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Compassionate Use of the PASCAL Transcatheter Valve Repair System for Severe Tricuspid Regurgitation. JACC Cardiovasc Interv 2019; 12:2488-2495. [DOI: 10.1016/j.jcin.2019.09.046] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/16/2019] [Accepted: 09/24/2019] [Indexed: 11/23/2022]
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202
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Nickenig G, Weber M, Lurz P, von Bardeleben RS, Sitges M, Sorajja P, Hausleiter J, Denti P, Trochu JN, Näbauer M, Dahou A, Hahn RT. Transcatheter edge-to-edge repair for reduction of tricuspid regurgitation: 6-month outcomes of the TRILUMINATE single-arm study. Lancet 2019; 394:2002-2011. [PMID: 31708188 DOI: 10.1016/s0140-6736(19)32600-5] [Citation(s) in RCA: 244] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/09/2019] [Accepted: 09/16/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Tricuspid regurgitation is a prevalent disease associated with high morbidity and mortality, with few treatment options. The aim of the TRILUMINATE trial is to evaluate the safety and effectiveness of TriClip, a minimally invasive transcatheter tricuspid valve repair system, for reducing tricuspid regurgitation. METHODS The TRILUMINATE trial is a prospective, multicentre, single-arm study in 21 sites in Europe and the USA. Patients with moderate or greater triscuspid regurgitation, New York Heart Association class II or higher, and who were adequately treated per applicable standards were eligible for enrolment. Patients were excluded if they had systolic pulmonary artery pressure of more than 60 mm Hg, a previous tricuspid valve procedure, or a cardiovascular implantable electronic device that would inhibit TriClip placement. Participants were treated using a clip-based edge-to-edge repair technique with the TriClip tricuspid valve repair system. Tricuspid regurgitation was graded using a five-class grading scheme (mild, moderate, severe, massive, and torrential) that expanded on the standard American Society of Echocardiography grading scheme. The primary efficacy endpoint was a reduction in tricuspid regurgitation severity by at least one grade at 30 days post procedure, with a performance goal of 35%, analysed in all patients who had an attempted tricuspid valve repair procedure upon femoral vein puncture. The primary safety endpoint was a composite of major adverse events at 6 months, with a performance goal of 39%. Patients were excluded from the primary safety analysis if they did not reach 6-month follow-up and did not have a major adverse event during previous follow-ups. The trial has completed enrolment and follow-up is ongoing; it is registered with ClinicalTrials.gov, number NCT03227757. FINDINGS Between Aug 1, 2017, and Nov 29, 2018, 85 patients (mean age 77·8 years [SD 7·9]; 56 [66%] women) were enrolled and underwent successful TriClip implantation. Tricuspid regurgitation severity was reduced by at least one grade at 30 days in 71 (86%) of 83 patients who had available echocardiogram data and imaging. The one-sided lower 97·5% confidence limit was 76%, which was greater than the prespecified performance goal of 35% (p<0·0001). One patient withdrew before 6-month follow-up without having had a major adverse event and was excluded from analysis of the primary safety endpoint. At 6 months, three (4%) of 84 patients experienced a major adverse event, which was less than the prespecified performance goal of 39% (p<0·0001). Single leaflet attachment occurred in five (7%) of 72 patients. No periprocedural deaths, conversions to surgery, device embolisations, myocardial infarctions, or strokes occurred. At 6 months, all-cause mortality had occurred in four (5%) of 84 patients. INTERPRETATION The TriClip system appears to be safe and effective at reducing tricuspid regurgitation by at least one grade. This reduction could translate to significant clinical improvement at 6 months post procedure. FUNDING Abbott.
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Affiliation(s)
| | - Marcel Weber
- Heart Center, University Hospital, Bonn, Germany
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | - Marta Sitges
- Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Barcelona, Spain
| | - Paul Sorajja
- Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Jörg Hausleiter
- Medizinische Klinik I der Ludwig-Maximilians Universität München, Munich, Germany
| | | | | | - Michael Näbauer
- Medizinische Klinik I der Ludwig-Maximilians Universität München, Munich, Germany
| | | | - Rebecca T Hahn
- The Cardiovascular Research Foundation, New York, NY, USA; New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
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203
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Godoy M, Mugharbil A, Anastasius M, Leipsic J. Cardiac Computed Tomography (CT) Evaluation of Valvular Heart Disease in Transcatheter Interventions. Curr Cardiol Rep 2019; 21:154. [DOI: 10.1007/s11886-019-1241-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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204
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Williams AM, Bolling SF, Latib A. The five Ws of transcatheter tricuspid valve repair: Who, What, When, Where, and Why. EUROINTERVENTION 2019; 15:841-845. [PMID: 31746749 DOI: 10.4244/eijv15i10a159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Aaron M Williams
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
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205
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Gallet R, Ternacle J, Teiger E. [Transcatheter treatment of tricuspid regurgitation]. Ann Cardiol Angeiol (Paris) 2019; 68:480-485. [PMID: 31668340 DOI: 10.1016/j.ancard.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Tricuspid regurgitation is serious disease for which surgical correction is underperformed because of a prohibitive risk. It is responsible for a 50% mortality at 3 years which is decreased by surgical treatment. However, only a negligible proportion of patients undergoes surgery. In this context, there is currently an unmet need for percutaneous treatment technique. Several technologies are undergoing preclinical or early clinical development. These techniques aim to mimic the different surgical strategies used for the treatment of tricuspid regurgitation. Thus, some target the leaflets, the tricuspid annulus or offer a complete tricuspid valve replacement. Before planning a transcatheter tricuspid intervention, a comprehensive evaluation is mandatory, addressing the patient clinical status and comorbidities, the tricuspid regurgitation ad its consequences on right heart and, the anatomy of the tricuspid annulus and the right heart to determine if the patient is eligible for the chosen technique. This article will review the indications, contraindications and exams to perform before transcatheter tricuspid intervention and will then detail the different strategies available or undergoing development.
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Affiliation(s)
- R Gallet
- Service de Cardiologie, CHU Henri-Mondor, 51, avenue du Maréchal de Lattre de-Tassigny, 94010 Créteil, France.
| | - J Ternacle
- Service de Cardiologie, CHU Henri-Mondor, 51, avenue du Maréchal de Lattre de-Tassigny, 94010 Créteil, France
| | - E Teiger
- Service de Cardiologie, CHU Henri-Mondor, 51, avenue du Maréchal de Lattre de-Tassigny, 94010 Créteil, France
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206
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Patients' selection for transcatheter tricuspid valve interventions: Who will benefit? Prog Cardiovasc Dis 2019; 62:467-472. [DOI: 10.1016/j.pcad.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 09/08/2019] [Indexed: 01/09/2023]
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207
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Peri Y, Sadeh B, Sherez C, Hochstadt A, Biner S, Aviram G, Ingbir M, Nachmany I, Topaz G, Flint N, Keren G, Topilsky Y. Quantitative assessment of effective regurgitant orifice: impact on risk stratification, and cut-off for severe and torrential tricuspid regurgitation grade. Eur Heart J Cardiovasc Imaging 2019; 21:768-776. [DOI: 10.1093/ehjci/jez267] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/18/2019] [Accepted: 10/12/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Asses the added value of quantitative evaluation of tricuspid regurgitation (TR), the proper cut-off value for severe TR and ‘torrential TR’ based on outcome data. The added value of quantitative evaluation of TR, and the cut-off values associated with increased mortality are unknown.
Methods and results
In patients with all-cause TR assessed both qualitatively and quantitatively by proximal iso-velocity surface area method, long-term and 1-year outcome analysis was conducted. Thresholds for excess mortality were assessed using spline curves, receiver-operating characteristic curves, and minimum P-value analysis. The study involved 676 patients with all-cause TR (age 73.9 ± 14 years, male 45%, ejection fraction 52.9 ± 14%). Effective regurgitant orifice (ERO) was strongly associated with decreased survival in unadjusted [hazard ratio (HR) 2.38 (1.79–3.01), P < 0.0001 per 0.1 cm2 increment] and adjusted [2.6 (1.25–5.0), P = 0.01] analyses. Quantitative grading was superior to qualitative grading in prediction of outcome (P < 0.01). The optimal cut-off value for the best separation in survival between groups of patients with severe vs. lesser degree of TR was 0.35 cm2 [P < 0.0001, HR =2.0 (1.5–2.7)]. ERO negatively impacted survival, even when including only the subgroup of patients with severe TR [HR 1.5 (1.01–2.3); P = 0.04]. The optimal threshold corresponding for the best separation for survival between groups of patients with severe vs. ‘torrential’ TR was 0.7 cm2 [P = 0.005, HR =2.6 (1.2–5.1)].
Conclusion
TR can be severe and even ‘torrential’ and is associated with excess mortality. Quantitative assessment of TR by ERO measurement is a powerful independent predictor of outcome, superior to standard qualitative assessment. The optimal cut-off above which mortality is increased is 0.35 cm2, similar albeit slightly lower than suggested in recent guidelines. Torrential TR >0.7 cm2 is associated with poorer survival compared to patients with severe TR (ERO > 0.4 cm2 and <0.7 cm2).
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Affiliation(s)
- Yogev Peri
- Department of Cardiology, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Ben Sadeh
- Department of Cardiology, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Chen Sherez
- Department of Cardiology, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Simon Biner
- Department of Cardiology, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Galit Aviram
- Division of Radiology, Sackler Faculty of Medicine, Tel Aviv University, Weizmann 6, 6423906, Tel Aviv, Israel
| | - Meirav Ingbir
- Department of Cardiology, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Ido Nachmany
- Division of Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Weizmann 6, 6423906, Tel Aviv, Israel
| | - Guy Topaz
- Department of Internal Medicine, Meir Hospital, Kfar-Saba and Sackler Faculty of Medicine, Tel Aviv University, Weizmann 6, 6423906, Tel Aviv, Israel
| | - Nir Flint
- Department of Cardiology, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Gad Keren
- Department of Cardiology, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
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208
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[Edge-to-edge repair : What has changed compared to the position paper in 2013?]. Herz 2019; 44:586-591. [PMID: 31628494 DOI: 10.1007/s00059-019-04847-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This short review article aims to explain the changes in the treatment strategies of interventional care designed to treat secondary mitral valve regurgitation with edge-to-edge repair in comparison to the position paper published in 2013 by the German Society of Cardiology and the German Society of Thoracic and Cardiovascular Surgery. To this end the current data situation with respect to the European Society of Cardiology (ESC) guidelines from 2017, the intraprocedural assessment of mitral valve regurgitation and new technical developments are discussed.
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209
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Faza NN, Özden Tok Ö, Hahn RT. Imaging in Structural Heart Disease: The Evolution of a New Subspecialty. JACC Case Rep 2019; 1:440-445. [PMID: 34316851 PMCID: PMC8288782 DOI: 10.1016/j.jaccas.2019.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 06/06/2023]
Abstract
Structural heart disease is a new field in cardiovascular medicine, which has resulted in the creation of a new imaging subspecialty. Structural heart disease imagers have been instrumental in stimulating innovations in both the imaging and interventional spheres. Perhaps most importantly, they play a key role on the clinical heart team, interacting with team members and patients before, during, and long after a structural procedure is performed.
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Affiliation(s)
- Nadeen N. Faza
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Özge Özden Tok
- Cardiology Department, Memorial Bahçelievler Hospital, Istanbul, Turkey
| | - Rebecca T. Hahn
- Columbia University Medical Center/NewYork–Presbyterian Hospital, New York, New York
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210
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Bohbot Y, Chadha G, Delabre J, Landemaine T, Beyls C, Tribouilloy C. Characteristics and prognosis of patients with significant tricuspid regurgitation. Arch Cardiovasc Dis 2019; 112:604-614. [DOI: 10.1016/j.acvd.2019.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 10/25/2022]
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211
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Chang CC, Veen KM, Hahn RT, Bogers AJJC, Latib A, Oei FBS, Abdelghani M, Modolo R, Ho SY, Abdel-Wahab M, Fattouch K, Bosmans J, Caliskan K, Taramasso M, Serruys PW, Bax JJ, van Mieghem NMDA, Takkenberg JJM, Lurz P, Modine T, Soliman O. Uncertainties and challenges in surgical and transcatheter tricuspid valve therapy: a state-of-the-art expert review. Eur Heart J 2019; 41:1932-1940. [DOI: 10.1093/eurheartj/ehz614] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/04/2019] [Accepted: 08/09/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Tricuspid regurgitation (TR) is a frequent and complex problem, commonly combined with left-sided heart disease, such as mitral regurgitation. Significant TR is associated with increased mortality if left untreated or recurrent after therapy. Tricuspid regurgitation was historically often disregarded and remained undertreated. Surgery is currently the only Class I Guideline recommended therapy for TR, in the form of annuloplasty, leaflet repair, or valve replacement. As growing experience of transcatheter therapy in structural heart disease, many dedicated transcatheter tricuspid repair or replacement devices, which mimic well-established surgical techniques, are currently under development. Nevertheless, many aspects of TR are little understood, including the disease process, surgical or interventional risk stratification, and predictors of successful therapy. The optimal treatment timing and the choice of proper surgical or interventional technique for significant TR remain to be elucidated. In this context, we aim to highlight the current evidence, underline major controversial issues in this field and present a future roadmap for TR therapy.
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Affiliation(s)
- Chun Chin Chang
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Kevin M Veen
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Rebecca T Hahn
- Structural Heart & Valve Center, New York Presbyterian Hospital, Columbia University Medical Center,161 Fort Washington Avenue, New York, NY 10032, USA
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, 3400 Bainbridge Ave, The Bronx, New York, NY, USA
| | - Frans B S Oei
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Mohammad Abdelghani
- Heart Center, Segeberger Kliniken, Am Kurpark 1, 23795, Bad Segeberg, Germany
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Rodrigo Modolo
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Cardiology Division, Department of Internal Medicine, University of Campinas (UNICAMP), Campinas- SP, 13083-970, Brazil
| | - Siew Yen Ho
- Brompton Cardiac Morphology Unit, Royal Brompton Hospital, Imperial College London, London, SW7 2AZ UK
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig, University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Viale Regione Siciliana 1571, 90100 Palermo, Italy
- GVM Care and Research, Maria Cecilia Hospital, Via Madonna di Genova, 1, 48033, Cotignola, Italy
| | - Johan Bosmans
- Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Kadir Caliskan
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Patrick W Serruys
- National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, Chelsea, London SW3 6LY, UK
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Nicolas M D A van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Philip Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Thomas Modine
- Department of Cardiovascular Surgery, Hopital Cardiologique CHRU de Lille, 2 Avenue Oscar Lambret, 59000 Lille, France
| | - Osama Soliman
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
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212
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Maisano F. All Roads Lead to Rome?: Out-of-the-Box Thinking in the Quest of Tricuspid Interventions. JACC Cardiovasc Interv 2019; 12:1448-1450. [PMID: 31395214 DOI: 10.1016/j.jcin.2019.06.012] [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: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Francesco Maisano
- University Hospital Zurich, University Heart Center, Zurich, Switzerland.
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213
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Mehr M, Taramasso M, Besler C, Ruf T, Connelly KA, Weber M, Yzeiraj E, Schiavi D, Mangieri A, Vaskelyte L, Alessandrini H, Deuschl F, Brugger N, Ahmad H, Biasco L, Orban M, Deseive S, Braun D, Rommel KP, Pozzoli A, Frerker C, Näbauer M, Massberg S, Pedrazzini G, Tang GHL, Windecker S, Schäfer U, Kuck KH, Sievert H, Denti P, Latib A, Schofer J, Nickenig G, Fam N, von Bardeleben RS, Lurz P, Maisano F, Hausleiter J. 1-Year Outcomes After Edge-to-Edge Valve Repair for Symptomatic Tricuspid Regurgitation: Results From the TriValve Registry. JACC Cardiovasc Interv 2019; 12:1451-1461. [PMID: 31395215 DOI: 10.1016/j.jcin.2019.04.019] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/01/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate procedural and 1-year clinical and echocardiographic outcomes of patients treated with tricuspid edge-to-edge repair. BACKGROUND Transcatheter edge-to-edge repair has been successfully performed in selected patients with symptomatic tricuspid regurgitation (TR) and high risk for surgery, but outcome data are sparse. METHODS This analysis of the multicenter international TriValve (Transcatheter Tricuspid Valve Therapies) registry included 249 patients with severe TR treated with edge-to-edge repair in compassionate and/or off-label use. Clinical and echocardiographic outcomes were prospectively collected and retrospectively analyzed. RESULTS In 249 patients (mean age 77 ± 9 years; European System for Cardiac Operative Risk Evaluation II score 6.4% [interquartile range: 3.9% to 13.9%]), a successful procedure with TR reduction to grade ≤2+ was achieved in 77% by placement of 2 ± 1 tricuspid clips. Concomitant treatment of severe TR and mitral regurgitation was performed in 52% of patients. At 1-year follow-up, significant and durable improvements in TR severity (TR ≤2+ in 72% of patients) and New York Heart Association functional class (≤II in 69% of patients) were observed. All-cause mortality was 20%, and the combined rate of mortality and unplanned hospitalization for heart failure was 35%. Predictors of procedural failure included effective regurgitant orifice area, tricuspid coaptation gap, tricuspid tenting area, and absence of central or anteroseptal TR jet location. Predictors of 1-year mortality were procedural failure, worsening kidney function, and absence of sinus rhythm. CONCLUSIONS Transcatheter tricuspid edge-to-edge repair can achieve TR reduction at 1 year, resulting in significant clinical improvement. Predictors of procedural failure and 1-year mortality identified here may help select patients who will benefit most from this therapy.
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Affiliation(s)
- Michael Mehr
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | | | - Tobias Ruf
- Mainz University Hospital, University of Mainz, Mainz, Germany
| | - Kim A Connelly
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marcel Weber
- Bonn University Hospital, University of Bonn, Bonn, Germany
| | | | | | | | | | | | - Florian Deuschl
- University Heart Center Hamburg, University of Hamburg, Hamburg, Germany
| | | | - Hasan Ahmad
- Westchester Medical Center, Valhalla, New York
| | | | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Alberto Pozzoli
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | | | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Gilbert H L Tang
- Westchester Medical Center, Valhalla, New York; Mount Sinai Medical Center, New York, New York
| | | | - Ulrich Schäfer
- University Heart Center Hamburg, University of Hamburg, Hamburg, Germany
| | | | | | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | - Azeem Latib
- San Raffaele University Hospital, Milan, Italy
| | | | - Georg Nickenig
- Bonn University Hospital, University of Bonn, Bonn, Germany
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Philipp Lurz
- Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany.
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214
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Singh S. MitraClip in the Tricuspid Position: Slowly, But Surely, the March Continues. JACC Cardiovasc Interv 2019; 12:1462-1464. [PMID: 31395216 DOI: 10.1016/j.jcin.2019.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/14/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Siddharth Singh
- Echocardiography Laboratory, Cedars Sinai Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California.
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Nickenig G, Weber M. Another Piece in the Tricuspid Puzzle. JACC Cardiovasc Interv 2019; 12:1435-1437. [DOI: 10.1016/j.jcin.2019.03.016] [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: 03/07/2019] [Accepted: 03/19/2019] [Indexed: 11/30/2022]
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216
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Karam N, Braun D, Mehr M, Orban M, Stocker TJ, Deseive S, Orban M, Hagl C, Näbauer M, Massberg S, Hausleiter J. Impact of Transcatheter Tricuspid Valve Repair for Severe Tricuspid Regurgitation on Kidney and Liver Function. JACC Cardiovasc Interv 2019; 12:1413-1420. [DOI: 10.1016/j.jcin.2019.04.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 11/29/2022]
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217
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Fam NP. Forgotten Valve Meets Neglected Organ. JACC Cardiovasc Interv 2019; 12:1421-1422. [DOI: 10.1016/j.jcin.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/06/2019] [Indexed: 12/23/2022]
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218
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Oliveira DC, Oliveira CGC. The Forgotten, Not Studied or Not Valorized Tricuspid Valve: The Transcatheter Revolution Is Coming. Cardiol Res 2019; 10:199-206. [PMID: 31413775 PMCID: PMC6681841 DOI: 10.14740/cr874] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/03/2019] [Indexed: 12/30/2022] Open
Abstract
The tricuspid valve (TV) has been known as the forgotten valve. However, considering recent information from scientific studies, this nomenclature may need to be adjusted for the valve, which also needs to be better studied and understood. For decades, tricuspid regurgitation (TR) was not fully appreciated and was never the priority. However, studies have revealed that such pathology is related to a possible negative impact on prognosis of patients. Severe TR is a predictor of higher mortality. For the treatment of TR, repair or valve replacement can be performed. Repair techniques can be performed on the annulus (suture annuloplasty or ring implant), on the leaflets (e.g. triangular resection), on the cords (transfers or new cords) and on the papillary muscles (e.g. sliding technique). The anatomical characteristics of the TV determine the repair technique to be used. In some cases, valve repair is not possible and/or not indicated and valve replacement is selected based on the strategy. Nowadays transcatheter therapies have been used and studied. The main transcatheter strategies for the treatment of TR are based on reduction of the annulus (Cardioband, Trialign, TriCinch, Millipede and TRAIPTA), improvement of the leaflet coaptation (Mitraclip, FORMA device, PASCAL system, and TV occluder), reduction of the reflux for the vena cava system (Tric valve and Sapien valve implant), and valve implants (Navigate, Trisol, Sapien, Melody). In this context, there are still other devices (such as Tricentro, Pasta, etc.) being developed and tested throughout several phases of research. In the future, improved knowledge of the TV and the evolution of transcatheter treatments will alter the history of the TV. The transcatheter revolution is coming!
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Affiliation(s)
- Dinaldo C Oliveira
- Federal University of Pernambuco, Recife, Pernambuco, Brazil.,Hospital Ilha do Leite, Recife, Pernambuco, Brazil
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Schlotter F, Orban M, Rommel KP, Besler C, von Roeder M, Braun D, Unterhuber M, Borger M, Hagl C, Orban M, Nabauer M, Massberg S, Thiele H, Hausleiter J, Lurz P. Aetiology-based clinical scenarios predict outcomes of transcatheter edge-to-edge tricuspid valve repair of functional tricuspid regurgitation. Eur J Heart Fail 2019; 21:1117-1125. [PMID: 31359620 DOI: 10.1002/ejhf.1547] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/09/2019] [Accepted: 06/01/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Florian Schlotter
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mathias Orban
- Klinikum der Universität München, Medizinische Klinik und Poliklinik I, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Christian Besler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Maximilian von Roeder
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Daniel Braun
- Klinikum der Universität München, Medizinische Klinik und Poliklinik I, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Matthias Unterhuber
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Michael Borger
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Christian Hagl
- Klinikum der Universität München, Herzchirurgische Klinik und Poliklinik, Munich, Germany
| | - Martin Orban
- Klinikum der Universität München, Medizinische Klinik und Poliklinik I, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Michael Nabauer
- Klinikum der Universität München, Medizinische Klinik und Poliklinik I, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Steffen Massberg
- Klinikum der Universität München, Medizinische Klinik und Poliklinik I, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Jörg Hausleiter
- Klinikum der Universität München, Medizinische Klinik und Poliklinik I, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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220
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Boudoulas KD, Barbetseas J, Pitsis AA, Boudoulas H. Tricuspid Valve Disease: The "Forgotten Valve". Cardiology 2019; 142:235-238. [PMID: 31238310 DOI: 10.1159/000497816] [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: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Konstantinos Dean Boudoulas
- Division of Cardiovascular Medicine, Department of Medicine, The Ohio State University, Columbus, Ohio, USA,
| | - John Barbetseas
- Department of Cardiology, Laiko General Hospital, Athens, Greece
| | | | - Harisios Boudoulas
- Division of Cardiovascular Medicine, Department of Medicine, The Ohio State University, Columbus, Ohio, USA.,Biomedical Research Foundation, Academy of Athens, Athens, Greece
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221
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Faletra FF, Leo LA, Paiocchi VL, Caretta A, Viani GM, Schlossbauer SA, Demertzis S, Ho SY. Anatomy of mitral annulus insights from non-invasive imaging techniques. Eur Heart J Cardiovasc Imaging 2019; 20:843-857. [DOI: 10.1093/ehjci/jez153] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/21/2019] [Indexed: 01/02/2023] Open
Abstract
AbstractThe mitral annulus (MA) is not a continuous ring of connective tissue from which are suspended mitral leaflets. Instead, it is a much more complex structure made up of a mix of fibrous, muscular, and adipose tissues. MA is a key structure in any type of mitral valve repair and recently it has been targeted for transcutaneous devices. Thus, a deep understanding of MA anatomy has never been more important. Traditionally, cardiac anatomy has been described using anatomic specimens. Currently, sophisticated non-invasive techniques allow imaging of MA with a richness of anatomical details unimaginable only two decades ago. The aim of this review is to provide a better understanding of the peculiar aspects of MA as they are revealed through these imaging techniques and discuss clinical implications related to this complex structure.
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Affiliation(s)
- Francesco F Faletra
- Department of Cardiology Fondazione, Cardiocentro Ticino Lugano, Via Tesserete 48, CH Lugano, Switzerland
| | - Laura Anna Leo
- Department of Cardiology Fondazione, Cardiocentro Ticino Lugano, Via Tesserete 48, CH Lugano, Switzerland
| | - Vera Lucia Paiocchi
- Department of Cardiology Fondazione, Cardiocentro Ticino Lugano, Via Tesserete 48, CH Lugano, Switzerland
| | - Alessandro Caretta
- Department of Cardiology Fondazione, Cardiocentro Ticino Lugano, Via Tesserete 48, CH Lugano, Switzerland
| | - Giacomo Maria Viani
- Department of Cardiology Fondazione, Cardiocentro Ticino Lugano, Via Tesserete 48, CH Lugano, Switzerland
| | - Susanne Anna Schlossbauer
- Department of Cardiology Fondazione, Cardiocentro Ticino Lugano, Via Tesserete 48, CH Lugano, Switzerland
| | - Stefanos Demertzis
- Department of Cardiology Fondazione, Cardiocentro Ticino Lugano, Via Tesserete 48, CH Lugano, Switzerland
| | - Siew Yen Ho
- Cardiac Morphology Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
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Curio J, Demir OM, Pagnesi M, Mangieri A, Giannini F, Weisz G, Latib A. Update on the Current Landscape of Transcatheter Options for Tricuspid Regurgitation Treatment. ACTA ACUST UNITED AC 2019; 14:54-61. [PMID: 31178930 PMCID: PMC6545971 DOI: 10.15420/icr.2019.5.1] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/21/2019] [Indexed: 11/04/2022]
Abstract
Most patients with severe tricuspid regurgitation lack treatment options because of prohibitive surgical risk. New transcatheter treatments under development and investigation might be able to address this unmet clinical need. This article gives an update on the landscape of devices for transcatheter tricuspid regurgitation treatment including different approaches (i.e. repair with leaflet approximation or annuloplasty and replacement using orthotopic or heterotopic valves) at different stages of development, from experimental to clinical trial. Repair devices such as the Cardioband or the MitraClip are leading the field with promising preliminary data and further trials are ongoing. However, with implantations of the Gate bioprosthesis, replacement devices are catching up. Potential advantages of different approaches and most recent data are discussed.
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Affiliation(s)
- Jonathan Curio
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute Milan, Italy.,Charité University Medical Care Berlin, Germany
| | - Ozan M Demir
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust London, UK
| | - Matteo Pagnesi
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital Cotignola, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital Cotignola, Italy
| | - Giora Weisz
- Department of Cardiology, Montefiore Medical Center New York, NY, US
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center New York, NY, US
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Ingraham BS, Pislaru SV, Nkomo VT, Nishimura RA, Stulak JM, Dearani JA, Rihal CS, Eleid MF. Characteristics and treatment strategies for severe tricuspid regurgitation. Heart 2019; 105:1244-1250. [PMID: 31092546 DOI: 10.1136/heartjnl-2019-314741] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/14/2019] [Accepted: 04/17/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study aimed to identify characteristics, spectrum of tricuspid regurgitation (TR) severity and treatment patterns in patients considered for intervention of severe TR at a tertiary centre. The population being considered for TR intervention is currently not well defined and the role of transcatheter interventions is unclear. METHODS The study involved 87 patients with severe TR considered for intervention from 1 March 2016 to 12 November 2018 at Mayo Clinic. Patients receiving medications alone were compared with those receiving intervention to identify patterns in demographics, clinical/echocardiographic associations and survival. RESULTS Mean age was 80±9 (56% female), 93% had atrial fibrillation and 64% had chronic kidney disease ≥3 a. Follow-up was 331±276 days; 95% were symptomatic with 6 min walk distance of 270±110 m. Loop diuretics were used in 93%; aldosterone antagonists in 35%. Mean tricuspid annular plane systolic excursion was 15.6±3.8 mm, effective regurgitant orifice area (EROA) 82±32 mm2 and stroke volume index 39±11 mL/m2; 48% had at least moderate right ventricular (RV) dysfunction, and 75% did not undergo intervention. Patients receiving intervention showed trends towards larger EROA (93±33 vs 75±31 mm2), better right ventricular function and more severe symptoms. Overall group 30-day and 1-year survival were 100% and 76%, respectively. CONCLUSIONS Patients with severe TR considered for intervention are commonly elderly with atrial fibrillation, advanced TR and RV dysfunction; 75% were treated with medications alone and not offered intervention. Patients with greater EROA, better RV function and more severe symptoms were more likely to receive intervention. These findings have implications for future trial design.
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Affiliation(s)
- Brenden S Ingraham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - John M Stulak
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph A Dearani
- 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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Grayburn PA, Chandrashekhar Y. Imaging Challenges in Tricuspid Regurgitation and Right Ventricular Failure. JACC Cardiovasc Imaging 2019; 12:768-770. [DOI: 10.1016/j.jcmg.2019.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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227
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The Potential Role of Transcatheter Heart Valve Interventions in Heart Failure Treatment. JACC Cardiovasc Interv 2019; 12:166-168. [PMID: 30594512 DOI: 10.1016/j.jcin.2018.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/06/2018] [Indexed: 01/14/2023]
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