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Staubach S, Sailer M, Koch J, Maier A, Jeron A. Tricuspid transcatheter edge-to-edge repair in a 72-year-old patient with a left ventricular assist device and prior mitral edge-to-edge repair: a case report. Eur Heart J Case Rep 2024; 8:ytae074. [PMID: 38638282 PMCID: PMC11024804 DOI: 10.1093/ehjcr/ytae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/24/2024] [Accepted: 02/02/2024] [Indexed: 04/20/2024]
Abstract
Background We report a case of a 72-year-old patient developing a significant tricuspid regurgitation (TR) 6 years after a left ventricular assist device (LVAD) implantation. The aim of this case is to demonstrate the feasibility of transcatheter edge-to-edge repair (TEER) of the tricuspid valve and the excellent clinical benefit in long-term follow-up in an LVAD patient. Case summary Our patient presented with recurrent acute heart failure syndrome. After a fulminant myocarditis in 2005, his previous treatment consisted of cardiac resynchronization therapy, TEER of the mitral valve, and LVAD (HeartMate III) implantation. At that point in time, his TR was only mild to moderate. Due to recurrent hospitalization despite optimized heart failure medication, we decided to treat the patient with a tricuspid TEER. His immediate post-interventional result and 1-year follow-up showed an excellent outcome with only minimal TR on transoesophageal echocardiogram. Discussion In general, TR improves after LVAD implantation. However, there are two possible pathophysiological mechanisms, which result in an increasing TR: firstly, supporting LV dysfunction may lead to a leftward shift of the interventricular septum with restriction of the tricuspid leaflets. Secondly, the increase of venous preload with LVAD support may result in an annular dilatation with secondary TR, particularly in patients with pre-existing right ventricular dysfunction. According to the data currently available, the unpredictable course of developing TR necessitates regular clinical examination and echocardiographic investigation. Treatment with TEER appears to be feasible and safe, with excellent 1-year results in patients with previously implanted LVADs.
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Affiliation(s)
- Stephan Staubach
- Department of Cardiology, Rems-Murr-Klinikum Winnenden, Am Jakobsweg 1, 71364 Winnenden, Germany
| | - Michael Sailer
- Department of Cardiology, Rems-Murr-Klinikum Winnenden, Am Jakobsweg 1, 71364 Winnenden, Germany
| | - Johannes Koch
- Department of Cardiology, Rems-Murr-Klinikum Winnenden, Am Jakobsweg 1, 71364 Winnenden, Germany
| | - Anatol Maier
- Department of Cardiology, Rems-Murr-Klinikum Winnenden, Am Jakobsweg 1, 71364 Winnenden, Germany
| | - Andreas Jeron
- Department of Cardiology, Rems-Murr-Klinikum Winnenden, Am Jakobsweg 1, 71364 Winnenden, Germany
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2
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Dagher O, Santaló-Corcoy M, Perrin N, Dorval JF, Duggal N, Modine T, Ducharme A, Lamarche Y, Noly PE, Asgar A, Ben Ali W. Transcatheter valvular therapies in patients with left ventricular assist devices. Front Cardiovasc Med 2023; 10:1071805. [PMID: 36993995 PMCID: PMC10040555 DOI: 10.3389/fcvm.2023.1071805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 02/21/2023] [Indexed: 03/14/2023] Open
Abstract
Aortic, mitral and tricuspid valve regurgitation are commonly encountered in patients with continuous-flow left ventricular assist devices (CF-LVADs). These valvular heart conditions either develop prior to CF-LVAD implantation or are induced by the pump itself. They can all have significant detrimental effects on patients' survival and quality of life. With the improved durability of CF-LVADs and the overall rise in their volume of implants, an increasing number of patients will likely require a valvular heart intervention at some point during CF-LVAD therapy. However, these patients are often considered poor reoperative candidates. In this context, percutaneous approaches have emerged as an attractive “off-label” option for this patient population. Recent data show promising results, with high device success rates and rapid symptomatic improvements. However, the occurrence of distinct complications such as device migration, valve thrombosis or hemolysis remain of concern. In this review, we will present the pathophysiology of valvular heart disease in the setting of CF-LVAD support to help us understand the underlying rationale of these potential complications. We will then outline the current recommendations for the management of valvular heart disease in patients with CF-LVAD and discuss their limitations. Lastly, we will summarize the evidence related to transcatheter heart valve interventions in this patient population.
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Affiliation(s)
- Olina Dagher
- Department of Surgery, Montreal Heart Institute, Montreal, QC, Canada
- Departmentof Cardiac Sciences, Libin Cardiovascular Institute, Calgary, AB, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Marcel Santaló-Corcoy
- Department of Cardiology, Montreal Heart Institute, Montreal, QC, Canada
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Nils Perrin
- Department of Cardiology, Montreal Heart Institute, Montreal, QC, Canada
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
- Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-François Dorval
- Department of Cardiology, Montreal Heart Institute, Montreal, QC, Canada
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Neal Duggal
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI, United States
| | - Thomas Modine
- Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévêque, CHU Bordeaux, Bordeaux, France
| | - Anique Ducharme
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Department of Cardiology, Montreal Heart Institute, Montreal, QC, Canada
| | - Yoan Lamarche
- Department of Surgery, Montreal Heart Institute, Montreal, QC, Canada
| | | | - Anita Asgar
- Department of Cardiology, Montreal Heart Institute, Montreal, QC, Canada
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Walid Ben Ali
- Department of Surgery, Montreal Heart Institute, Montreal, QC, Canada
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
- Correspondence: Walid Ben Ali
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3
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Riccardi M, Sammartino AM, Piepoli M, Adamo M, Pagnesi M, Rosano G, Metra M, von Haehling S, Tomasoni D. Heart failure: an update from the last years and a look at the near future. ESC Heart Fail 2022; 9:3667-3693. [PMID: 36546712 PMCID: PMC9773737 DOI: 10.1002/ehf2.14257] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
In the last years, major progress occurred in heart failure (HF) management. Quadruple therapy is now mandatory for all the patients with HF with reduced ejection fraction. Whilst verciguat is becoming available across several countries, omecamtiv mecarbil is waiting to be released for clinical use. Concurrent use of potassium-lowering agents may counteract hyperkalaemia and facilitate renin-angiotensin-aldosterone system inhibitor implementations. The results of the EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved) trial were confirmed by the Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (DELIVER) trial, and we now have, for the first time, evidence for treatment of also patients with HF with preserved ejection fraction. In a pre-specified meta-analysis of major randomized controlled trials, sodium-glucose co-transporter-2 inhibitors reduced all-cause mortality, cardiovascular (CV) mortality, and HF hospitalization in the patients with HF regardless of left ventricular ejection fraction. Other steps forward have occurred in the treatment of decompensated HF. Acetazolamide in Acute Decompensated Heart Failure with Volume Overload (ADVOR) trial showed that the addition of intravenous acetazolamide to loop diuretics leads to greater decongestion vs. placebo. The addition of hydrochlorothiazide to loop diuretics was evaluated in the CLOROTIC trial. Torasemide did not change outcomes, compared with furosemide, in TRANSFORM-HF. Ferric derisomaltose had an effect on the primary outcome of CV mortality or HF rehospitalizations in IRONMAN (rate ratio 0.82; 95% confidence interval 0.66-1.02; P = 0.070). Further options for the treatment of HF, including device therapies, cardiac contractility modulation, and percutaneous treatment of valvulopathies, are summarized in this article.
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Affiliation(s)
- Mauro Riccardi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Antonio Maria Sammartino
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Massimo Piepoli
- Clinical Cardiology, IRCCS Policlinico San DonatoUniversity of MilanMilanItaly
- Department of Preventive CardiologyUniversity of WrocławWrocławPoland
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | | | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Goettingen Medical CenterGottingenGermany
- German Center for Cardiovascular Research (DZHK), Partner Site GöttingenGottingenGermany
| | - Daniela Tomasoni
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
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4
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Afzal S, Haschemi J, Bönner F, Kelm M, Horn P. Case report: Transcatheter edge-to-edge repair after prior surgical tricuspid annuloplasty. Front Cardiovasc Med 2022; 9:1044410. [DOI: 10.3389/fcvm.2022.1044410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022] Open
Abstract
Residual and recurrent tricuspid regurgitation may occur frequently after surgical tricuspid valve repair. However, reoperation for tricuspid regurgitation is rare, although many patients are again highly symptomatic. Tricuspid transcatheter edge-to-edge repair (TEER) is a promising therapy for severe tricuspid regurgitation. Herein, we report a 77-year-old woman with recurrent symptomatic massive tricuspid regurgitation 2 years after sutured annuloplasty of the tricuspid valve. TEER was successfully performed using the TriClip® device and tricuspid regurgitation was reduced to a mild degree. In conclusion, tricuspid TEER is feasible following surgical suture annuloplasty. TEER is an alternative option for patients with a failed previous annuloplasty repair for tricuspid regurgitation to undergo a less invasive treatment rather than a potentially higher-risk reoperation.
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5
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Russo M, Saitto G, Lio A, Di Mauro M, Berretta P, Taramasso M, Scrofani R, Della Corte A, Sponga S, Greco E, Saccocci M, Calafiore A, Bianchi G, Biondi A, Binaco I, Della Ratta E, Livi U, Werner P, De Vincentiis C, Ranocchi F, Di Eusanio M, Kocher A, Antona C, Miraldi F, Troise G, Solinas M, Maisano F, Laufer G, Musumeci F, Andreas M. Observed versus predicted mortality after isolated tricuspid valve surgery. J Card Surg 2022; 37:1959-1966. [PMID: 35385588 PMCID: PMC9325428 DOI: 10.1111/jocs.16483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/21/2022] [Accepted: 02/13/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Aim of this study is to analyse the performances of Clinical Risk Score (CRS) and European System for Cardiac Operative Risk Evaluation (EuroSCORE)-II in isolated tricuspid surgery. METHODS Three hundred and eighty-three patients (54 ± 16 year; 54% female) were enrolled. Receiver operating characteristic analysis was performed to evaluate the relationship between the true positive fraction of test results and the false-positive fraction for a procedure. RESULTS Considering the 30-day mortality the area under the curve was 0.6 (95% confidence interval [CI] 0.50-0.72) for EuroSCORE II and 0.7 (95% CI 0.56-0.84) for CRS-score. The ratio of expected/observed mortality showed underestimation when considering EuroSCORE-II (min. 0.46-max. 0.6). At multivariate analysis, the CRS score (p = .005) was predictor of late cardiac death. CONCLUSION We suggest using both scores to obtain a range of expected mortality. CRS to speculate on late survival.
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Affiliation(s)
- Marco Russo
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.,Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Guglielmo Saitto
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy.,Department of Cardiac Surgery, IRCSS Policlinico San Donato, Milan, Italy
| | - Antonio Lio
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Maurizio Taramasso
- Department of Cardiac Surgery, University Heart Center of Zurich, Zurich, Switzerland
| | - Roberto Scrofani
- Cardiac Surgery Unit, Ospedale Fatenefratelli Sacco, Milano, Italy
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, Unit of Cardiac Surgery, V Monaldi Hospital, University of Campania "L. Vanvitelli", Campania, Italy
| | - Sandro Sponga
- Cardiac Surgery Unit, University Hospital of Udine, Udine, Italy
| | - Ernesto Greco
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Sapienza University, Rome, Italy
| | - Matteo Saccocci
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | - Giacomo Bianchi
- Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Andrea Biondi
- Department of Cardiac Surgery, IRCSS Policlinico San Donato, Milan, Italy
| | - Irene Binaco
- Cardiac Surgery Unit, Ospedale Fatenefratelli Sacco, Milano, Italy
| | - Ester Della Ratta
- Department of Translational Medical Sciences, Unit of Cardiac Surgery, V Monaldi Hospital, University of Campania "L. Vanvitelli", Campania, Italy
| | - Ugolino Livi
- Cardiac Surgery Unit, University Hospital of Udine, Udine, Italy
| | - Paul Werner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Federico Ranocchi
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Alfred Kocher
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Carlo Antona
- Cardiac Surgery Unit, Ospedale Fatenefratelli Sacco, Milano, Italy
| | - Fabio Miraldi
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Sapienza University, Rome, Italy
| | - Giovanni Troise
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Marco Solinas
- Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Francesco Maisano
- Department of Cardiac Surgery, University Heart Center of Zurich, Zurich, Switzerland
| | - Guenther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Francesco Musumeci
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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6
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Russo M, Musumeci F, Ranocchi F, Andreas M. Prediction of mortality in isolated tricuspid surgery. J Card Surg 2021; 37:135-137. [PMID: 34674305 DOI: 10.1111/jocs.16104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Isolated tricuspid surgery is a rarely performed procedure considered at high risk for mortality. Preoperative risk estimation is still a s missing process and currently used risk score system are not validated for this procedures. AIM To discuss the external validation of the EuroSCORE II and STS-TVS score in the setting of isolated tricuspid valve surgery. DISCUSSION The stratification of the patient profile and risk estimation are still lacking in isolated tricuspid surgery. MELD Score, EuroSCORE II and STS-TVS score may help in the preoperative evaluation. Recently a dedicated score called TRI-SCORE has been introduced. We believe that the combination of these scores may determine a range of expected mortality rate and it could be an interesting approach to define the preoperative risk-profile of a patient planned for isolated tricuspid disease. Conclusion Further studies are needed to define the optimal risk stratification of patient affected by isolated tricuspid disease.
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Affiliation(s)
- Marco Russo
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy.,Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Francesco Musumeci
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Federico Ranocchi
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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7
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Russo M, Di Mauro M, Saitto G, Lio A, Berretta P, Taramasso M, Scrofani R, Della Corte A, Sponga S, Greco E, Saccocci M, Calafiore A, Bianchi G, Leviner DB, Biondi A, Della Ratta E, Livi U, Sharoni E, Werner P, De Vincentiis C, Di Eusanio M, Kocher A, Antona C, Miraldi F, Troise G, Solinas M, Maisano F, Laufer G, Musumeci F, Andreas M. Beating vs Arrested Heart Isolated Tricuspid Valve Surgery: Long-term Outcomes. Ann Thorac Surg 2021; 113:585-592. [PMID: 33831392 DOI: 10.1016/j.athoracsur.2021.03.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 02/22/2021] [Accepted: 03/15/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Isolated tricuspid valve (TV) surgery is a rare procedure generally considered at high risk of perioperative mortality and poor long-term outcomes. Surgical treatment can be performed with either an arrested heart (AH) or beating heart (BH) technique. Aim of this study is to compare the outcomes of isolated tricuspid surgery with two different approaches. METHODS The SUR-TRI study is a multicenter international retrospective study enrolling adult patients who underwent isolated tricuspid valve procedures (n=406, 56±16 years; 56% female) at 13 international sites. AH and BH strategies were performed in 253 and 153 cases, respectively. Propensity score-matched analysis was used to compare groups. RESULTS After matching, 129 pairs were obtained and analyzed. The 30-day mortality rate was 6.2 vs 5.0% in the AH and BH groups, respectively (p=0.9). The rates of acute renal failure requiring replacement therapy (3 vs 10%, p=0.02) and stroke (0 vs 1.8%, p=0.08) were numerically higher in the AH group. The 6-year survival rate was 67±6 vs 78±5% in the AH and BH groups, respectively (p=0.18), while freedom from cardiac death was 75±5 vs 84±4% (p=0.21). The six-year composite cardiac endpoint of cardiac death and reoperation rate was 60±9 vs 86±5% (p=0.024) comparing AH-TV replacement and BH-TV repair groups. CONCLUSIONS Isolated tricuspid valve surgery performed with a beating heart strategy is a safe option and resulted in a trend of increased long-term survival and freedom from reoperation when compared with the standard arrested heart technique. Patients undergoing beating heart valve repair had the best long-term outcome.
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Affiliation(s)
- Marco Russo
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria; Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy.
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Guglielmo Saitto
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy; Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Antonio Lio
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy; Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Maurizio Taramasso
- Cardiac Surgery Department, University Heart Center of Zurich, Zurich, Switzerland
| | - Roberto Scrofani
- Cardiac Surgery Unit, Ospedale Fatenefratelli Sacco, Milano, Italy
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli," Unit of Cardiac Surgery, V Monaldi Hospital, Neaples, Italy
| | - Sandro Sponga
- Cardiac Surgery Unit, University Hospital of Udine, Udine, Italy
| | - Ernesto Greco
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Sapienza University, Rome, Italy
| | - Matteo Saccocci
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | - Giacomo Bianchi
- Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | | | - Andrea Biondi
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Ester Della Ratta
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli," Unit of Cardiac Surgery, V Monaldi Hospital, Neaples, Italy
| | - Ugolino Livi
- Cardiac Surgery Unit, University Hospital of Udine, Udine, Italy
| | | | - Paul Werner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Alfred Kocher
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Carlo Antona
- Cardiac Surgery Unit, Ospedale Fatenefratelli Sacco, Milano, Italy
| | - Fabio Miraldi
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Sapienza University, Rome, Italy
| | - Giovanni Troise
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Marco Solinas
- Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Francesco Maisano
- Cardiac Surgery Department, University Heart Center of Zurich, Zurich, Switzerland
| | - Guenther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Francesco Musumeci
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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8
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Hayashi H, Naka Y, Sanchez J, Takayama H, Kurlansky P, Ning Y, Topkara VK, Yuzefpolskaya M, Colombo PC, Sayer GT, Uriel N, Takeda K. Influence of Atrial Fibrillation on Functional Tricuspid Regurgitation in Patients With HeartMate 3. J Am Heart Assoc 2021; 10:e018334. [PMID: 33412902 PMCID: PMC7955423 DOI: 10.1161/jaha.120.018334] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Functional tricuspid regurgitation (TR) can occur secondary to atrial fibrillation (AF). The impact of AF on functional TR and cardiovascular events is uncertain in patients with left ventricular assist devices. This study aimed to investigate the effect of AF on functional TR and cardiovascular events in patients with a HeartMate 3 left ventricular assist device. Methods and Results We retrospectively reviewed 133 patients who underwent HeartMate 3 implantation at our center between November 2014 and November 2018. We excluded patients who had undergone previous or concomitant tricuspid valve procedures and those whose echocardiographic images were of insufficient quality. The primary end point was death and the presence of a cardiovascular event at 1 year. We defined cardiovascular event as a composite of death, stroke, and hospital readmission due to recurrent heart failure and significant residual TR as vena contracta width ≥3 mm. In total, 110 patients were included in this analysis. Patients were divided into 3 groups: no AF (n=51), paroxysmal AF (n=40), and persistent AF (PeAF) (n=19). Kaplan‐Meier analysis showed that patients with PeAF had the worst survival (no AF 98%, paroxysmal AF 98%, PeAF 84%, log‐rank P=0.038) and event‐free rate (no AF 93%, paroxysmal AF 89%, PeAF 72%, log‐rank P=0.048) at 1 year. Thirty‐one (28%) patients had residual TR 1 month after left ventricular assist device implantation. Patients with residual TR had a significantly poor prognosis compared with those without residual TR (log‐rank P=0.014). Conclusions PeAF was associated with increased mortality, cardiovascular events, and residual TR compared with no AF and paroxysmal AF.
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Affiliation(s)
- Hideyuki Hayashi
- Division of Cardiothoracic Surgery Department of Surgery Columbia University Medical Center New York NY
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery Department of Surgery Columbia University Medical Center New York NY
| | - Joseph Sanchez
- Division of Cardiothoracic Surgery Department of Surgery Columbia University Medical Center New York NY
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery Department of Surgery Columbia University Medical Center New York NY
| | - Paul Kurlansky
- Division of Cardiothoracic Surgery Department of Surgery Columbia University Medical Center New York NY
| | - Yuming Ning
- Department of Surgery Center for Innovation and Outcomes Research Columbia University Medical Center New York NY
| | - Veli K Topkara
- Division of Cardiology Department of Medicine Columbia University Medical Center New York NY
| | - Melana Yuzefpolskaya
- Division of Cardiology Department of Medicine Columbia University Medical Center New York NY
| | - Paolo C Colombo
- Division of Cardiology Department of Medicine Columbia University Medical Center New York NY
| | - Gabriel T Sayer
- Division of Cardiology Department of Medicine Columbia University Medical Center New York NY
| | - Nir Uriel
- Division of Cardiology Department of Medicine Columbia University Medical Center New York NY
| | - Koji Takeda
- Division of Cardiothoracic Surgery Department of Surgery Columbia University Medical Center New York NY
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9
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Andreas M, Russo M, Werner P, Schneider M, Wittmann F, Scherzer S, Mascherbauer J, Kocher A, Laufer G, Wiedemann D, Zimpfer D. Transcatheter edge-to-edge tricuspid repair for recurrence of valvular regurgitation after left ventricular assist device and tricuspid ring implantation. ESC Heart Fail 2020; 7:915-919. [PMID: 32144947 PMCID: PMC7261524 DOI: 10.1002/ehf2.12577] [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: 06/25/2019] [Revised: 10/06/2019] [Accepted: 11/11/2019] [Indexed: 11/09/2022] Open
Abstract
Tricuspid regurgitation in patients with left ventricular assist device (LVAD) has a significant impact on prognosis and quality of life, and its effects on liver and renal function could negatively impact planned heart transplantation. The aim of the present case is to report the feasibility and the clinical impact of tricuspid transcatheter edge‐to‐edge repair in LVAD patients as adjunctive bridge to transplantation strategy. A 59‐year‐old female patient previously treated with LVAD implantation (HeartMate III) and tricuspid valve repair with 32 mm rigid ring (Medtronic Contour 3D) as bridge to transplantation developed recurrence of significant tricuspid regurgitation with right ventricular decompensation needing inotropic support. Preoperative echo showed torrential tricuspid valve regurgitation Effective regurgitant orifice area(EROA 1.4 cm2) with suspicious of partial detachment of the prosthetic ring. The patient was successfully treated with transcatheter edge‐to‐edge repair with the MitraClip XTR device. Tricuspid regurgitation was reduced by 50% (postoperative EROA 0.7 cm2). She remained stable under continuous inotropic support with no other episodes of right ventricular decompensation and was successfully transplanted 30 days after the clipping procedure. Transcatheter treatment of tricuspid regurgitation in a patient with LVAD was an effective strategy to gain time and bridge the patient to heart transplantation.
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Affiliation(s)
- Martin Andreas
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Marco Russo
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Paul Werner
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Matthias Schneider
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Franziska Wittmann
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Sabine Scherzer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Julia Mascherbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Alfred Kocher
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Guenther Laufer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Dominik Wiedemann
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Daniel Zimpfer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
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