR reduction was associated with increased symptomatic benefit.
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Affiliation(s)
- Martin Geyer
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
| | - Karsten Keller
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- Department of Sports Medicine, Medical Clinic VII, University Hospital Heidelberg, Heidelberg, Germany
| | - Kevin Bachmann
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Sonja Born
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Alexander R Tamm
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Tobias Friedrich Ruf
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Felix Kreidel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Omar Hahad
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Aniela Petrescu
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Michaela Hell
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Andres Beiras-Fernandez
- Department for Cardiothoracic and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr 1, 55131, Mainz, Germany
| | - Angela Kornberger
- Department for Cardiothoracic and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr 1, 55131, Mainz, Germany
| | - Eberhard Schulz
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Ralph Stephan von Bardeleben
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
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Rahgozar K, Ho E, Goldberg Y, Chau M, Latib A. Transcatheter tricuspid valve repair and replacement: a landscape review of current techniques and devices for the treatment of tricuspid valve regurgitation. Expert Rev Cardiovasc Ther 2021; 19:399-411. [PMID: 33834941 DOI: 10.1080/14779072.2021.1915133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background and ObjectiveTricuspid regurgitation is a prevalent and undertreated cardiac pathology impacting millions across the globe. While historically surgical interventions for isolated tricuspid regurgitation were largely avoided due to data citing poor surgical outcomes, advances in transcatheter techniques and imaging modalities have reframed the approach to tricuspid valve disease in promising new ways.MethodsHere we sought to provide a landscape review of the current state of the field for transcatheter tricuspid valve interventions. We first start with a descriptive overview of the tricuspid valve, reviewing the anatomy, imaging characteristics, and the current guidelines for tricuspid interventions. We then review both transcatheter valve repair and valve replacement modalities, highlighting the devices, techniques, and valves currently under investigation, summarizing available outcomes data for each modality when possible.Results and ConclusionOur aim in writing this landscape review is the create an all-encompassing, up-to-date resource for clinicians to refer to when seeking to learn about the current state of transcatheter tricuspid valve interventions. We also hope to highlight the exciting promise of transcatheter tricuspid valve replacement in appropriate patients, and review the valves currently under development for use in the tricuspid position.
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Affiliation(s)
- Kusha Rahgozar
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Edwin Ho
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ythan Goldberg
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mei Chau
- Department of Cardiothoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Hahn RT, Weckbach LT, Noack T, Hamid N, Kitamura M, Bae R, Lurz P, Kodali SK, Sorajja P, Hausleiter J, Nabauer M. Proposal for a Standard Echocardiographic Tricuspid Valve Nomenclature. JACC Cardiovasc Imaging 2021; 14:1299-1305. [PMID: 33744134 DOI: 10.1016/j.jcmg.2021.01.012] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/29/2020] [Accepted: 01/15/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The purpose of this study was to introduce a novel clinically relevant nomenclature system for the TV and determine the relative incidence of each morphological type. BACKGROUND With the rapid development of transcatheter tricuspid valve (TV) repair techniques, there is a growing recognition of the variability in leaflet morphology and a need for a unified nomenclature, which could aid in procedural planning and execution. METHODS Patients from 4 medical centers (2 in Europe, 2 in the United States) referred for transesophageal echocardiography (TEE) to assess native TV function, were retrospectively analyzed for leaflet morphology with the use of a novel classification scheme. Four morphological types were identified: type I, 3 leaflets; type II, 2 leaflets; type IIIA, 4 leaflets with 2 anterior; type IIIB, 4 leaflets with 2 posterior; type IIIC, 4 leaflets with 2 septal; and type IV, >4 leaflets. RESULTS A total of 579 patients were analyzed: mean age 78.1 ± 8.0 years, 50.4% female, 70.9% in atrial fibrillation, and 32.2% with previous left heart surgery or transcatheter intervention. Tricuspid regurgitation was moderate or less in 9.4%, severe in 40.5%, massive in 32.3%, and torrential in 17.7%. The etiology of tricuspid regurgitation was primary in 9.4%, mixed in 10.8%, and secondary in all of the other patients (18.6% atriogenic/isolated). The incidence of type I morphology was 312 of 579 (53.9%), type II was 26 of 579 (4.5%), type IIIA was 15 of 579 (2.6%), type IIIB was 186 of 579 (32.1%), type IIIC was 22 of 579 (3.8%), and type IV was 14 of 579 (2.4%). CONCLUSIONS A novel TV leaflet nomenclature classification scheme can be used to identify 4 types of TV morphologies with the use of TEE imaging. From this multinational retrospective study, the TV has 3 well defined leaflets in only ∼54% of patients and 4 functional leaflets in ∼39% of patients, with type IIIB (2 posterior leaflets) being the most common of the latter. The utility of this classification scheme deserves further study.
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Affiliation(s)
- Rebecca T Hahn
- New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.
| | - Ludwig T Weckbach
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, and Munich Heart Alliance, Munich, Germany
| | - Thilo Noack
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Nadira Hamid
- New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA
| | | | - Richard Bae
- Abbott Northwestern, Minneapolis, Minnesota, USA
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Susheel K Kodali
- New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA
| | - Paul Sorajja
- Abbott Northwestern, Minneapolis, Minnesota, USA
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, and Munich Heart Alliance, Munich, Germany
| | - Michael Nabauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, and Munich Heart Alliance, Munich, Germany
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Kitamura M, Fam NP, Braun D, Ruf T, Sugiura A, Narang A, Connelly KA, Ho E, Nabauer M, Hausleiter J, Weber M, Nickenig G, Davidson CJ, Thiele H, von Bardeleben RS, Lurz P. 12-Month outcomes of transcatheter tricuspid valve repair with the PASCAL system for severe tricuspid regurgitation. Catheter Cardiovasc Interv 2021; 97:1281-1289. [PMID: 33660364 DOI: 10.1002/ccd.29583] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/01/2021] [Accepted: 02/13/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES We investigated the durability of tricuspid regurgitation (TR) reduction and the clinical outcomes through 12 months after transcatheter tricuspid valve repair (TTVr) with the PASCAL Transcatheter Valve Repair System. BACKGROUND TTVr has rapidly developed and demonstrated favorable acute outcomes, but longer follow-up data are needed. METHODS Overall, 30 patients (age 77 ± 6 years; 57% female) received PASCAL implantation from September 2017 to May 2019 and completed a clinical follow-up at 12 months. RESULTS The TR etiology was functional in 25 patients (83%), degenerative in three (10%), and mixed in two (7%). All patients had TR severe or greater (massive or torrential in 80%) and heart failure symptoms (90% in NYHA III or IV) under optimal medical treatment. Single-leaflet device attachment occurred in two patients. Moderate or less TR was achieved in 23/28 patients (82%) at 30 days, which was sustained at 12 months (86%). Two patients underwent repeat TTVr due to residual torrential TR (day 173) and recurrence of severe TR (day 280), respectively. One-year survival rate was 93%; 6 patients required rehospitalization due to acute heart failure. NYHA functional class I or II was achieved in 90% and 6-minute walk distance improved from 275 ± 122 m at baseline to 347 ± 112 m at 12-month (+72 ± 82 m, p < .01). There was no stroke, endocarditis, or device embolization during the follow-up. CONCLUSIONS Twelve-month outcomes from this multicenter compassionate use experience with the PASCAL System demonstrated high procedural success, acceptable safety, and significant clinical improvement.
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Affiliation(s)
- Mitsunobu Kitamura
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Neil P Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Tobias Ruf
- Zentrum für Kardiologie, Universitätsmedizin Mainz, Johannes Gutenberg Universität Mainz, Mainz, Germany
| | - Atsushi Sugiura
- Medizinische Klinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Akhil Narang
- Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kim A Connelly
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Edwin Ho
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael Nabauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Marcel Weber
- Medizinische Klinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Georg Nickenig
- Medizinische Klinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Charles J Davidson
- Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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Transcatheter Tricuspid Valve Intervention in Patients With Previous Left Valve Surgery. Can J Cardiol 2021; 37:1094-1102. [PMID: 33617978 DOI: 10.1016/j.cjca.2021.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/08/2021] [Accepted: 02/13/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Scarce data exist on patients with previous left valve surgery (PLVS) undergoing transcatheter tricuspid valve intervention (TTVI). This study sought to investigate the procedural and early outcomes in patients with PLVS undergoing TTVI. METHODS This was a subanalysis of the multicenter TriValve registry including 462 patients, 82 (18%) with PLVS. Data were analyzed according to the presence of PLVS in the overall cohort and in a propensity score-matched population including 51 and 115 patients with and without PLVS, respectively. RESULTS Patients with PLVS were younger (72 ± 10 vs 78 ± 9 years; p < 0.01) and more frequently female (67.1% vs 53.2%; P = 0.02). Similar rates of procedural success (PLVS 80.5%; no-PLVS 82.1%; P = 0.73), and 30-day mortality (PLVS 2.4%, no-PLVS 3.4%; P = 0.99) were observed. After matching, there were no significant differences in both all-cause rehospitalisation (PLVS 21.1%, no-PLVS 26.5%; P = 0.60) and all-cause mortality (PLVS 9.8%, no-PLVS 6.7%; P = 0.58). At last follow-up (median 6 [interquartile range 1-12] months after the procedure), most patients (81.8%) in the PLVS group were in NYHA functional class I-II (P = 0.12 vs no-PLVS group), and TR grade was ≤ 2 in 82.6% of patients (P = 0.096 vs no-PVLS group). A poorer right ventricular function and previous heart failure hospitalization determined increased risks of procedural failure and poorer outcomes at follow-up, respectively. CONCLUSIONS In patients with PLVS, TTVI was associated with high rates of procedural success and low early mortality. However, about one-third of patients required rehospitalisation or died at midterm follow-up. These results would support TTVI as a reasonable alternative to redo surgery in patients with PLVS and suggest the importance of earlier treatment to improve clinical outcomes.
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110
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Goldberg YH, Ho E, Chau M, Latib A. Update on Transcatheter Tricuspid Valve Replacement Therapies. Front Cardiovasc Med 2021; 8:619558. [PMID: 33659278 PMCID: PMC7917079 DOI: 10.3389/fcvm.2021.619558] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/25/2021] [Indexed: 11/17/2022] Open
Abstract
Severe tricuspid regurgitation is relatively common, especially in the elderly, and portends poor survival. Neither medical therapy nor conventional surgery is efficacious for most patients. In contrast, transcatheter tricuspid valve interventions are showing promise to improve quality of life and mortality. Although there is more clinical experience with transcatheter tricuspid valve repair, there are many patients for which repair is either not possible or cannot optimally reduce the severity of tricuspid regurgitation. Transcatheter tricuspid valve replacement is rapidly emerging and may ultimately become the preferred treatment option. In this review, we discuss transcatheter tricuspid valve replacement, analyze the devices in development and in clinical trials, and highlight the advantages and drawbacks of transcatheter tricuspid valve replacement vs. repair.
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Affiliation(s)
- Ythan H Goldberg
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States
| | - Edwin Ho
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States
| | - Mei Chau
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States
| | - Azeem Latib
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States
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Transfemoral Transcatheter Tricuspid Valve Replacement With the EVOQUE System: A Multicenter, Observational, First-in-Human Experience. JACC Cardiovasc Interv 2021; 14:501-511. [PMID: 33582084 DOI: 10.1016/j.jcin.2020.11.045] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The purpose of this observational first-in-human experience was to investigate the feasibility and safety of the EVOQUE tricuspid valve replacement system and its impact on short-term clinical outcomes. BACKGROUND Transcatheter tricuspid intervention is a promising option for selected patients with severe tricuspid regurgitation (TR). Although transcatheter leaflet repair is an option for some, transcatheter tricuspid valve replacement (TTVR) may be applicable to a broader population. METHODS Twenty-five patients with severe TR underwent EVOQUE TTVR in a compassionate-use experience. The primary outcome was technical success, with NYHA (NYHA) functional class, TR grade, and major adverse cardiac and cerebrovascular events assessed at 30-day follow-up. RESULTS All patients (mean age 76 ± 3 years, 88% women) were at high surgical risk (mean Society of Thoracic Surgeons risk score 9.1 ± 2.3%), with 96% in NYHA functional class III or IV. TR etiology was predominantly functional, with mean tricuspid annular diameter of 44.8 ± 7.8 mm and mean tricuspid annular plane systolic excursion of 16 ± 2 mm. Technical success was 92%, with no intraprocedural mortality or conversion to surgery. At 30-day follow-up, mortality was 0%, 76% of patients were in NYHA functional class I or II, and TR grade was ≤2+ in 96%. Major bleeding occurred in 3 patients (12%), 2 patients (8%) required pacemaker implantation, and 1 patient (4%) required dialysis. CONCLUSIONS This first-in-human experience evaluating EVOQUE TTVR demonstrated high technical success, acceptable safety, and significant clinical improvement. Larger prospective studies are needed to confirm durability and safety and the impact on long-term clinical outcomes.
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Transcatheter Interventions for Tricuspid Valve Disease: What to Do and Who to Do It On. Can J Cardiol 2021; 37:953-967. [PMID: 33493660 DOI: 10.1016/j.cjca.2020.12.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/01/2020] [Accepted: 12/14/2020] [Indexed: 11/21/2022] Open
Abstract
Tricuspid valve disease, and particularly the management of severe tricuspid regurgitation (TR), has gained momentum in recent years. Although it is well known that this frequent condition is associated with poor clinical outcomes, these patients have been classically managed medically, leading to end-stage right ventricular heart failure. Moreover, late referral to surgery has contributed to a high rate of periprocedural complications and in-hospital surgical mortality. Thus, the development of a less invasive catheter-based therapy would be of high clinical relevance in this context. Several transcatheter tricuspid valve intervention (TTVI) devices have been developed in recent years. The particular characteristics of the tricuspid valve (large noncalcific annulus, presence of chief surrounding structures such as the conduction system or the right coronary artery) make multimodality imaging (eg, transesophageal echocardiography, computed tomography) key in the preprocedural assessment of TTVI. According to their mechanism of action and therapeutic target, TTVI includes transcatheter repair either with coaptation or annuloplasty systems, caval valve devices, and transcatheter tricuspid valve replacement. The initial TTVI experience showed that most procedures were well tolerated, with high procedural success and low in-hospital and early mortality. Also, most TTVI recipients improved their functional status and recent data suggest improved outcomes compared with medical management. However, the rate of significant residual TR after transcatheter tricuspid valve repair remains high and very scarce data exist on longer term (beyond 6-12 months) outcomes. The present review provides an overview regarding the framework of chronic TR and TTVI therapeutic options, and describes the updated current evidence in this challenging field.
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Mueller KAL, Jorbenadze R, Gawaz M, Schreieck J, Seizer P. "Mind the Gap": An 85-Year-Old Man with Severe Tricuspid Valve Regurgitation Who Underwent Percutaneous Edge-to-Edge Valve Leaflet Plication Using the New and Advanced MitraClip XTR System. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928089. [PMID: 33456048 PMCID: PMC7823151 DOI: 10.12659/ajcr.928089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patient: Male, 85-year-old Final Diagnosis: Severe tricuspid regurgitation Symptoms: Cardiac decompenstion • dyspnea Medication: — Clinical Procedure: Edge-to-edge valve repair using MitraCLip System XTR Specialty: Cardiology
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Affiliation(s)
- Karin Anne Lydia Mueller
- Department of Cardiology and Angiology, University Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Rezo Jorbenadze
- Department of Cardiology and Angiology, University Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Angiology, University Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Juergen Schreieck
- Department of Cardiology and Angiology, University Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Peter Seizer
- Department of Cardiology and Angiology, University Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany.,Hospital Ostalb gkAöR, Aalen, Germany
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Laricchia A, Khokhar AA, Giannini F. New Percutaneous Options for Tricuspid Intervention: How to Identify the Good Clinical Candidate. Front Cardiovasc Med 2020; 7:583307. [PMID: 33409292 PMCID: PMC7779547 DOI: 10.3389/fcvm.2020.583307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/30/2020] [Indexed: 11/24/2022] Open
Abstract
The tricuspid valve has been neglected for a long time and severe tricuspid regurgitation (TR) was largely undertreated in the past due to a high operative risk. In the last years we observed the development of different less invasive percutaneous options to treat TR. Currently, percutaneous treatments are reserved for high-risk patients presenting with advanced stage disease by which time they are likely to derive a partial benefit at best. There is a limited evidence base, including no randomized trials, to guide the management strategy for severe TR. In the interim we feel that choosing the best device for the most appropriate clinical candidate and with an adequate timing (most probably an “earlier” timing) will be the key combination to improve early and late outcomes of percutaneous treatments.
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Affiliation(s)
- Alessandra Laricchia
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Arif A Khokhar
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
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PASCAL versus MitraClip-XTR edge-to-edge device for the treatment of tricuspid regurgitation: a propensity-matched analysis. Clin Res Cardiol 2020; 110:451-459. [PMID: 33313975 PMCID: PMC7907034 DOI: 10.1007/s00392-020-01784-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022]
Abstract
Background Transcatheter tricuspid valve repair (TTVR) is a promising technique for the treatment of tricuspid regurgitation (TR). Data comparing the performance of novel edge-to-edge devices (PASCAL and MitraClip-XTR) are scarce. Methods We identified 80 consecutive patients who underwent TTVR using either the PASCAL or MitraClip-XTR system to treat symptomatic TR from July 2018 to June 2020. To adjust for baseline imbalances, we performed a propensity score (PS) 1:1 matching. The primary endpoint was a reduction in TR severity by at least one grade at 30 days. Results The PS-matched cohort (n = 44) was at high-surgical risk (EuroSCORE II: 7.5% [interquartile range (IQR) 4.8–12.1%]) with a mean TR grade of 4.3 ± 0.8 and median coaptation gap of 6.2 mm [IQR 3.2–9.1 mm]. The primary endpoint was similarly observed in both groups (PASCAL: 91% vs. MitraClip-XTR: 96%). Multiple device implantation was the most common form (59% vs. 82%, p = 0.19), and the occurrence of SLDA was comparable between the PASCAL and MitraClip-XTR system (5.7% [2 of 35 implanted devices] vs. 4.4% [2 of 45 implanted devices], p = 0.99). No periprocedural death or conversions to surgery occurred, and 30-day mortality (5.0% vs. 5.0%, log-rank p = 0.99) and 3-month mortality (10.0% vs. 5.0%, log-rank p = 0.56) were similar between both groups. During follow-up, functional NYHA class, 6-min walking distance, and health status improved in both groups. Conclusions Both TTVR devices, PASCAL and MitraClip-XTR, appeared feasible and comparable for an effective TR reduction. Randomized head-to-head comparisons will help to further define the appropriate scope of application of each system. Supplementary Information The online version contains supplementary material available at 10.1007/s00392-020-01784-w.
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116
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Stocker TJ, Hertell H, Orban M, Braun D, Rommel KP, Ruf T, Ong G, Nabauer M, Deseive S, Fam N, von Bardeleben RS, Thiele H, Massberg S, Lurz P, Hausleiter J. Cardiopulmonary Hemodynamic Profile Predicts Mortality After Transcatheter Tricuspid Valve Repair in Chronic Heart Failure. JACC Cardiovasc Interv 2020; 14:29-38. [PMID: 33309317 DOI: 10.1016/j.jcin.2020.09.033] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study was designed to assess hemodynamic changes in response to transcatheter tricuspid valve edge-to-edge repair (TTVR) and to identify hemodynamic predictors associated with mortality. BACKGROUND Severe tricuspid regurgitation (TR) is associated with high mortality. TTVR effectively alleviates heart failure symptoms, but comprehensive hemodynamic characterization of patients undergoing TTVR is currently lacking. METHODS This international, multicenter study included 236 patients undergoing TTVR. Data from clinical assessment, echocardiography, intraprocedural right heart catheterization, and noninvasive cardiac output measurement were analyzed. Hemodynamic predictors for mortality were identified using linear Cox regression analysis and were used for stratification of patients with subsequent analysis of survival time. RESULTS Patients (median age 78 years, 53% women) were symptomatic (89% in New York Heart Association functional class III or IV) because of severe TR (grade ≥3+ in 100%). TTVR significantly reduced TR at discharge (grade ≥3+ in 16%; p < 0.001), with a corresponding 19% reduction of the right atrial v wave (21 mm Hg vs. 16 mm Hg; p < 0.001) and an improvement in cardiac output (from 3.5 to 4.0 l/min; p < 0.01). Invasive mean pulmonary artery pressure, transpulmonary gradient, pulmonary vascular resistance, and right ventricular stroke work were significant predictors of 1-year mortality (p < 0.05 for all). Hemodynamic stratification by mean pulmonary artery pressure and transpulmonary gradient best predicted 1-year survival (p < 0.001). Although patients with pre-capillary dominant pulmonary hypertension showed an unfavorable prognosis (1-year survival 38%), patients without or with post-capillary pulmonary hypertension had favorable outcome (1-year survival 92% or 78%, respectively). CONCLUSIONS Invasive assessment of cardiopulmonary hemodynamic status predicts survival after TTVR. Invasive hemodynamic characterization may help identify patients profiting most from TTVR.
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Affiliation(s)
- Thomas J Stocker
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
| | - Helene Hertell
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Tobias Ruf
- Zentrum für Kardiologie, Johannes Gutenberg University, Mainz, Germany
| | - Geraldine Ong
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael Nabauer
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Holger Thiele
- Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Philipp Lurz
- Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
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117
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Ali FM, Ong G, Edwards J, Connelly KA, Fam NP. Comparison of transcatheter tricuspid valve repair using the MitraClip NTR and XTR systems. Int J Cardiol 2020; 327:156-162. [PMID: 33301831 DOI: 10.1016/j.ijcard.2020.11.073] [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: 10/05/2020] [Revised: 11/19/2020] [Accepted: 11/30/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Transcatheter tricuspid leaflet repair (TTVr) using the MitraClip is a promising option for patients with severe tricuspid regurgitation (TR) and heart failure. However, no comparative studies of the NTR and XTR systems have been reported. OBJECTIVES The aim of this study was to assess the relative efficacy, safety, and clinical outcomes of patients with severe TR treated with the MitraClip NTR and XTR systems. METHODS Forty consecutive patients with severe TR underwent TTVr. The primary outcome was procedural success, with NYHA functional class, TR grade and major adverse cardiac and cerebrovascular events (MACCE) assessed at 30-day follow-up. RESULTS The majority of patients had functional TR and a greater proportion of XTR patients had torrential TR with larger coaptation gaps. Procedural success was achieved in 70% vs 80% in the NTR and XTR cohorts. Single leaflet device attachment was equal in both groups (5%). At 30-day follow-up, 70% vs 85% of NTR and XTR patients were in NYHA Class I/II. The mean reduction in TR grade was greater in the XTR group (1.5 ± 0.3 vs 2.3 ± 0.4, p-0.012). In patients with torrential TR at baseline, 55% in the XTR group achieved TR ≤ 2+ compared to none in the NTR group (p < 0.001). CONCLUSIONS In this first study comparing the MitraClip NTR and XTR systems for TTVr, we found both to be safe and effective, while the XTR system allowed treatment of larger coaptation gaps, greater mean reduction in TR grade, with more effective reduction of torrential TR.
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Affiliation(s)
- Faeez M Ali
- St. Michael's Hospital, University of Toronto, Canada
| | - Geraldine Ong
- St. Michael's Hospital, University of Toronto, Canada
| | | | | | - Neil P Fam
- St. Michael's Hospital, University of Toronto, Canada.
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118
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Santaló-Corcoy M, Asmarats L, Li CH, Arzamendi D. Catheter-based treatment of tricuspid regurgitation: state of the art. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:964. [PMID: 32953764 PMCID: PMC7475403 DOI: 10.21037/atm.2020.03.219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Tricuspid regurgitation is a highly prevalent condition, with detrimental effects on long-term survival. However, it has been historically neglected, and only surgically addressed when symptomatic diuretic agents proved insufficient to alleviate congestion. Besides, mortality rates of isolated tricuspid regurgitation surgery have been persistently high, even in contemporary series. This has led to the advent of a myriad of transcatheter tricuspid valve interventions mimicking current surgical technologies, for which a comprehensive imaging work-up holds the key for proper patient selection and intraprocedural monitoring. Although initially designed for compassionate use patients, growing experience and encouraging results of these less-invasive technologies are broadening the spectrum of beneficiaries. In this review, we will focus on the current picture of transcatheter tricuspid valve interventions, with special interest on the current understanding of pathoanatomic tricuspid regurgitation progression, preprocedural multimodality imaging and the latest experience on the different transcatheter devices.
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Affiliation(s)
- Marcel Santaló-Corcoy
- Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lluís Asmarats
- Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Chi-Hion Li
- Division of Cardiac Imaging, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Dabit Arzamendi
- Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Kresoja K, Lauten A, Orban M, Rommel K, Alushi B, Besler C, Braun D, Unterhuber M, Stangl K, Landmesser U, Massberg S, Thiele H, Hausleiter J, Lurz P. Transcatheter tricuspid valve repair in the setting of heart failure with preserved or reduced left ventricular ejection fraction. Eur J Heart Fail 2020; 22:1817-1825. [DOI: 10.1002/ejhf.1975] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/26/2020] [Accepted: 07/29/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Karl‐Patrik Kresoja
- Department of Cardiology Heart Center Leipzig at University Leipzig Leipzig Germany
| | - Alexander Lauten
- Department of Cardiology University Heart Center Berlin and Charite University Medicine Berlin Berlin Germany
- German Centre for Cardiovascular Research (DZHK) Berlin 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) Munich Germany
| | - Karl‐Philipp Rommel
- Department of Cardiology Heart Center Leipzig at University Leipzig Leipzig Germany
| | - Brunilda Alushi
- Department of Cardiology University Heart Center Berlin and Charite University Medicine Berlin Berlin Germany
| | - Christian Besler
- Department of Cardiology Heart Center Leipzig at University 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) Munich Germany
| | - Matthias Unterhuber
- Department of Cardiology Heart Center Leipzig at University Leipzig Leipzig Germany
| | - Karl Stangl
- Department of Cardiology University Heart Center Berlin and Charite University Medicine Berlin Berlin Germany
| | - Ulf Landmesser
- Department of Cardiology University Heart Center Berlin and Charite University Medicine Berlin Berlin Germany
- 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) Munich Germany
| | - Holger Thiele
- Department of Cardiology Heart Center Leipzig at University 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) Munich Germany
| | - Philipp Lurz
- Department of Cardiology Heart Center Leipzig at University Leipzig Leipzig Germany
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Zaccone G, Di Pasquale M, Fiorina C, Curello S, Metra M, Adamo M. Transcatheter therapies for tricuspid valve regurgitation. J Cardiovasc Med (Hagerstown) 2020; 21:964-974. [DOI: 10.2459/jcm.0000000000001062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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121
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Agricola E, Asmarats L, Maisano F, Cavalcante JL, Liu S, Milla F, Meduri C, Rodés-Cabau J, Vannan M, Pibarot P. Imaging for Tricuspid Valve Repair and Replacement. JACC Cardiovasc Imaging 2020; 14:61-111. [PMID: 32828782 DOI: 10.1016/j.jcmg.2020.01.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 01/21/2020] [Accepted: 01/29/2020] [Indexed: 12/16/2022]
Abstract
Primary or secondary tricuspid regurgitation (TR) represents an important health care burden and challenge which has often been neglected or undertreated in the past. The expansion and reinforcement of the indications for tricuspid valve (TV) intervention in the 2017 editions of the guidelines as well as the introduction of transcatheter tricuspid valve intervention (TTVI) has considerably increased the attention of the community on the TV and the volume of TV interventions in the past years. Depending on the anatomic target, TTVI can be categorized as the following: 1) direct or indirect tricuspid restrictive annuloplasty; 2) direct (edge-to-edge repair) or indirect (coaptation device) restoration of leaflet coaptation; 3) heterotopic tricuspid valve implantation; and 4) transcatheter tricuspid valve replacement. Multimodality imaging has crucial role for the following: 1) patient selection for TTVI and procedure planning; 2) guiding and monitoring the procedure; and 3) assessing and following over time the results of the procedure. The key points for pre-procedural imaging are: 1) accurate quantitation of TR severity; 2) proper identification of the mechanism(s) responsible for the TR; and 3) quantitation of RV dysfunction and pulmonary arterial hypertension. This imaging work-up is essential to select the right type of intervention for the right patient and TV. Transesophageal echocardiography and fluoroscopy imaging is also key for guiding the TTVI procedures and fusion between these 2 modalities may further enhance the quality of procedure guiding.
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Affiliation(s)
| | - Lluis Asmarats
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Université Laval, Québec, Canada
| | | | - João L Cavalcante
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Shizhen Liu
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Federico Milla
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Christopher Meduri
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Josep Rodés-Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Université Laval, Québec, Canada
| | - Mani Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Université Laval, Québec, Canada.
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Muntané-Carol G, Alperi A, Faroux L, Bédard E, Philippon F, Rodés-Cabau J. Transcatheter Tricuspid Valve Intervention: Coaptation Devices. Front Cardiovasc Med 2020; 7:139. [PMID: 32903754 PMCID: PMC7438895 DOI: 10.3389/fcvm.2020.00139] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/30/2020] [Indexed: 11/13/2022] Open
Abstract
Transcatheter tricuspid valve intervention (TTVI) has recently emerged as an alternative for the treatment of severe tricuspid regurgitation (TR). Multiple percutaneous devices have been developed in the last decade with promising early results. Among them, the coaptation devices are designed to reduce TR severity by valve leaflet plication or occupying the regurgitant orifice with a spacer. To date, the MitraClip/TriClip devices (Abbott, Santa Clara, CA, USA), the PASCAL system (Edwards Lifesciencies, Irvine, CA, USA), and the FORMA device (Edwards Lifesciencies, Irvine, CA, USA) have been used as coaptation devices for treating severe TR. The present document aimed to review the clinical evidence on coaptation devices in the field of TTVI, describing its design characteristics, main procedural steps, and early and mid-term outcomes.
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Affiliation(s)
| | - Alberto Alperi
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Elisabeth Bédard
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - François Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
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Lurz P, Orban M, Besler C, Braun D, Schlotter F, Noack T, Desch S, Karam N, Kresoja KP, Hagl C, Borger M, Nabauer M, Massberg S, Thiele H, Hausleiter J, Rommel KP. Clinical characteristics, diagnosis, and risk stratification of pulmonary hypertension in severe tricuspid regurgitation and implications for transcatheter tricuspid valve repair. Eur Heart J 2020; 41:2785-2795. [DOI: 10.1093/eurheartj/ehaa138] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract
Aims
Patients with pulmonary hypertension (PHT) are often excluded from surgical therapies for tricuspid regurgitation (TR). Transcatheter tricuspid valve repair (TTVR) with the MitraClip™ technique is a novel treatment option for these patients. We aimed to assess the role of PHT in severe TR and its implications for TTVR.
Methods and results
A total of 243 patients underwent TTVR at two centres. One hundred twenty-one patients were grouped as iPHT+ [invasive systolic pulmonary artery pressures (PAPs) ≥50 mmHg]. Patients were similarly stratified according to echocardiographic PAPs (ePHT). The occurrence of the combined clinical endpoint (death, heart failure hospitalization, and reintervention) was investigated during a follow-up of 330 (interquartile range 175–402) days. iPHT+ patients were at higher preoperative risk (P < 0.01), had more severe symptoms (P = 0.01), higher N-terminal pro-B-type natriuretic peptide levels (P < 0.01), more impaired right ventricular (RV) function (P < 0.01), and afterload corrected RV function (P < 0.01). Procedural TTVR success was similar in iPHT+ and iPHT− patients (84 vs. 84%, P = 0.99). The echocardiographic diagnostic accuracy to detect iPHT was only 55%. During follow-up, 35% of patients reached the combined clinical endpoint. The discordant diagnosis of iPHT+/ePHT− carried the highest risk for the combined clinical endpoint [HR 3.76 (CI 2.25–6.37), P < 0.01], while iPHT+/ePHT+ patients had a similar survival-free time from the combined endpoint compared to iPHT− patients (P = 0.48). In patients with isolated tricuspid procedure (n = 131) a discordant iPHT+/ePHT− diagnosis and an impaired afterload corrected RV function (P < 0.01 for both) were independent predictors for the occurrence of the combined endpoint.
Conclusion
The discordant echocardiographic and invasive diagnosis of PHT in severe TR predicts outcomes after TTVR.
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Affiliation(s)
- Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig , Struempellstrasse 39, 04289 Leipzig, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München , Marchioninistrasse 15, 81377 Munich, Germany
- Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK) , Biedersteiner Strasse 29, Munich, Germany
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig , Struempellstrasse 39, 04289 Leipzig, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München , Marchioninistrasse 15, 81377 Munich, Germany
| | - Florian Schlotter
- Department of Cardiology, Heart Center Leipzig at University of Leipzig , Struempellstrasse 39, 04289 Leipzig, Germany
| | - Thilo Noack
- Department of Cardiac Surgery, Heart Center at University of Leipzig , Struempellstrasse 39, 04289 Leipzig, Germany
| | - Steffen Desch
- Department of Cardiology, Heart Center Leipzig at University of Leipzig , Struempellstrasse 39, 04289 Leipzig, Germany
| | - Nicole Karam
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München , Marchioninistrasse 15, 81377 Munich, Germany
- Department of Cardiology, European Hospital Georges Pompidou and Paris Cardiovascular Research Center (INSERMU970) , 20 rue Leblanc, 75015 Paris, France
| | - Karl-Patrik Kresoja
- Department of Cardiology, Heart Center Leipzig at University of Leipzig , Struempellstrasse 39, 04289 Leipzig, Germany
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München , Marchioninistrasse 15, 81377 Munich, Germany
| | - Michael Borger
- Department of Cardiac Surgery, Heart Center at University of Leipzig , Struempellstrasse 39, 04289 Leipzig, Germany
| | - Michael Nabauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München , Marchioninistrasse 15, 81377 Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München , Marchioninistrasse 15, 81377 Munich, Germany
- Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK) , Biedersteiner Strasse 29, Munich, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig , Struempellstrasse 39, 04289 Leipzig, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München , Marchioninistrasse 15, 81377 Munich, Germany
- Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK) , Biedersteiner Strasse 29, Munich, Germany
| | - Karl-Philipp Rommel
- Department of Cardiology, Heart Center Leipzig at University of Leipzig , Struempellstrasse 39, 04289 Leipzig, Germany
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Lebehn M, Nikolou E, Grapsa J, Hahn RT. Edge-to-Edge Tricuspid Valve Repair: Closing the Gap on Tricuspid Regurgitation. JACC Case Rep 2020; 2:1093-1096. [PMID: 34317422 PMCID: PMC8311872 DOI: 10.1016/j.jaccas.2020.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Mark Lebehn
- Department of Cardiology, Columbia University Irving Medical Center/NewYork Presbyterian Hospital, New York, New York
| | - Evgenia Nikolou
- Cardiology Department, Guy’s and St. Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | - Julia Grapsa
- Cardiology Department, Guy’s and St. Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | - Rebecca T. Hahn
- Department of Cardiology, Columbia University Irving Medical Center/NewYork Presbyterian Hospital, New York, New York
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125
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The PASCAL Device—Early Experience with a Leaflet Approximation Device: What Are the Benefits/Limitations Compared with the MitraClip? Curr Cardiol Rep 2020; 22:74. [PMID: 32594261 DOI: 10.1007/s11886-020-01305-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Hahn RT, Waxman AB, Denti P, Delhaas T. Anatomic Relationship of the Complex Tricuspid Valve, Right Ventricle, and Pulmonary Vasculature: A Review. JAMA Cardiol 2020; 4:478-487. [PMID: 30994879 DOI: 10.1001/jamacardio.2019.0535] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Severe functional or secondary tricuspid regurgitation (TR) is associated with poor long-term outcomes in natural history studies as well as specific disease states. An understanding of the physiologic causes of the TR is lacking precluding a systematic approach to treatment. Observations The complex anatomic relationship between the tricuspid valve apparatus and structure of the right side of the heart lends insight into the functional changes seen with secondary TR. The association of these changes with changes in pulmonary vascular hemodynamics can lead to a cascade of events that result in disease progression. Conclusions and Relevance Appreciating the role of pulmonary vascular hemodynamics on right ventricular and tricuspid valve morphology and function improves our understanding of the pathophysiology of secondary TR. The limitations of current therapeutic approaches for secondary TR have stimulated interest in improving outcomes with this morbid disease. Changes in timing or approach to intervention require a more comprehensive understanding of the pathophysiology.
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Affiliation(s)
- Rebecca T Hahn
- Department of Medicine, Division of Cardiology/New York Presbyterian Hospital, New York-Presbyterian/Columbia University Medical Center, New York
| | - Aaron B Waxman
- Brigham and Women's Hospital Heart and Vascular and Lung Center, Harvard Medical School, Boston, Massachusetts
| | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | - Tammo Delhaas
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center/Maastricht University, Maastricht, the Netherlands
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Russo M, Zilberszac R, Werner P, Kocher A, Wiedemann D, Schneider M, Mascherbauer J, Laufer G, Rosenhek R, Andreas M. Isolated tricuspid valve regurgitation. J Cardiovasc Med (Hagerstown) 2020; 21:406-414. [DOI: 10.2459/jcm.0000000000000933] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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128
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Karam N, Mehr M, Taramasso M, Besler C, Ruf T, Connelly KA, Weber M, Yzeiraj E, Schiavi D, Mangieri A, Vaskelyte L, Alessandrini H, Deuschl F, Brugger N, Ahmad H, Ho E, Biasco L, Orban M, Deseive S, Braun D, Gavazzoni M, Rommel KP, Pozzoli A, Frerker C, Näbauer M, Massberg S, Pedrazzini G, Tang GHL, Windecker S, Schäfer U, Kuck KH, Sievert H, Denti P, Latib A, Schofer J, Nickenig G, Fam N, von Bardeleben RS, Lurz P, Maisano F, Hausleiter J. Value of Echocardiographic Right Ventricular and Pulmonary Pressure Assessment in Predicting Transcatheter Tricuspid Repair Outcome. JACC Cardiovasc Interv 2020; 13:1251-1261. [PMID: 32360260 DOI: 10.1016/j.jcin.2020.02.028] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/10/2020] [Accepted: 02/19/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to assess the value of echocardiographic right ventricular (RV) and systolic pulmonary artery pressure (sPAP) assessment in predicting transcatheter tricuspid edge-to-edge valve repair (TTVR) outcome. BACKGROUND RV dysfunction and pulmonary hypertension are associated with poor prognosis and are systematically sought during tricuspid regurgitation evaluation. The value of echocardiographic assessment in predicting TTVR outcome is unknown. METHODS Data were taken from the TriValve (Transcatheter Tricuspid Valve Therapies) registry, which includes patients undergoing TTVR at 14 European and North American centers. The primary outcome was 1-year survival free from hospitalization for heart failure, and secondary outcomes were 1-year survival and absence of hospital admission for heart failure at 1 year. RESULTS Overall, 249 patients underwent TTVR between June 2015 and 2018 (mean tricuspid annular plane systolic excursion [TAPSE] 15.8 ± 15.3 mm, mean sPAP 43.6 ± 16.0 mm Hg). Tricuspid regurgitation grade ≥3+ was found in 96.8% of patients at baseline and 29.4% at final follow-up; 95.6% were in New York Heart Association functional class III or IV initially, compared with 34.3% at follow-up (p < 0.05). Final New York Heart Association functional class did not differ among TAPSE and sPAP quartiles, even when both low TAPSE and high sPAP were present. Rates of 1-year survival and survival free from hospitalization for heart failure were 83.9% and 78.7%, respectively, without significant differences according to baseline echocardiographic RV characteristics (TAPSE, fractional area change, and end-diastolic area) and sPAP (p > 0.05 for all). CONCLUSIONS TTVR provides clinical improvement, with 1-year survival free from hospital readmission >75% in patients with severe tricuspid regurgitation. Conventional echocardiographic parameters used to assess RV function and sPAP did not predict clinical outcome after TTVR.
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Affiliation(s)
- Nicole Karam
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; European Hospital Georges Pompidou, Cardiology Department, Université de Paris, PARCC, INSERM, Paris, France
| | - Michael Mehr
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | | | - Tobias Ruf
- Mainz University Hospital, University of Mainz, Mainz, Germany
| | - Kim A Connelly
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marcel Weber
- Bonn University Hospital, University of Bonn, Bonn, Germany
| | | | - Davide Schiavi
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Antonio Mangieri
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | | | | | - Florian Deuschl
- University Heart Center Hamburg, University of Hamburg, Hamburg, Germany
| | | | - Hasan Ahmad
- Westchester Medical Center, Valhalla, New York
| | - Edwin Ho
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Mara Gavazzoni
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | | | - Alberto Pozzoli
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | | | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | | | | | | | - Ulrich Schäfer
- University Heart Center Hamburg, University of Hamburg, Hamburg, Germany
| | | | | | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | - Azeem Latib
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy; Department of Cardiology, Montefiore Medical Center, Bronx, New York
| | | | - Georg Nickenig
- Bonn University Hospital, University of Bonn, Bonn, Germany
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Philipp Lurz
- Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease, Munich, Germany.
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129
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Winkel MG, Brugger N, Khalique OK, Gräni C, Huber A, Pilgrim T, Billinger M, Windecker S, Hahn RT, Praz F. Imaging and Patient Selection for Transcatheter Tricuspid Valve Interventions. Front Cardiovasc Med 2020; 7:60. [PMID: 32432125 PMCID: PMC7214677 DOI: 10.3389/fcvm.2020.00060] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/25/2020] [Indexed: 12/23/2022] Open
Abstract
With the emergence of transcatheter solutions for the treatment of tricuspid regurgitation (TR) increased attention has been directed to the once neglected tricuspid valve (TV) complex. Recent studies have highlighted new aspects of valve anatomy and TR etiology. The assessment of valve morphology along with quantification of regurgitation severity and RV function pose several challenges to cardiac imagers guiding transcatheter valve procedures. This review article aims to give an overview over the role of modern imaging modalities during assessment and treatment of the TV.
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Affiliation(s)
- Mirjam G. Winkel
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Omar K. Khalique
- Columbia University Medical Center/NY Presbyterian Hospital, New York, NY, United States
| | - Christoph Gräni
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Adrian Huber
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Michael Billinger
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Rebecca T. Hahn
- Columbia University Medical Center/NY Presbyterian Hospital, New York, NY, United States
| | - Fabien Praz
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
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130
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Orban M, Rommel KP, Ho EC, Unterhuber M, Pozzoli A, Connelly KA, Deseive S, Besler C, Ong G, Braun D, Edwards J, Miura M, Gülmez G, Stolz L, Gavazzoni M, Zuber M, Orban M, Nabauer M, Maisano F, Thiele H, Massberg S, Taramasso M, Fam NP, Lurz P, Hausleiter J. Transcatheter Edge-to-Edge Tricuspid Repair for Severe Tricuspid Regurgitation Reduces Hospitalizations for Heart Failure. JACC-HEART FAILURE 2020; 8:265-276. [DOI: 10.1016/j.jchf.2019.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/18/2022]
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Ro R, Tang GHL, Seetharam K, Khera S, Sharma SK, Kini AS, Lerakis S. Echocardiographic Imaging for Transcatheter Tricuspid Edge-to-Edge Repair. J Am Heart Assoc 2020; 9:e015682. [PMID: 32089056 PMCID: PMC7335573 DOI: 10.1161/jaha.119.015682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Richard Ro
- Division of Cardiology Icahn School of Medicine at Mount Sinai Mount Sinai Hospital New York NY
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery Icahn School of Medicine at Mount Sinai Mount Sinai Hospital New York NY
| | - Karthik Seetharam
- Division of Cardiology Icahn School of Medicine at Mount Sinai Mount Sinai Hospital New York NY
| | - Sahil Khera
- Division of Cardiology Icahn School of Medicine at Mount Sinai Mount Sinai Hospital New York NY
| | - Samin K Sharma
- Division of Cardiology Icahn School of Medicine at Mount Sinai Mount Sinai Hospital New York NY
| | - Annapoorna S Kini
- Division of Cardiology Icahn School of Medicine at Mount Sinai Mount Sinai Hospital New York NY
| | - Stamatios Lerakis
- Division of Cardiology Icahn School of Medicine at Mount Sinai Mount Sinai Hospital New York NY
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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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133
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Arora L, Krishnan S, Subramani S, Sharma A, Hanada S, Villablanca PA, Núñez-Gil IJ, Ramakrishna H. Functional Tricuspid Regurgitation: Analysis of Percutaneous Transcatheter Techniques and Current Outcomes. J Cardiothorac Vasc Anesth 2020; 35:921-931. [PMID: 32247538 DOI: 10.1053/j.jvca.2020.02.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/22/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Lovkesh Arora
- Division of Critical Care, Vascular and Organ Transplant Anesthesiology, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Sundar Krishnan
- Division of Cardiothoracic Anesthesiology and Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Sudhakar Subramani
- Division of Cardiothoracic Anesthesiology, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Archit Sharma
- Division of Cardiothoracic Anesthesiology Solid Organ Transplant and Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Satoshi Hanada
- Division of Cardiothoracic Anesthesiology, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | | | - Iván J Núñez-Gil
- Interventional Cardiology, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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Besler C, Unterhuber M, Rommel K, Unger E, Hartung P, Roeder M, Noack T, Zachäus M, Halm U, Borger M, Desch S, Thiele H, Lurz P. Nutritional status in tricuspid regurgitation: implications of transcatheter repair. Eur J Heart Fail 2020; 22:1826-1836. [DOI: 10.1002/ejhf.1752] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/30/2019] [Accepted: 01/04/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Christian Besler
- Department of Internal Medicine/Cardiology Heart Center Leipzig, University of Leipzig Leipzig Germany
| | - Matthias Unterhuber
- Department of Internal Medicine/Cardiology Heart Center Leipzig, University of Leipzig Leipzig Germany
| | - Karl‐Philipp Rommel
- Department of Internal Medicine/Cardiology Heart Center Leipzig, University of Leipzig Leipzig Germany
| | - Elisabeth Unger
- Department of Internal Medicine/Cardiology Heart Center Leipzig, University of Leipzig Leipzig Germany
| | - Philipp Hartung
- Department of Internal Medicine/Cardiology Heart Center Leipzig, University of Leipzig Leipzig Germany
| | - Maximilian Roeder
- Department of Internal Medicine/Cardiology Heart Center Leipzig, University of Leipzig Leipzig Germany
| | - Thilo Noack
- Department of Heart Surgery, Heart Center Leipzig University of Leipzig Leipzig Germany
| | - Markus Zachäus
- Department of Internal Medicine and Gastroenterology Park‐Klinikum Leipzig Leipzig Germany
| | - Ulrich Halm
- Department of Internal Medicine and Gastroenterology Park‐Klinikum Leipzig Leipzig Germany
| | - Michael Borger
- Department of Heart Surgery, Heart Center Leipzig University of Leipzig Leipzig Germany
| | - Steffen Desch
- Department of Internal Medicine/Cardiology Heart Center Leipzig, University of Leipzig Leipzig Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig, University of Leipzig Leipzig Germany
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology Heart Center Leipzig, University of Leipzig Leipzig Germany
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Utsunomiya H, Itabashi Y, Kobayashi S, Rader F, Siegel RJ, Shiota T. Clinical Impact of Size, Shape, and Orientation of the Tricuspid Annulus in Tricuspid Regurgitation as Assessed by Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2020; 33:191-200.e1. [DOI: 10.1016/j.echo.2019.09.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 11/24/2022]
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Transcatheter Versus Medical Treatment of Patients With Symptomatic Severe Tricuspid Regurgitation. J Am Coll Cardiol 2019; 74:2998-3008. [DOI: 10.1016/j.jacc.2019.09.028] [Citation(s) in RCA: 193] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 09/20/2019] [Accepted: 09/21/2019] [Indexed: 12/21/2022]
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137
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Abstract
New developments in transcatheter valve technologies including aortic valve replacement and mitral valve and tricuspid valve interventions are described. Recent studies evaluating the success rate, patient outcomes, and anesthesiologic management of the procedures are discussed.
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Affiliation(s)
- Michael A Ackermann
- Department of Anesthesiology and Intensive Care Medicine, Heart Centre Leipzig, Struempellstr 39, Leipzig 04289, Germany
| | - Jörg K Ender
- Department of Anesthesiology and Intensive Care Medicine, Heart Centre Leipzig, Struempellstr 39, Leipzig 04289, Germany.
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138
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Compassionate Use of the PASCAL Transcatheter Valve Repair System for Severe Tricuspid Regurgitation. JACC Cardiovasc Interv 2019; 12:2488-2495. [DOI: 10.1016/j.jcin.2019.09.046] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/16/2019] [Accepted: 09/24/2019] [Indexed: 11/23/2022]
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139
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Nickenig G, Weber M, Lurz P, von Bardeleben RS, Sitges M, Sorajja P, Hausleiter J, Denti P, Trochu JN, Näbauer M, Dahou A, Hahn RT. Transcatheter edge-to-edge repair for reduction of tricuspid regurgitation: 6-month outcomes of the TRILUMINATE single-arm study. Lancet 2019; 394:2002-2011. [PMID: 31708188 DOI: 10.1016/s0140-6736(19)32600-5] [Citation(s) in RCA: 266] [Impact Index Per Article: 53.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/09/2019] [Accepted: 09/16/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Tricuspid regurgitation is a prevalent disease associated with high morbidity and mortality, with few treatment options. The aim of the TRILUMINATE trial is to evaluate the safety and effectiveness of TriClip, a minimally invasive transcatheter tricuspid valve repair system, for reducing tricuspid regurgitation. METHODS The TRILUMINATE trial is a prospective, multicentre, single-arm study in 21 sites in Europe and the USA. Patients with moderate or greater triscuspid regurgitation, New York Heart Association class II or higher, and who were adequately treated per applicable standards were eligible for enrolment. Patients were excluded if they had systolic pulmonary artery pressure of more than 60 mm Hg, a previous tricuspid valve procedure, or a cardiovascular implantable electronic device that would inhibit TriClip placement. Participants were treated using a clip-based edge-to-edge repair technique with the TriClip tricuspid valve repair system. Tricuspid regurgitation was graded using a five-class grading scheme (mild, moderate, severe, massive, and torrential) that expanded on the standard American Society of Echocardiography grading scheme. The primary efficacy endpoint was a reduction in tricuspid regurgitation severity by at least one grade at 30 days post procedure, with a performance goal of 35%, analysed in all patients who had an attempted tricuspid valve repair procedure upon femoral vein puncture. The primary safety endpoint was a composite of major adverse events at 6 months, with a performance goal of 39%. Patients were excluded from the primary safety analysis if they did not reach 6-month follow-up and did not have a major adverse event during previous follow-ups. The trial has completed enrolment and follow-up is ongoing; it is registered with ClinicalTrials.gov, number NCT03227757. FINDINGS Between Aug 1, 2017, and Nov 29, 2018, 85 patients (mean age 77·8 years [SD 7·9]; 56 [66%] women) were enrolled and underwent successful TriClip implantation. Tricuspid regurgitation severity was reduced by at least one grade at 30 days in 71 (86%) of 83 patients who had available echocardiogram data and imaging. The one-sided lower 97·5% confidence limit was 76%, which was greater than the prespecified performance goal of 35% (p<0·0001). One patient withdrew before 6-month follow-up without having had a major adverse event and was excluded from analysis of the primary safety endpoint. At 6 months, three (4%) of 84 patients experienced a major adverse event, which was less than the prespecified performance goal of 39% (p<0·0001). Single leaflet attachment occurred in five (7%) of 72 patients. No periprocedural deaths, conversions to surgery, device embolisations, myocardial infarctions, or strokes occurred. At 6 months, all-cause mortality had occurred in four (5%) of 84 patients. INTERPRETATION The TriClip system appears to be safe and effective at reducing tricuspid regurgitation by at least one grade. This reduction could translate to significant clinical improvement at 6 months post procedure. FUNDING Abbott.
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Affiliation(s)
| | - Marcel Weber
- Heart Center, University Hospital, Bonn, Germany
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | - Marta Sitges
- Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Barcelona, Spain
| | - Paul Sorajja
- Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Jörg Hausleiter
- Medizinische Klinik I der Ludwig-Maximilians Universität München, Munich, Germany
| | | | | | - Michael Näbauer
- Medizinische Klinik I der Ludwig-Maximilians Universität München, Munich, Germany
| | | | - Rebecca T Hahn
- The Cardiovascular Research Foundation, New York, NY, USA; New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
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140
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Utsunomiya H, Kihara Y. Role of 3-Dimensional Echocardiography in the Comprehensive Evaluation of the Tricuspid Valve in Patients With Tricuspid Regurgitation. Circ Rep 2019; 2:1-9. [PMID: 33693168 PMCID: PMC7929706 DOI: 10.1253/circrep.cr-19-0108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Three-dimensional echocardiography is one of the most promising methods for the diagnosis of valvular heart disease, and recently has become an essential clinical tool owing to the continued development of real-time transesophageal echocardiography (TEE) technology. And now an era of renewed interest and enthusiasm surrounding the diagnosis and treatment of valvular heart disease has come, which is driven by emerging trans-catheter procedures. Nonetheless, little or no attention has been given to the treatment of tricuspid regurgitation (TR). The application of 3D-TEE is useful for simultaneous visualization of all 3 leaflets in order to grasp the whole picture of the tricuspid valve (TV; “en face” view). The implications of 3-D assessment of TV annulus, leaflets, and morphology involve an improved understanding of both the mechanics and treatment of TR. This method has been useful for surgical management, including accurate measurement of tricuspid annular diameter and prediction of the post-surgical outcome. Moreover, this method may be indispensable for detailed and comprehensive evaluation of the TV in patients with TR who are candidates for trans-catheter tricuspid procedures. In addition, color Doppler 3D-TEE has been valuable to identify the location of the regurgitant orifice and the severity of the TR. It is now clear that this method will enhance the diagnosis and management of TR patients.
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Affiliation(s)
- Hiroto Utsunomiya
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences Hiroshima Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences Hiroshima Japan
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Gallet R, Ternacle J, Teiger E. [Transcatheter treatment of tricuspid regurgitation]. Ann Cardiol Angeiol (Paris) 2019; 68:480-485. [PMID: 31668340 DOI: 10.1016/j.ancard.2019.10.004] [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: 10/25/2022]
Abstract
Tricuspid regurgitation is serious disease for which surgical correction is underperformed because of a prohibitive risk. It is responsible for a 50% mortality at 3 years which is decreased by surgical treatment. However, only a negligible proportion of patients undergoes surgery. In this context, there is currently an unmet need for percutaneous treatment technique. Several technologies are undergoing preclinical or early clinical development. These techniques aim to mimic the different surgical strategies used for the treatment of tricuspid regurgitation. Thus, some target the leaflets, the tricuspid annulus or offer a complete tricuspid valve replacement. Before planning a transcatheter tricuspid intervention, a comprehensive evaluation is mandatory, addressing the patient clinical status and comorbidities, the tricuspid regurgitation ad its consequences on right heart and, the anatomy of the tricuspid annulus and the right heart to determine if the patient is eligible for the chosen technique. This article will review the indications, contraindications and exams to perform before transcatheter tricuspid intervention and will then detail the different strategies available or undergoing development.
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Affiliation(s)
- R Gallet
- Service de Cardiologie, CHU Henri-Mondor, 51, avenue du Maréchal de Lattre de-Tassigny, 94010 Créteil, France.
| | - J Ternacle
- Service de Cardiologie, CHU Henri-Mondor, 51, avenue du Maréchal de Lattre de-Tassigny, 94010 Créteil, France
| | - E Teiger
- Service de Cardiologie, CHU Henri-Mondor, 51, avenue du Maréchal de Lattre de-Tassigny, 94010 Créteil, France
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142
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Secondary tricuspid regurgitation: Do we understand what we would like to treat? Arch Cardiovasc Dis 2019; 112:642-651. [DOI: 10.1016/j.acvd.2019.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/28/2019] [Accepted: 04/30/2019] [Indexed: 11/19/2022]
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143
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Utsunomiya H, Harada Y, Susawa H, Takahari K, Ueda Y, Izumi K, Itakura K, Ikenaga H, Hidaka T, Fukuda Y, Shiota T, Kihara Y. Comprehensive Evaluation of Tricuspid Regurgitation Location and Severity Using Vena Contracta Analysis: A Color Doppler Three-Dimensional Transesophageal Echocardiographic Study. J Am Soc Echocardiogr 2019; 32:1526-1537.e2. [PMID: 31563434 DOI: 10.1016/j.echo.2019.07.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The clinical significance of three-dimensional (3D) vena contracta area (VCA) in tricuspid regurgitation (TR) is not fully elucidated. The aim of this study was to investigate the diagnostic accuracy of 3D VCA using 3D echocardiography-derived regurgitation volume as a reference standard. METHODS One hundred sixteen patients with at least moderate TR underwent two-dimensional transthoracic and color Doppler 3D transesophageal echocardiography. The 3D vena contracta, which was located at the narrowest neck of the TR jet just above and toward the right atrial side of the flow convergence zone, was assessed for TR location and severity. RESULTS As for TR location, patients with severe functional TR had the highest prevalence of central jet location among TR subgroups, whereas patients with severe primary TR showed a greater spatial extent of TR jet location involved compared with the moderate TR group (P < .05 for both). As for TR severity, a 3D VCA cutoff value of 0.61 cm2 discriminated severe TR with sensitivity of 78% and specificity of 97% in the total patient population (area under the curve = 0.93, P < .001). Multivariate analysis revealed that 3D VCA, a dilated right ventricle, and hepatic vein systolic reversal were independently associated with regurgitant volume (P < .001 for all). The χ2 value for the model that incorporated clinical and two-dimensional integrative parameters and 3D VCA > 0.61 cm2 to evaluate severe TR was significantly higher than that for the model that incorporated only clinical and two-dimensional integrative parameters (P = .001). CONCLUSIONS Three-dimensional VCA has independent and incremental diagnostic value for evaluating severe TR. Comprehensive evaluation of TR location and severity using 3D vena contracta analysis may help in treatment selection for TR.
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Affiliation(s)
- Hiroto Utsunomiya
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Yu Harada
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hitoshi Susawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kosuke Takahari
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yusuke Ueda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kanako Izumi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kiho Itakura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takayuki Hidaka
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukihiro Fukuda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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144
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Chang CC, Veen KM, Hahn RT, Bogers AJJC, Latib A, Oei FBS, Abdelghani M, Modolo R, Ho SY, Abdel-Wahab M, Fattouch K, Bosmans J, Caliskan K, Taramasso M, Serruys PW, Bax JJ, van Mieghem NMDA, Takkenberg JJM, Lurz P, Modine T, Soliman O. Uncertainties and challenges in surgical and transcatheter tricuspid valve therapy: a state-of-the-art expert review. Eur Heart J 2019; 41:1932-1940. [DOI: 10.1093/eurheartj/ehz614] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/04/2019] [Accepted: 08/09/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Tricuspid regurgitation (TR) is a frequent and complex problem, commonly combined with left-sided heart disease, such as mitral regurgitation. Significant TR is associated with increased mortality if left untreated or recurrent after therapy. Tricuspid regurgitation was historically often disregarded and remained undertreated. Surgery is currently the only Class I Guideline recommended therapy for TR, in the form of annuloplasty, leaflet repair, or valve replacement. As growing experience of transcatheter therapy in structural heart disease, many dedicated transcatheter tricuspid repair or replacement devices, which mimic well-established surgical techniques, are currently under development. Nevertheless, many aspects of TR are little understood, including the disease process, surgical or interventional risk stratification, and predictors of successful therapy. The optimal treatment timing and the choice of proper surgical or interventional technique for significant TR remain to be elucidated. In this context, we aim to highlight the current evidence, underline major controversial issues in this field and present a future roadmap for TR therapy.
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Affiliation(s)
- Chun Chin Chang
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Kevin M Veen
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Rebecca T Hahn
- Structural Heart & Valve Center, New York Presbyterian Hospital, Columbia University Medical Center,161 Fort Washington Avenue, New York, NY 10032, USA
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, 3400 Bainbridge Ave, The Bronx, New York, NY, USA
| | - Frans B S Oei
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Mohammad Abdelghani
- Heart Center, Segeberger Kliniken, Am Kurpark 1, 23795, Bad Segeberg, Germany
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Rodrigo Modolo
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Cardiology Division, Department of Internal Medicine, University of Campinas (UNICAMP), Campinas- SP, 13083-970, Brazil
| | - Siew Yen Ho
- Brompton Cardiac Morphology Unit, Royal Brompton Hospital, Imperial College London, London, SW7 2AZ UK
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig, University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Viale Regione Siciliana 1571, 90100 Palermo, Italy
- GVM Care and Research, Maria Cecilia Hospital, Via Madonna di Genova, 1, 48033, Cotignola, Italy
| | - Johan Bosmans
- Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Kadir Caliskan
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Patrick W Serruys
- National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, Chelsea, London SW3 6LY, UK
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Nicolas M D A van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Philip Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Thomas Modine
- Department of Cardiovascular Surgery, Hopital Cardiologique CHRU de Lille, 2 Avenue Oscar Lambret, 59000 Lille, France
| | - Osama Soliman
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
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Mehr M, Taramasso M, Besler C, Ruf T, Connelly KA, Weber M, Yzeiraj E, Schiavi D, Mangieri A, Vaskelyte L, Alessandrini H, Deuschl F, Brugger N, Ahmad H, Biasco L, Orban M, Deseive S, Braun D, Rommel KP, Pozzoli A, Frerker C, Näbauer M, Massberg S, Pedrazzini G, Tang GHL, Windecker S, Schäfer U, Kuck KH, Sievert H, Denti P, Latib A, Schofer J, Nickenig G, Fam N, von Bardeleben RS, Lurz P, Maisano F, Hausleiter J. 1-Year Outcomes After Edge-to-Edge Valve Repair for Symptomatic Tricuspid Regurgitation: Results From the TriValve Registry. JACC Cardiovasc Interv 2019; 12:1451-1461. [PMID: 31395215 DOI: 10.1016/j.jcin.2019.04.019] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/01/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate procedural and 1-year clinical and echocardiographic outcomes of patients treated with tricuspid edge-to-edge repair. BACKGROUND Transcatheter edge-to-edge repair has been successfully performed in selected patients with symptomatic tricuspid regurgitation (TR) and high risk for surgery, but outcome data are sparse. METHODS This analysis of the multicenter international TriValve (Transcatheter Tricuspid Valve Therapies) registry included 249 patients with severe TR treated with edge-to-edge repair in compassionate and/or off-label use. Clinical and echocardiographic outcomes were prospectively collected and retrospectively analyzed. RESULTS In 249 patients (mean age 77 ± 9 years; European System for Cardiac Operative Risk Evaluation II score 6.4% [interquartile range: 3.9% to 13.9%]), a successful procedure with TR reduction to grade ≤2+ was achieved in 77% by placement of 2 ± 1 tricuspid clips. Concomitant treatment of severe TR and mitral regurgitation was performed in 52% of patients. At 1-year follow-up, significant and durable improvements in TR severity (TR ≤2+ in 72% of patients) and New York Heart Association functional class (≤II in 69% of patients) were observed. All-cause mortality was 20%, and the combined rate of mortality and unplanned hospitalization for heart failure was 35%. Predictors of procedural failure included effective regurgitant orifice area, tricuspid coaptation gap, tricuspid tenting area, and absence of central or anteroseptal TR jet location. Predictors of 1-year mortality were procedural failure, worsening kidney function, and absence of sinus rhythm. CONCLUSIONS Transcatheter tricuspid edge-to-edge repair can achieve TR reduction at 1 year, resulting in significant clinical improvement. Predictors of procedural failure and 1-year mortality identified here may help select patients who will benefit most from this therapy.
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Affiliation(s)
- Michael Mehr
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | | | - Tobias Ruf
- Mainz University Hospital, University of Mainz, Mainz, Germany
| | - Kim A Connelly
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marcel Weber
- Bonn University Hospital, University of Bonn, Bonn, Germany
| | | | | | | | | | | | - Florian Deuschl
- University Heart Center Hamburg, University of Hamburg, Hamburg, Germany
| | | | - Hasan Ahmad
- Westchester Medical Center, Valhalla, New York
| | | | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Alberto Pozzoli
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | | | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Gilbert H L Tang
- Westchester Medical Center, Valhalla, New York; Mount Sinai Medical Center, New York, New York
| | | | - Ulrich Schäfer
- University Heart Center Hamburg, University of Hamburg, Hamburg, Germany
| | | | | | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | - Azeem Latib
- San Raffaele University Hospital, Milan, Italy
| | | | - Georg Nickenig
- Bonn University Hospital, University of Bonn, Bonn, Germany
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Philipp Lurz
- Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany.
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Rommel KP, Besler C, Noack T, Blazek S, von Roeder M, Fengler K, Ender J, Gutberlet M, Desch S, Borger MA, Thiele H, Lurz P. Physiological and Clinical Consequences of Right Ventricular Volume Overload Reduction After Transcatheter Treatment for Tricuspid Regurgitation. JACC Cardiovasc Interv 2019; 12:1423-1434. [DOI: 10.1016/j.jcin.2019.02.042] [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: 11/05/2018] [Revised: 02/21/2019] [Accepted: 02/26/2019] [Indexed: 10/26/2022]
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147
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Karam N, Braun D, Mehr M, Orban M, Stocker TJ, Deseive S, Orban M, Hagl C, Näbauer M, Massberg S, Hausleiter J. Impact of Transcatheter Tricuspid Valve Repair for Severe Tricuspid Regurgitation on Kidney and Liver Function. JACC Cardiovasc Interv 2019; 12:1413-1420. [DOI: 10.1016/j.jcin.2019.04.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 11/29/2022]
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148
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Schlotter F, Orban M, Rommel KP, Besler C, von Roeder M, Braun D, Unterhuber M, Borger M, Hagl C, Orban M, Nabauer M, Massberg S, Thiele H, Hausleiter J, Lurz P. Aetiology-based clinical scenarios predict outcomes of transcatheter edge-to-edge tricuspid valve repair of functional tricuspid regurgitation. Eur J Heart Fail 2019; 21:1117-1125. [PMID: 31359620 DOI: 10.1002/ejhf.1547] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/09/2019] [Accepted: 06/01/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Florian Schlotter
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mathias Orban
- Klinikum der Universität München, Medizinische Klinik und Poliklinik I, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Christian Besler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Maximilian von Roeder
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Daniel Braun
- Klinikum der Universität München, Medizinische Klinik und Poliklinik I, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Matthias Unterhuber
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Michael Borger
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Christian Hagl
- Klinikum der Universität München, Herzchirurgische Klinik und Poliklinik, Munich, Germany
| | - Martin Orban
- Klinikum der Universität München, Medizinische Klinik und Poliklinik I, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Michael Nabauer
- Klinikum der Universität München, Medizinische Klinik und Poliklinik I, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Steffen Massberg
- Klinikum der Universität München, Medizinische Klinik und Poliklinik I, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Jörg Hausleiter
- Klinikum der Universität München, Medizinische Klinik und Poliklinik I, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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Abstract
PURPOSE OF REVIEW This review aims to provide an updated overview and a clinical perspective on novel transcatheter tricuspid valve interventions (TTVI), highlighting potential challenges and future directions. RECENT FINDINGS Severe tricuspid regurgitation (TR) is a predictor of mortality. However, a sizeable number of patients remain untreated until the end-stage when cardiac surgery presents a prohibitive risk. The emergent need in finding a treatment for patients with TR, deemed for surgery options, has encouraged the development of TTVI. These procedures mimic classical surgery techniques and are mainly divided in four categories: annuloplasty and coaptation devices, edge-to-edge techniques and transcatheter tricuspid valve replacement. Early studies showed promising results, but long-term follow-up data are not available. For patients with severe TR and high surgical risk, several percutaneous options are available. However, these therapies are in a growing phase and bigger studies and long term follow-up are needed to prove their efficacy.
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