151
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Misumida N, Steidley DE, Eleid MF. Edge-to-edge tricuspid valve repair for severe tricuspid regurgitation 20 years after cardiac transplantation. ESC Heart Fail 2020; 7:4320-4325. [PMID: 32945151 PMCID: PMC7754756 DOI: 10.1002/ehf2.12992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 11/24/2022] Open
Abstract
Tricuspid valve regurgitation in orthotopic heart transplant recipients is common. Surgical corrections have been the mainstay of the treatment for diuretic‐refractory heart failure due to severe tricuspid regurgitation. However, post‐transplant patients inherently carry higher surgical risk owing to previous sternotomy and immunocompromised state. We report a case of successful percutaneous edge‐to‐edge tricuspid valve repair for severe tricuspid regurgitation after cardiac transplantation. A 27‐year‐old man with a history of idiopathic restrictive cardiomyopathy status after orthotopic heart transplant presented with severe right‐sided heart failure symptoms. A transthoracic echocardiogram showed bi‐atrial enlargement and moderate‐to‐severe tricuspid regurgitation, and an increase to the severe range with exercise. Percutaneous edge‐to‐edge tricuspid valve repair was performed. The patient's symptoms improved, and follow‐up echocardiogram showed mild tricuspid regurgitation. Percutaneous tricuspid valve repair can be considered as an alternative option to conventional surgery for symptomatic severe tricuspid regurgitation in orthotopic heart transplant recipients with suitable anatomy.
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Affiliation(s)
- Naoki Misumida
- Division of Interventional Cardiology, Division of Structural Heart Disease, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - D Eric Steidley
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Mackram F Eleid
- Division of Interventional Cardiology, Division of Structural Heart Disease, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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152
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Fatehi Hassanabad A, Turcotte M, Dennehy C, Kim A, Malaisrie SC, Kent WDT. Contemporary Reoperative Mitral Valve Surgery: Technical Considerations and Clinical Outcomes. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:425-439. [DOI: 10.1177/1556984520949955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As patients with cardiac disease live longer, reoperative mitral valve surgery has become more common. Although these operations are technically challenging and of high risk, outcomes continue to improve. Minimally invasive techniques, better cardioprotective strategies, and advanced perioperative care have contributed to this. In this review, we discuss surgical approaches, intraoperative strategies, novel catheter-directed devices, and clinical outcomes of contemporary reoperative mitral valve surgery.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, AB, Canada
| | | | | | - Angela Kim
- Faculty of Medicine, University of Calgary, AB, Canada
| | - S. Chris Malaisrie
- Department of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - William D. T. Kent
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, AB, Canada
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153
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Sun YP. How Much Tricuspid Regurgitation?: To Clip or Not to Clip. J Am Coll Cardiol 2020; 76:1315-1317. [PMID: 32912446 DOI: 10.1016/j.jacc.2020.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Yee-Ping Sun
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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154
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Curio J, Abulgasim K, Kasner M, Rroku A, Lauten A, Lendlein A, Landmesser U, Reinthaler M. Intracardiac echocardiography to enable successful edge-to-edge transcatheter tricuspid valve repair in patients with insufficient TEE quality. Clin Hemorheol Microcirc 2020; 76:199-210. [PMID: 32925015 DOI: 10.3233/ch-209211] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Transesophageal echocardiography (TEE) as a guiding tool for edge-to-edge transcatheter tricuspid valve repair (EETVr) using MitraClip (Abbott Vascular, Santa Clara, USA) may not offer sufficient image quality in a significant proportion of patients. OBJECTIVES Intracardiac echocardiography (ICE) as additional guiding tool in EETVr with the MitraClip device. METHODS Appropriate angulations of the ICE catheter to visualize each commissure of the tricuspid valve were established in 3D printed heart models. In a single tertiary-care center ICE was used to support EETVr as additional guidance when TEE image quality was insufficient. Procedural safety and outcomes up to 30-days were compared between ICE/TEE and TEE only guided patients. RESULTS In 6 of 11 patients (54.5%) undergoing EETVr with MitraClip TEE alone was unsatisfactory, necessitating additional ICE guidance. In 4 of these 6 patients ICE enabled a successful completion of the procedure. The steering maneuvers identified in the 3D models were well applicable in all patients, providing examples for potential future ICE implementation in EETVr. Under both TEE alone (n = 5) and ICE (n = 6) guidance the rate of procedural complications was 0%. According to vena contracta values at discharge significant TR reduction was achievable in the treated cohort (p = 0.011). At 30-days follow-up one patient (ICE guided) died following global heart failure, not associated with the procedure itself. CONCLUSIONS ICE guidance may offer an additional tool to guide EETVr with the MitraClip device in patients with poor TEE quality, as it enables successful results without impairing procedural safety.
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Affiliation(s)
- Jonathan Curio
- Department of Cardiology, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Kamal Abulgasim
- Department of Cardiology, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Mario Kasner
- Department of Cardiology, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Andi Rroku
- Department of Cardiology, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Alexander Lauten
- Department of Cardiology, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Andreas Lendlein
- Institute of Biomaterial Science, Helmholtz-Zentrum Geesthacht, Teltow, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Markus Reinthaler
- Department of Cardiology, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany.,Institute of Biomaterial Science, Helmholtz-Zentrum Geesthacht, Teltow, Germany
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155
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Modine T, Ibrahim R, Ben-Ali W. Massive or Torrential Tricuspid Regurgitation: The Weight of the Flow! JACC Cardiovasc Interv 2020; 13:2010-2011. [PMID: 32912461 DOI: 10.1016/j.jcin.2020.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Thomas Modine
- Bordeaux University Hospital, Service Médico-Chirurgical de Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, Bordeaux, France; University of Bordeaux, Bordeaux-Pessac, France; IHU Lyrics, Bordeaux, France.
| | - Reda Ibrahim
- Structural Valve Program, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Walid Ben-Ali
- Structural Valve Program, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
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156
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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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157
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Miura M, Alessandrini H, Alkhodair A, Attinger-Toller A, Biasco L, Lurz P, Braun D, Brochet E, Connelly KA, de Bruijn S, Denti P, Deuschl F, Estevez-Loureiro R, Fam N, Frerker C, Gavazzoni M, Hausleiter J, Himbert D, Ho E, Juliard JM, Kaple R, Besler C, Kodali S, Kreidel F, Kuck KH, Latib A, Lauten A, Monivas V, Mehr M, Muntané-Carol G, Nazif T, Nickenig G, Pedrazzini G, Philippon F, Pozzoli A, Praz F, Puri R, Rodés-Cabau J, Schäfer U, Schofer J, Sievert H, Tang GH, Thiele H, Rommel KP, Vahanian A, Von Bardeleben RS, Webb JG, Weber M, Windecker S, Winkel M, Zuber M, Leon MB, Maisano F, Hahn RT, Taramasso M. Impact of Massive or Torrential Tricuspid Regurgitation in Patients Undergoing Transcatheter Tricuspid Valve Intervention. JACC Cardiovasc Interv 2020; 13:1999-2009. [DOI: 10.1016/j.jcin.2020.05.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/17/2020] [Accepted: 05/07/2020] [Indexed: 12/11/2022]
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158
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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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159
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Gaydos SS, Capps CD, Judd RN, Rhodes JF, Steinberg DH, Katz MR, Gregg DD. Hemodynamic Impact of MitraClip Procedure for Systemic Tricuspid Regurgitation in Congenitally Corrected Transposition of Great Arteries: A Case Report. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 28S:114-117. [PMID: 32883583 DOI: 10.1016/j.carrev.2020.08.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
Patients with congenitally-corrected transposition of the great arteries (ccTGA) commonly develop significant systemic tricuspid valve regurgitation and systemic right ventricular dysfunction in adulthood, both of which presenting a therapeutic dilemma for the care team. Here we describe the case of a 35-year-old male with congenitally-corrected transposition of the great arteries who presented with severe systemic tricuspid valve regurgitation, biventricular systolic failure, and pulmonary hypertension. Due to prohibitive surgical risk, he underwent percutaneous tricuspid valve repair via MitraClip placement. Post-procedure, he demonstrated rapidly improved symptoms and sustained echocardiographic and hemodynamic evaluations. Few reports exist describing the safety and feasibility of the MitraClip procedure on a systemic tricuspid valve, but to our knowledge, this is the first to describe invasive hemodynamic improvements in patients with this degree of cardiopulmonary sequelae from the congenital lesion. There may be optimism for the MitraClip procedure as "bridge to list" in patients with ccTGA otherwise initially ineligible for surgical valve intervention or transplant.
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Affiliation(s)
- Stephanie S Gaydos
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, 30 Courtenay Drive, MSC 592, Charleston, SC 29425, United States of America.
| | - Christopher D Capps
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, 30 Courtenay Drive, MSC 592, Charleston, SC 29425, United States of America
| | - Rochelle N Judd
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, 30 Courtenay Drive, MSC 592, Charleston, SC 29425, United States of America
| | - John F Rhodes
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, 10 McClennan Banks Drive, MSC915, Charleston, SC 29425, United States of America
| | - Daniel H Steinberg
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, 30 Courtenay Drive, MSC 592, Charleston, SC 29425, United States of America
| | - Marc R Katz
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, 30 Courtenay Drive, MSC 592, Charleston, SC 29425, United States of America
| | - David D Gregg
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, 30 Courtenay Drive, MSC 592, Charleston, SC 29425, United States of America
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160
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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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161
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Utility of Three-Dimensional (3D) Modeling for Planning Structural Heart Interventions (with an Emphasis on Valvular Heart Disease). Curr Cardiol Rep 2020; 22:125. [PMID: 32789652 DOI: 10.1007/s11886-020-01354-6] [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] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Advanced imaging has played a vital role in the contemporary, rapid rise of structural heart interventions. 3D modeling and printing has emerged as one of the most recent imaging tools and the implementation of 3D modeling is expected to increase with further advances in imaging, print hardware, and materials. RECENT FINDINGS 3D modeling can be used to educate patients and clinical teams, provide ex vivo procedural simulation, and improve outcomes. Intra-procedural success rates may be improved, and post-procedural complications can be predicted more robustly with appropriate application of 3D modeling. Recent advances in technology have increased the availability of this tool, such that there can be more ready adoption into a routine clinical workflow. Familiarity with 3D modeling and its current utilization and role in structural interventions will help inform how to approach and adapt this exciting new technology.
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162
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Yeo KK, Wong N. Percutaneous Edge-to-Edge Mitral Valve Repair. Korean Circ J 2020; 50:961-973. [PMID: 32975055 PMCID: PMC7596204 DOI: 10.4070/kcj.2020.0308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 11/20/2022] Open
Abstract
Percutaneous edge-to-edge mitral valve repair, using the MitraClip device for severe mitral regurgitation (MR) was first introduced in 2003. Since then, more than 100,000 cases have been performed worldwide and it remains the most established percutaneous therapy available for the treatment of severe MR. Currently, it is indicated for severe, symptomatic functional MR in patients who continue to have significant symptoms despite optimal guideline directed medical therapy, as well as in symptomatic patients with severe degenerative MR who are deemed too high risk for conventional surgical therapy in the opinion of the heart team. In this paper, we discuss the evolution of the MitraClip device, the clinical studies supporting its use as well as the important concept of proportionate and disproportionate MR.
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Affiliation(s)
- Khung Keong Yeo
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore.
| | - Ningyan Wong
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore
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163
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Pascual I, Pozzoli A, Taramasso M, Maisano F, Ho EC. Fusion imaging for transcatheter mitral and tricuspid interventions. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:965. [PMID: 32953765 PMCID: PMC7475437 DOI: 10.21037/atm.2020.02.169] [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: 11/06/2022]
Abstract
Image guidance for transcatheter mitral and tricuspid valve intervention commonly utilizes the unique advantages of both fluoroscopy and live echocardiography. In some cases, pre-procedural computed tomography is also needed. Classically, they are displayed separately even if modalities are in simultaneous use. This requires procedural operators to watch separate images displaying complementary information and mentally combine these data sources. New hybrid, or fusion, imaging systems allow for multiple imaging modalities to be overlaid on one another to provide the most relevant information on a single screen. While this technological advancement may have some advantages in certain procedures, more data is needed to understand if these systems will improve procedural or clinical outcomes.
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Affiliation(s)
- Isaac Pascual
- Certificate of Advanced Studies Mitral and Tricuspid Structural Heart Interventions (2019 cohort), Zurich, Switzerland.,Department of Cardiology, Asturias Central University Hospital, Oviedo, Spain.,Oviedo University Medical School, Oviedo, Spain
| | - Alberto Pozzoli
- Certificate of Advanced Studies Mitral and Tricuspid Structural Heart Interventions (2019 cohort), Zurich, Switzerland.,Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Maurizio Taramasso
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Francesco Maisano
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Edwin C Ho
- Certificate of Advanced Studies Mitral and Tricuspid Structural Heart Interventions (2019 cohort), Zurich, Switzerland.,Department of Cardiology, Montefiore Medical Center, New York, USA.,Department of Cardiology, St. Michael's Hospital, Toronto, Canada
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164
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Gyoten T, Schenk S, Rochor K, Herwig V, Harnath A, Grimmig O, Just S, Fritzsche D, Messroghli D. Outcome comparison of mitral valve surgery and MitraClip therapy in patients with severely reduced left ventricular dysfunction. ESC Heart Fail 2020; 7:1781-1790. [PMID: 32445540 PMCID: PMC7373891 DOI: 10.1002/ehf2.12741] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 11/11/2022] Open
Abstract
AIMS The aim of this study was to compare the outcomes of surgical mitral valve repair or replacement (sMVR) and percutaneous edge-to-edge repair using MitraClip (pMVR) in patients with severe left ventricular dysfunction affected by functional mitral regurgitation (FMR). METHODS AND RESULTS We retrospectively identified 132 patients with left ventricular ejection fraction (LVEF) ≦ 30% submitted to sMVR (n = 47) or pMVR (n = 85) for FMR at our centre from January 2013 to December 2017. To adjust for baseline imbalances, we used a propensity score matching by age, logistic EuroSCORE, and left ventricular end-systolic volume. After being matched, MitraClip therapy showed lower perioperative mortality and rate of complications yet increased residual mitral regurgitation (MR) grade than did surgery (0.2 ± 0.50 in sMVR vs. 1.3 ± 0.88 in pMVR, P < 0.0001). According to stratified multivariate Cox model analysis, residual MR severity was an independent risk factor for cardiac death [hazard ratio (HR), 2.81; 95% confidence interval [CI], 1.44-5.48, P = 0.0025] and re-hospitalization for heart failure (HR, 3.07; 95% CI, 1.50-6.29, P = 0.0022) at 1 year follow-up. Stratified multivariable Cox regression analysis at 3 years identified pMVR as risk factor for cardiac death (HR, 0.19; 95% CI, 0.040-0.86, P = 0.031) and re-hospitalization for heart failure (HR, 0.28; 95% CI, 0.077-0.99, P = 0.048). CONCLUSIONS In patients with FMR and LVEF ≤ 30%, MitraClip therapy resulted in lower perioperative complications and mortality than sMVR. However, surgically treated patients who survived the perioperative stage had less residual MR and experienced lower rates of re-hospitalization for heart failure at 1 year and lower cardiac mortality at 1 and 3 years of follow-up than did patients undergoing pMVR.
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Affiliation(s)
- Takayuki Gyoten
- Department of Cardiovascular SurgerySana‐Herzzentrum CottbusLeipziger Strasse 5003048CottbusGermany
| | - Sören Schenk
- Department of Cardiovascular SurgerySana‐Herzzentrum CottbusLeipziger Strasse 5003048CottbusGermany
| | - Kristin Rochor
- Department of CardiologySana‐Herzzentrum CottbusLeipziger Strasse 5003048CottbusGermany
| | - Volker Herwig
- Department of CardiologySana‐Herzzentrum CottbusLeipziger Strasse 5003048CottbusGermany
| | - Axel Harnath
- Department of CardiologySana‐Herzzentrum CottbusLeipziger Strasse 5003048CottbusGermany
| | - Oliver Grimmig
- Department of Cardiovascular SurgerySana‐Herzzentrum CottbusLeipziger Strasse 5003048CottbusGermany
| | - Sören Just
- Department of Cardiovascular SurgerySana‐Herzzentrum CottbusLeipziger Strasse 5003048CottbusGermany
| | - Dirk Fritzsche
- Department of Cardiovascular SurgerySana‐Herzzentrum CottbusLeipziger Strasse 5003048CottbusGermany
| | - Daniel Messroghli
- Department of Internal Medicine—CardiologyDeutsches Herzzentrum BerlinBerlinGermany
- Department of Internal Medicine and Cardiology, Campus Virchow‐KlinikumCharité—Universitätsmedizin BerlinBerlinGermany
- German Center for Cardiovascular Research (DZHK), partner siteBerlinGermany
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165
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Asmarats L, Perlman G, Praz F, Hensey M, Chrissoheris MP, Philippon F, Ofek H, Ye J, Puri R, Pibarot P, Attinger A, Moss R, Bédard E, Moschovitis A, Reineke D, Lauck S, Blanke P, Leipsic J, Spargias K, Windecker S, Webb JG, Rodés-Cabau J. Long-Term Outcomes of the FORMA Transcatheter Tricuspid Valve Repair System for the Treatment of Severe Tricuspid Regurgitation: Insights From the First-in-Human Experience. JACC Cardiovasc Interv 2020; 12:1438-1447. [PMID: 31395213 DOI: 10.1016/j.jcin.2019.04.038] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/23/2019] [Accepted: 04/26/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To evaluate the long-term (≥2 years) outcomes following transcatheter tricuspid valve repair (TTVr) with the FORMA Transcatheter Tricuspid Valve Repair System (Edwards Lifesciences, Irvine, California). BACKGROUND Scarce data exist on long-term outcomes following TTVr. METHODS This multicenter experience included patients with severe tricuspid regurgitation (TR) who underwent TTVr with the FORMA system at 4 centers under a compassionate clinical use program. Data were collected at baseline, 30 days, and 1 year, and yearly thereafter. RESULTS Nineteen patients (76 ± 9 years of age, 74% women, mean EuroSCORE II [European System for Cardiac Operative Risk Evaluation] 9.2 ± 5.6%) with functional TR were included. Procedural success was achieved in 17 (89%) patients and there were no cases of 30-day mortality. At a median follow-up of 32 (interquartile range: 24 to 36) months, 4 (24%) patients had died (3 from terminal heart failure, 1 from sepsis) and 3 (18%) patients required rehospitalization for heart failure. There was 1 device-related thrombosis and 1 pulmonary embolism, both in the setting of subtherapeutic oral anticoagulation. Less than severe TR was observed at echocardiography in 67% of patients at the 2- to 3-year follow-up. Among 15 successfully implanted patients with at least 24-month follow-up, significant improvements in New York Heart Association functional class (p < 0.001), 6-min walk test (+54 m; p = 0.016) and Kansas City Cardiomyopathy Questionnaire score (+16 points; p = 0.016) were observed, compared with baseline. CONCLUSIONS TTVr using the FORMA system showed favorable long-term safety profile in high-surgical-risk patients, with sustained functional improvement and acceptable TR reduction up to 3 years.
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Affiliation(s)
- Lluis Asmarats
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Gidon Perlman
- Department of Cardiology, St. Paul's Hospital, Vancouver, Canada; Department of Cardiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mark Hensey
- Department of Cardiology, St. Paul's Hospital, Vancouver, Canada
| | | | - Francois Philippon
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Hadass Ofek
- Department of Cardiology, St. Paul's Hospital, Vancouver, Canada
| | - Jian Ye
- Department of Cardiology, St. Paul's Hospital, Vancouver, Canada
| | - Rishi Puri
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada; Department of Medicine, University of Adelaide, Adelaide, Australia; Department of Cardiology, Cleveland Clinic Coordinating Center for Clinical Research, Cleveland, Ohio
| | - Philippe Pibarot
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Adrian Attinger
- Department of Cardiology, St. Paul's Hospital, Vancouver, Canada
| | - Robert Moss
- Department of Cardiology, St. Paul's Hospital, Vancouver, Canada
| | - Elisabeth Bédard
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Aris Moschovitis
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sandra Lauck
- Department of Cardiology, St. Paul's Hospital, Vancouver, Canada
| | - Philipp Blanke
- Department of Cardiology, St. Paul's Hospital, Vancouver, Canada
| | - Jonathon Leipsic
- Department of Cardiology, St. Paul's Hospital, Vancouver, Canada
| | | | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - John G Webb
- Department of Cardiology, St. Paul's Hospital, Vancouver, Canada
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada.
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166
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Refining Severe Tricuspid Regurgitation Definition by Echocardiography with a New Outcomes-Based "Massive" Grade. J Am Soc Echocardiogr 2020; 33:1087-1094. [PMID: 32651124 DOI: 10.1016/j.echo.2020.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Current echocardiographic guidelines recommend that tricuspid regurgitation (TR) severity be graded in three categories, following assessment of specific parameters. Findings from recent trials have shown that the severity of TR frequently far exceeds the current definition of severe. We postulated that a grading approach that emphasizes outcomes could be useful to identify patients with severe TR at increased risk of mortality. METHODS We identified 284 patients with echocardiograms demonstrating severe functional TR, defined as vena contracta (VC) ≥ 0.7 cm. Demographics and mortality data were obtained from the medical records. Patients were divided into study (n = 122 patients with three-dimensional images) and validation (n = 162) cohorts. The VC was measured in both the right ventricular (RV) inflow and apical four-chamber views and averaged. For the study cohort, tricuspid annular, RV end-diastolic (basal, mid, long axis) dimensions, tricuspid leaflet tenting height and area, RV free-wall longitudinal strain, and RV volumes were measured from two- and three-dimensional data sets. A K-partition algorithm was used in the study cohort to derive a mortality-related cutoff VC value, above which TR was termed "massive." The ability of this VC cutoff to identify patients at greater mortality risk was then tested in the validation cohort using Kaplan-Meier survival analysis. RESULTS In the study cohort, VC > 0.92 cm (massive TR) was optimally associated with worse survival. Tricuspid annular and RV size were larger in the massive group (P < .05), while there were no significant differences in demographics between the TR groups. Importantly, in the independent validation cohort, the above VC cutoff also correlated with increased mortality in the massive group (log-rank P < .05). CONCLUSIONS Among patients traditionally defined as having severe TR, a subset exists with massive TR, resulting in greater adverse RV remodeling and increased mortality. These patients may derive the greatest benefit from emerging percutaneous therapies.
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167
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Zoller JK, Gregory SH. Anesthetic Considerations for Transcatheter Tricuspid Valve Repair. J Cardiothorac Vasc Anesth 2020; 34:1942-1951. [DOI: 10.1053/j.jvca.2019.09.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/05/2019] [Accepted: 09/26/2019] [Indexed: 12/17/2022]
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168
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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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169
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Taramasso M. Expanding the Tools for Transcatheter Tricuspid Valve Intervention: Transcatheter Tricuspid Valve Repair. JACC Case Rep 2020; 2:1112-1114. [PMID: 34317428 PMCID: PMC8311719 DOI: 10.1016/j.jaccas.2020.05.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Maurizio Taramasso
- Clinic of Cardiac Surgery, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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170
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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: 36] [Impact Index Per Article: 9.0] [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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171
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Ramsdell GC, Nelson JA, Pislaru SV, Ramakrishna H. Tricuspid Regurgitation in Congestive Heart Failure: Management Strategies and Analysis of Outcomes. J Cardiothorac Vasc Anesth 2020; 35:1205-1214. [PMID: 32622710 DOI: 10.1053/j.jvca.2020.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 11/11/2022]
Abstract
Tricuspid regurgitation is a notable aspect of congestive heart failure and is linked with worse outcomes if untreated. Functional tricuspid regurgitation commonly is seen in patients with heart failure, particularly in patients presenting for surgical management, such as those for mechanical cardiac assist device implantation. This review aims to study the published data related to the surgical management of tricuspid regurgitation in the cardiac surgical population comprehensively.
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Affiliation(s)
- Geoffrey C Ramsdell
- Adult Cardiothoracic Anesthesiology, Department of Anesthesiology, Mayo Clinic, Rochester, MN
| | - James A Nelson
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Sorin V Pislaru
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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172
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Wang TKM, Harb SC, Miyasaka RL, Wagener J, Krishnaswamy A, Reed GK, Kapadia SR. Live Three-Dimensional Multiplanar Reconstruction Imaging Guidance for Concomitant Mitral and Tricuspid Valve Repairs Using the MitraClip. CASE 2020; 4:119-126. [PMID: 32577589 PMCID: PMC7303246 DOI: 10.1016/j.case.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
TEE is critical in evaluation and guidance of mitral and tricuspid interventions. 3D MPR allows simultaneous valve views in 2 long-axis, 1 short-axis, and 3D planes. 3D MPR enables accurate spatial delineation of MR/TR location and clip positioning. Adequate mitral and tricuspid views are achievable in most patients with 3D MPR.
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173
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Emerging transcatheter therapies for tricuspid valve disease. JTCVS OPEN 2020; 2:14-19. [PMID: 36003678 PMCID: PMC9390332 DOI: 10.1016/j.xjon.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/24/2020] [Accepted: 04/07/2020] [Indexed: 11/22/2022]
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174
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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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175
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Alushi B, Vathie K, Thiele H, Lauten A. Transcatheter therapies for severe tricuspid regurgitation. Quo vadis? Herz 2020; 46:234-241. [PMID: 32468139 DOI: 10.1007/s00059-020-04941-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/13/2020] [Accepted: 05/04/2020] [Indexed: 11/25/2022]
Abstract
Moderate-to-severe tricuspid regurgitation (TR) is common and is associated with a poor prognosis. To date, most patients are undertreated; therefore, transcatheter options could be clinically impactful in those who are denied surgery. Several transcatheter solutions have been developed that address the problem via leaflet enhancement, annuloplasty, or heterotopic implantation of self-expandable or balloon-expandable valves in the caval veins. A comprehensive patient evaluation, based on multimodality imaging techniques for a better understanding of the valvular pathology and TR mechanism, remains paramount for an appropriate device selection. To date, several trials have shown the feasibility and safety of a multitude of devices in this setting, but data from randomized clinical trials regarding clinical benefit based on hard endpoints are still lacking. Although the optimal patient profile and timing of intervention remain under investigation, data from available studies indicate that an earlier treatment referral, before onset of irreversible right ventricular remodeling, could be beneficial. This review discusses the present landscape and future implications of transcatheter therapies for severe TR.
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Affiliation(s)
- Brunilda Alushi
- Department of General and Interventional Cardiology, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089, Erfurt, Germany.
- Department of Cardiology, Campus Benjamin Franklin, Charité Medical University Berlin, Berlin, Germany.
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany.
| | - Kourosh Vathie
- Department of General and Interventional Cardiology, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089, Erfurt, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Alexander Lauten
- Department of General and Interventional Cardiology, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089, Erfurt, Germany
- Department of Cardiology, Campus Benjamin Franklin, Charité Medical University Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
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176
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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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177
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Muntané-Carol G, Rodés-Cabau J. Commentary: Transcatheter tricuspid valve interventions for treating isolated tricuspid regurgitation: Toward a new gold standard? J Thorac Cardiovasc Surg 2020; 160:1465-1466. [PMID: 32417056 DOI: 10.1016/j.jtcvs.2020.02.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Affiliation(s)
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
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178
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Winkel MG, Praz F, Wenaweser P. Mitral and Tricuspid Transcatheter Interventions Current Indications and Future Directions. Front Cardiovasc Med 2020; 7:61. [PMID: 32500083 PMCID: PMC7242641 DOI: 10.3389/fcvm.2020.00061] [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] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 03/25/2020] [Indexed: 11/13/2022] Open
Abstract
Valvular heart disease is responsible for a high rate of morbidity and mortality, especially in the elderly population. With the emergence of new transcatheter treatment options, the therapeutic spectrum for patients with valvular heart disease has considerably expanded during the past years. Interventional treatment of the mitral and tricuspid valve requires an individualized and versatile approach owing to the different etiologies of valvular dysfunction and the complex anatomy of the atrioventricular valves. This article aims to review recent developments, summarize the evidence, indications and limitations of the available systems, and provide a glimpse into the future of transcatheter interventions for the treatment of mitral and tricuspid valve disease.
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Affiliation(s)
- Mirjam Gauri Winkel
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Wenaweser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Heart Clinic Hirslanden Zurich, Zurich, Switzerland
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179
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O'Gara PT, Gillinov M, Rodés-Cabau J. Surgery for Isolated Tricuspid Regurgitation: Limitations of Observational Analyses. J Am Coll Cardiol 2020; 74:726-728. [PMID: 31395121 DOI: 10.1016/j.jacc.2019.06.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Patrick T O'Gara
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Marc Gillinov
- Cleveland Clinic Foundation, Lerner College of Medicine, Cleveland, Ohio
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
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180
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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: 13] [Impact Index Per Article: 3.3] [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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181
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Essayagh B, Antoine C, Benfari G, Maalouf J, Michelena HI, Crestanello JA, Thapa P, Avierinos JF, Enriquez-Sarano M. Functional tricuspid regurgitation of degenerative mitral valve disease: a crucial determinant of survival. Eur Heart J 2020; 41:1918-1929. [DOI: 10.1093/eurheartj/ehaa192] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/24/2019] [Accepted: 03/04/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
To assess functional tricuspid regurgitation (FTR) determinants, consequences, and independent impact on outcome in degenerative mitral regurgitation (DMR).
Methods and results
All patients diagnosed with isolated DMR 2003–2011, with structurally normal tricuspid leaflets, prospective FTR grading and systolic pulmonary artery pressure (sPAP) estimation by Doppler echocardiography at diagnosis were identified and long-term outcome analysed. The 5083 DMR eligible patients [63 ± 16 years, 47% female, ejection fraction (EF) 63 ± 7%, and sPAP 35 ± 13 mmHg] presented with FTR graded trivial in 45%, mild in 37%, moderate in 15%, and severe in 3%. While pulmonary hypertension (PHTN-sPAP ≥ 50 mmHg) was the most powerful FTR severity determinant, other strong FTR determinants were older age, female sex, lower left ventricle EF, DMR, and particularly atrial fibrillation (AFib) (all P ≤ 0.002). Functional tricuspid regurgitation moderate/severe was independently linked to more severe clinical presentation, more oedema, lower stroke volume, and impaired renal function (P ≤ 0.01). Survival (95% confidence interval) throughout follow-up [70% (69–72%) at 10 years] was strongly associated with FTR severity [82% (80–84%) for trivial, 69% (66–71%) for mild, 51% (47–57%) for moderate, and 26% (19–35%) for severe, P < 0.0001]. Excess mortality persisted after comprehensive adjustment [adjusted hazard ratio 1.40 (1.18–1.67) for moderate FTR and 2.10 (1.63–2.70) for severe FTR, P ≤ 0.01]. Excess mortality persisted adjusting for sPAP/right ventricular function (P < 0.0001), by matching [adjusted hazard ratios 2.08 (1.50–2.89), P < 0.0001] and vs. expected survival [risk ratio 1.79 (1.48–2.16), P < 0.0001]. Within 5-year of diagnosis valve surgery was performed in 73% (70–75%) and 15% (13–17%) of severe and moderate DMR and in only 26% (19–34%) and 6% (4–8%) of severe and moderate FTR. Valvular surgery improved outcome without alleviating completely higher mortality associated with FTR (P < 0.0001).
Conclusion
In this large DMR cohort, FTR was frequent and causally, not only linked to PHTN but also to other factors, particularly AFib. Higher FTR severity is associated at diagnosis with more severe clinical presentation. Long term, FTR is independently of all confounders, associated with considerably worse mortality. Functional tricuspid regurgitation moderate and even severe is profoundly undertreated. Thus careful assessment, consideration for tricuspid surgery, and testing of new transcatheter therapy is warranted.
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Affiliation(s)
- Benjamin Essayagh
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Clémence Antoine
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Giovanni Benfari
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Joseph Maalouf
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Juan A Crestanello
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Prabin Thapa
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | | | - Maurice Enriquez-Sarano
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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182
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Nagaraja V, Kapadia SR, Miyasaka R, Harb SC, Krishnaswamy A. Contemporary review of percutaneous therapy for tricuspid valve regurgitation. Expert Rev Cardiovasc Ther 2020; 18:209-218. [DOI: 10.1080/14779072.2020.1750370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Vinayak Nagaraja
- Division of Interventional Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - Samir R. Kapadia
- Department of Cardiovascular Medicine, Section Head, Interventional Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - Rhonda Miyasaka
- Division of Cardiac Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Serge C. Harb
- Division of Cardiac Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amar Krishnaswamy
- Division of Interventional Cardiology, Cleveland Clinic, Cleveland, OH, USA
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183
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Batchelor W, Lindenfeld J. Remembering the "Forgotten Valve": Further Insight Into Transcatheter Tricuspid Valve Repair for Right Heart Failure. JACC-HEART FAILURE 2020; 8:277-279. [PMID: 32241535 DOI: 10.1016/j.jchf.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 11/16/2022]
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184
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Wang TKM, Griffin BP, Miyasaka R, Xu B, Popovic ZB, Pettersson GB, Gillinov AM, Desai MY. Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patients. Open Heart 2020; 7:e001227. [PMID: 32206317 PMCID: PMC7078937 DOI: 10.1136/openhrt-2019-001227] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/30/2020] [Accepted: 02/17/2020] [Indexed: 11/14/2022] Open
Abstract
Objectives Tricuspid valve disease is increasingly encountered, but surgery is rarely performed in isolation, in part because of a reported higher operative risk than other single-valve operations. Although guidelines recommend valve repair, there is sparse literature for the optimal surgical approach in isolated tricuspid valve disease. We performed a meta-analysis examining outcomes of isolated tricuspid valve repair versus replacement. Methods We searched Pubmed, Embase, Scopus and Cochrane from January 1980 to June 2019 for studies reporting outcomes of both isolated tricuspid valve repair and replacement, excluding congenital tricuspid aetiologies. Data were extracted and pooled using random-effects models and Review Manager 5.3 software. Results There were 811 article abstracts screened, from which 52 full-text articles reviewed and 16 studies included, totalling 6808 repairs and 8261 replacements. Mean age ranged from 36 to 68 years and females made up 24%–92% of these studies. Pooled operative mortality rates and odds ratios (95% confidence intervals) for isolated tricuspid repair and replacement surgery were 8.4% vs 9.9%, 0.80 (0.64 to 1.00). Tricuspid repair was also associated with lower in-hospital acute renal failure 12.4% vs 15.6%, 0.82 (0.72 to 0.93) and pacemaker implantation 9.4% vs 21.0%, 0.37 (0.24 to 0.58), but higher stroke rate 1.5% vs 0.9%, 1.63 (1.10 to 2.41). There were no differences in rates of prolonged ventilation, mediastinitis, return to operating room or late mortality. Conclusion Isolated tricuspid valve repair was associated with significantly reduced in-hospital mortality, renal failure and pacemaker implantation compared with replacement and is therefore recommended where feasible for isolated tricuspid valve disease, although its higher stroke rate warrants further research.
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Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rhonda Miyasaka
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zoran B Popovic
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, United States
| | - Alan Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, United States
| | - Milind Y Desai
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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185
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Mahowald MK, Pislaru SV, Reeder GS, Padang R, Michelena HI, Mankad SV, Maalouf JF, Guerrero M, Alkhouli M, Rihal CS, Eleid MF. Institutional learning experience for combined edge-to-edge tricuspid and mitral valve repair. Catheter Cardiovasc Interv 2020; 96:1323-1330. [PMID: 32180349 DOI: 10.1002/ccd.28856] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/03/2020] [Accepted: 03/07/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Transcatheter edge-to-edge repair with MitraClip is only approved for treatment of mitral regurgitation but is increasingly used to treat concomitant tricuspid regurgitation (TR) due to its common coexistence and association with poor outcomes. This study aimed to describe the learning curve associated with the challenge of off-label treatment of concomitant TR. METHODS This is a retrospective review of initial and consecutive patients who underwent combined edge-to-edge repair of mitral and tricuspid valves (TVs) at our institution from August 2017 to October 2019. RESULTS Repair of both valves with MitraClip was performed in 22 patients (median age 81.5 years, 32% female). Mean procedure time was 176 ± 47 min; mean fluoroscopy time was 65 ± 24 min. Procedure duration in the first tertile was significantly longer (223 ± 13 min) than in the third tertile (143 ± 23 min, p = .0003). Median number of total clips placed per case was 3; in 15 patients (68%), the anterior and septal leaflets of the TV were clipped. The average changes in mean right atrial (RA) and left atrial (LA) pressures were -1.7 ± 2.5 mmHg (p = .0080) and -3.2 ± 4.6 mmHg (p = .0045), respectively. The average changes in RA and LA V-wave heights were -3.3 ± 4.0 mmHg (p = .0009) and -8.1 ± 9.9 mmHg (p = .038), respectively. There was a significant trend toward decreasing residual TR over the course of the series (p = .046). At 30 days, survival was 100% and mean NYHA class decreased from 2.8 to 1.8 (p < .0001). CONCLUSIONS Combined edge-to-edge tricuspid and mitral valve repair is safe and feasible. With experience, procedure duration and residual TR decreased.
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Affiliation(s)
- Madeline K Mahowald
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Guy S Reeder
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sunil V Mankad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph F Maalouf
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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186
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Miura M, Vicentini L, Taramasso M, Maisano F. Tangled wire in a Dacron band during Cardioband transcatheter tricuspid annuloplasty-How to solve the problem. Catheter Cardiovasc Interv 2020; 97:E724-E726. [PMID: 32154645 DOI: 10.1002/ccd.28845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/29/2020] [Accepted: 03/04/2020] [Indexed: 11/06/2022]
Abstract
Transcatheter tricuspid valve intervention (TTVI) is an emerging treatment for patients with symptomatic severe tricuspid regurgitation (TR). Currently, the issues that arise during TTVI are unclear. Here, a 78-year-old woman with severe TR underwent transcatheter tricuspid valve annuloplasty using a Cardioband (Edwards Lifesciences, Irvine, CA). We attempted to cinch the Dacron band after anchoring; however, it was impossible to connect the distal tip of the size adjustment tool and the Dacron band because the cinching wire was tangled around the Dacron band. We resolved this issue without surgical intervention, and eventually cinched the annulus. Final echocardiography revealed dramatic TR reduction. To our knowledge, no study has reported a tangled wire in a Dacron band during Cardioband use. Clinicians should be aware of the risks accompanying this concern in case where it is impossible to connect the distal tip of the size adjustment tool and the Dacron band during cinching.
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Affiliation(s)
- Mizuki Miura
- University Heart Center Zurich, Zürich, Switzerland
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187
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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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188
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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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189
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Kolte D, Elmariah S. Current state of transcatheter tricuspid valve repair. Cardiovasc Diagn Ther 2020; 10:89-97. [PMID: 32175231 PMCID: PMC7044094 DOI: 10.21037/cdt.2019.09.11] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/09/2019] [Indexed: 11/06/2022]
Abstract
Tricuspid regurgitation (TR) is a common valvular heart disease affecting >1.6 million people in the United States (US) and >70 million people worldwide. The age- and sex-adjusted prevalence of more than or equal to moderate TR in the US is estimated to be 0.55%. One-year mortality increases with increasing severity of TR. Yet, the majority of patients with severe TR are managed medically in the absence of another indication for cardiac surgery, and isolated tricuspid valve (TV) surgery remains infrequent. To address this unmet clinical need, various transcatheter TV therapies are now being developed as an alternative to surgery in extreme- and high-risk patients with severe functional TR. Transcatheter TV repair devices are aimed at improving leaflet coaptation either directly by bringing the leaflets together (leaflet/coaptation devices) or indirectly by repairing the dilated annulus (annuloplasty devices). In this review, we describe the current state of transcatheter TV repair therapies and summarize the available data on the efficacy and safety of various devices. Procedural and clinical outcomes of transcatheter TV repair therapies are expected to improve in the coming years with technological advancement, newer device iterations, and increased experience in this field. Appropriate patient selection, optimal timing of intervention, and evaluation of long-term outcomes and device durability will be key in ongoing and future studies.
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Affiliation(s)
- Dhaval Kolte
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sammy Elmariah
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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190
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Charles EJ, Ailawadi G. Commentary: Addressing tricuspid annular dilation: Cinch it down but not too tight. J Thorac Cardiovasc Surg 2020; 161:e288-e289. [PMID: 31973892 DOI: 10.1016/j.jtcvs.2019.11.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 11/29/2019] [Accepted: 11/30/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Eric J Charles
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
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191
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Taramasso M, Gavazzoni M, Pozzoli A, Alessandrini H, Latib A, Attinger-Toller A, Biasco L, Braun D, Brochet E, Connelly KA, de Bruijn S, Denti P, Deuschl F, Estevez-Louriero R, Fam N, Frerker C, Ho E, Juliard JM, Kaple R, Kodali S, Kreidel F, Kuck KH, Lauten A, Lurz J, Monivas V, Mehr M, Nazif T, Nickening G, Pedrazzini G, Praz F, Puri R, Rodés-Cabau J, Schäfer U, Schofer J, Sievert H, Tang GHL, Khattab AA, Thiele H, Unterhuber M, Vahanian A, Von Bardeleben RS, Webb JG, Weber M, Windecker S, Winkel M, Zuber M, Hausleiter J, Lurz P, Maisano F, Leon MB, Hahn RT. Outcomes of TTVI in Patients With Pacemaker or Defibrillator Leads: Data From the TriValve Registry. JACC Cardiovasc Interv 2020; 13:554-564. [PMID: 31954676 DOI: 10.1016/j.jcin.2019.10.058] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/30/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The interference of a transtricuspid cardiac implantable electronic device (CIED) lead with tricuspid valve function may contribute to the mechanism of tricuspid regurgitation (TR) and poses specific therapeutic challenges during transcatheter tricuspid valve intervention (TTVI). Feasibility and efficacy of TTVI in presence of a CIED is unclear. BACKGROUND Feasibility of TTVI in presence of a CIED lead has never been proven on a large basis. METHODS The study population consisted of 470 patients with severe symptomatic TR from the TriValve (Transcatheter Tricuspid Valve Therapies) registry who underwent TTVI at 21 centers between 2015 and 2018. The association of CIED and outcomes were assessed. RESULTS Pre-procedural CIED was present in 121 of 470 (25.7%) patients. The most frequent location of the CIED lead was the posteroseptal commissure (44.0%). As compared with patients without a transvalvular lead (no-CIED group), patients having a tricuspid lead (CIED group) were more symptomatic (New York Heart Association functional class III to IV in 95.9% vs. 92.3%; p = 0.02) and more frequently had previous episodes of right heart failure (87.8% vs. 69.0%; p = 0.002). No-CIED patients had more severe TR (effective regurgitant orifice area 0.7 ± 0.6 cm2 vs. 0.6 ± 0.3 cm2; p = 0.02), but significantly better right ventricular function (tricuspid annular plane systolic excursion = 16.7 ± 5.0 mm vs. 15.9 ± 4.0 mm; p = 0.04). Overall, 373 patients (79%) were treated with the MitraClip (Abbott Vascular, Santa Clara, California) (106 [87.0%] in the CIED group). Among them, 154 (33%) patients had concomitant transcatheter mitral repair (55 [46.0%] in the CIED group, all MitraClip). Procedural success was achieved in 80.0% of no-CIED patients and in 78.6% of CIED patients (p = 0.74), with an in-hospital mortality of 2.9% and 3.7%, respectively (p = 0.70). At 30 days, residual TR ≤2+ was observed in 70.8% of no-CIED and in 73.7% of CIED patients (p = 0.6). Symptomatic improvement was observed in both groups (NYHA functional class I to II at 30 days: 66.0% vs. 65.0%; p = 0.30). Survival at 12 months was 80.7 ± 3.0% in the no-CIED patients and 73.6 ± 5.0% in the CIED patients (p = 0.30). CONCLUSIONS TTVI is feasible in selected patients with CIED leads and acute procedural success and short-term clinical outcomes are comparable to those observed in patients without a transtricuspid lead.
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Affiliation(s)
- Maurizio Taramasso
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
| | - Mara Gavazzoni
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Alberto Pozzoli
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | | | - Azeem Latib
- Cardiology Department, Montefiore Medical Center, New York, New York
| | | | - Luigi Biasco
- Cardiology Department, Cardiocentro, Lugano, Switzerland
| | - Daniel Braun
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Eric Brochet
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | - Kim A Connelly
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada
| | - Sabine de Bruijn
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Florian Deuschl
- Cardiology Department, University Heart Center Hamburg, Hamburg, Germany
| | - Rodrigo Estevez-Louriero
- Cardiology Department, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Neil Fam
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada
| | | | - Edwin Ho
- Cardiology Department, Montefiore Medical Center, New York, New York; Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada
| | | | - Ryan Kaple
- Cardiology Department, Westchester Medical Center, Valhalla, New York
| | - Susheel Kodali
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Felix Kreidel
- Cardiology Department, Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Karl-Heinz Kuck
- Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Alexander Lauten
- Cardiology Department, Charité University Hospital, Berlin, Germany
| | - Julia Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Vanessa Monivas
- Cardiology Department, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Michael Mehr
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Tamin Nazif
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Georg Nickening
- Cardiology Department, Universitatsklinikum Bonn, Bonn, Germany
| | | | - Fabien Praz
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rishi Puri
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Josep Rodés-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Ulrich Schäfer
- Cardiology Department, University Heart Center Hamburg, Hamburg, Germany
| | - Joachim Schofer
- Cardiology Department, Albertinen Heart Center, Hamburg, Germany
| | - Horst Sievert
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Gilbert H L Tang
- Cardiac Surgery Department, Mount Sinai Hospital, New York, New York
| | - Ahmed A Khattab
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland; Cardiology Department, Cardiance Clinic, Pfäffikon, Switzerland; Cardiology Department, University of Bern, Bern, Switzerland
| | - Holger Thiele
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Matthias Unterhuber
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Alec Vahanian
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | | | - John G Webb
- Cardiology Department, St. Paul Hospital, Vancouver, Canada
| | - Marcel Weber
- Cardiology Department, Universitatsklinikum Bonn, Bonn, Germany
| | - Stephan Windecker
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam Winkel
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michel Zuber
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Jörg Hausleiter
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Philipp Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Francesco Maisano
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Martin B Leon
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Rebecca T Hahn
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
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192
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Winkel M, Hunziker L, Pilgrim T, Brugger N, Windecker S, Praz F. [Transcatheter Treatment of Severe Tricuspid Regurgitation]. PRAXIS 2020; 109:1243-1249. [PMID: 33292012 DOI: 10.1024/1661-8157/a003590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Transcatheter Treatment of Severe Tricuspid Regurgitation Abstract. Severe tricuspid regurgitation can lead to increased morbidity and mortality due to clinical symptoms and impairment of organ function. With the emergence of new interventional treatment options, the once neglected tricuspid valve is receiving increased attention. The following article intends to provide an overview of the causes, diagnostic modalities, and therapeutic options of severe tricuspid regurgitation.
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Affiliation(s)
- Mirjam Winkel
- Inselspital Bern, Universitätsklinik für Kardiologie, Bern
| | - Lukas Hunziker
- Inselspital Bern, Universitätsklinik für Kardiologie, Bern
| | - Thomas Pilgrim
- Inselspital Bern, Universitätsklinik für Kardiologie, Bern
| | | | | | - Fabien Praz
- Inselspital Bern, Universitätsklinik für Kardiologie, Bern
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193
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Bertrand PB, Hung J. Bicaval Valve Implantation for Severe Tricuspid Regurgitation: Thinking Outside the Valve Box. JACC Case Rep 2019; 1:725-726. [PMID: 34316919 PMCID: PMC8289099 DOI: 10.1016/j.jaccas.2019.10.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Philippe B. Bertrand
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Judy Hung
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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194
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Voci D, Pozzoli A, Miura M, Gavazzoni M, Gülmez G, Scianna S, Zuber M, Maisano F, Taramasso M. Developments in transcatheter tricuspid valve therapies. Expert Rev Cardiovasc Ther 2019; 17:841-856. [PMID: 31795771 DOI: 10.1080/14779072.2019.1699056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: Transcatheter tricuspid valve (TV) procedures emerged as an alternative to surgery for symptomatic high-risk patients with severe tricuspid regurgitation.Areas covered: A literature search was performed using PubMed. Authors review clinical evidence in this field, the imaging features and the developments in TV transcatheter technologies. Currently, transcatheter devices for TV procedures can be allocated into four main groups: 1) those ones targeting leaflet malcoaptation, 2) those addressing annular dilatation, 3) those performing heterotopic valve implantation and 4) those onesaccomplishing a complete transcatheter replacement of the valve.Expert opinion: Actually, encouraging results are provided by initial experience in the field of transcatheter TV procedures. However, this field remains full of challenges that faced could lead to better results and prognosis for the patients. The next steps in this emerging field will need to focus on accurate patient selection, an early patient referral and on studies comparable and providing long-term data.
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Affiliation(s)
- Davide Voci
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Alberto Pozzoli
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Mizuki Miura
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Mara Gavazzoni
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Gökhan Gülmez
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Salvatore Scianna
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Michel Zuber
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Francesco Maisano
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Maurizio Taramasso
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
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195
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Miura M, Taramasso M, Gavazzoni M, Zuber M, Maisano F. What Is the Best Option in Patients With Isolated Severe Tricuspid Regurgitation? J Am Coll Cardiol 2019; 74:2829. [PMID: 31779806 DOI: 10.1016/j.jacc.2019.09.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/03/2019] [Indexed: 10/25/2022]
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196
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Axtell AL, Wasfy JH. Reply: Isolated Severe Tricuspid Regurgitation: Opportunities for Future Research. J Am Coll Cardiol 2019; 74:2830-2831. [PMID: 31779807 DOI: 10.1016/j.jacc.2019.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/06/2019] [Indexed: 10/25/2022]
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197
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Gavazzoni M, Taramasso M. Transtricuspid gradient after percutaneous edge-to-edge tricuspid valve repair: are we looking at the right side? EUROINTERVENTION 2019; 15:e1038-e1040. [DOI: 10.4244/eijv15i12a195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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198
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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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199
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Avoiding Mistakes of the Past with Tricuspid Regurgitation. J Am Soc Echocardiogr 2019; 32:1547-1550. [DOI: 10.1016/j.echo.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 12/19/2022]
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200
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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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