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Khan MS, Baqi A, Tahir A, Ghumman GM, Ullah W, Shah J, Sattar Y, Mir T, Sheikh Z, Salman F, Baghal M, Luthra K, Khatri V, Waqar Z, Khan MWZ, Taleb M, Ali SS. National Estimates for the Percentage of All Readmissions With Demographic Features, Morbidity, Overall and Gender-Specific Mortality of Transcutaneous Versus Open Surgical Tricuspid Valve Replacement/Repair. Cardiol Res 2024; 15:223-232. [PMID: 39205967 PMCID: PMC11349133 DOI: 10.14740/cr1625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/24/2024] [Indexed: 09/04/2024] Open
Abstract
Background The aim of the study was to determine national estimates for the percentage of all readmissions with demographic features, length of stay (LOS), cost analysis, comorbidities, complications, overall and gender-specific mortality and complications of transcutaneous tricuspid valve replacement/repair (TTVR) vs. open surgical tricuspid valve replacement/repair (open TVR). Methods Data were extrapolated from the Nationwide Readmissions Database (NRD) 2015-19. Of the 75,266,750 (unweighted) cases recorded in the 2015 - 2019 dataset, 429 had one or more of the percutaneous approach codes as per the ICD-10 dataset, and 10,077 had one or more of the open approach codes. Results Overall, the number of cases performed each year through open TVR was higher than TTVR, but there was an increased trend towards the TTVR every passing year. TTVR was performed more in females and advanced age groups than open TVR. The LOS and cost were lower in the TTVR group than in open TVR. Patients undergoing TTVR had more underlying comorbidities like congestive heart failure, hypertension, and uncomplicated diabetes mellitus. Overall mortality was 3.49% in TTVR vs. 6.09% in open TVR. The gender-specific analysis demonstrated higher female mortality in the open TVR compared to TTVR (5.45% vs. 3.03%). Male mortality was statistically insignificant between the two groups (6.8% vs. 4.3%, P-value = 0.15). Patients with TTVR had lower rates of complications than open TVR, except for arrhythmias, which were higher in TTVR. Patients undergoing open TVR required more intracardiac support, such as intra-aortic balloon pump (IABP) and Impella, than TTVR. Conclusion TTVR is an emerging alternative to open TVR in patients with tricuspid valve diseases, especially tricuspid regurgitation. Despite having more underlying comorbidities, the TTVR group had lower in-hospital mortality, hospital cost, LOS, and fewer complications than open TVR.
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Affiliation(s)
| | - Abdul Baqi
- Department of Internal Medicine, Mercy Saint Vincent Medical Center, Toledo, OH, USA
| | - Ayesha Tahir
- Department of Internal Medicine, Mercy Saint Vincent Medical Center, Toledo, OH, USA
| | | | - Waqas Ullah
- Department of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Jay Shah
- Department of Cardiology, Mercy Saint Vincent Medical Center, Toledo, OH, USA
| | - Yasar Sattar
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Tanveer Mir
- Department of Cardiology, Detroit Medical Center/Wayne State University, Detroit, MI, USA
| | - Zain Sheikh
- Department of Internal Medicine, Franciscan Health Care, Michigan City, IN, USA
| | - Fnu Salman
- Department of Cardiology, Mercy Saint Vincent Medical Center, Toledo, OH, USA
| | - Moaaz Baghal
- Department of Cardiology, Mercy Saint Vincent Medical Center, Toledo, OH, USA
| | - Kritika Luthra
- Department of Cardiology, Mercy Saint Vincent Medical Center, Toledo, OH, USA
| | - Vinod Khatri
- Department of Pulmonology, Mercy Saint Vincent Medical Center, Toledo, OH, USA
| | - Zainulabedin Waqar
- Department of Internal Medicine, Mercy Saint Vincent Medical Center, Toledo, OH, USA
| | | | - Mohammed Taleb
- Department of Cardiology, Mercy Saint Vincent Medical Center, Toledo, OH, USA
| | - Syed Sohail Ali
- Department of Cardiology, Mercy Saint Vincent Medical Center, Toledo, OH, USA
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Dreyfus J, Taramasso M, Kresoja KP, Omran H, Iliadis C, Russo G, Weber M, Nombela-Franco L, Estevez Loureiro R, Hausleiter J, Latib A, Stolz L, Praz F, Windecker S, Zamorano JL, von Bardeleben RS, Tang GHL, Hahn R, Lubos E, Webb J, Schofer J, Fam N, Lauten A, Pedrazzini G, Rodés-Cabau J, Nejjari M, Badano L, Alessandrini H, Himbert D, Sievert H, Piayda K, Donal E, Modine T, Nickenig G, Pfister R, Rudolph V, Bernick J, Wells GA, Bax J, Lurz P, Enriquez-Sarano M, Maisano F, Messika-Zeitoun D. Prognostic Implications of Residual Tricuspid Regurgitation Grading After Transcatheter Tricuspid Valve Repair. JACC Cardiovasc Interv 2024; 17:1485-1495. [PMID: 38752971 DOI: 10.1016/j.jcin.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The safety profile of transcatheter tricuspid valve (TTV) repair techniques is well established, but residual tricuspid regurgitation (TR) remains a concern. OBJECTIVES The authors sought to assess the impact of residual TR severity post-TTV repair on survival. METHODS We evaluated the survival rate at 2 years of 613 patients with severe isolated functional TR who underwent TTV repair in TRIGISTRY according to the severity of residual TR at discharge using a 3-grade (mild, moderate, and severe) or 4-grade scheme (mild, mild to moderate, moderate to severe, and severe). RESULTS Residual TR was none/mild in 33%, moderate in 52%, and severe in 15%. The 2-year adjusted survival rates significantly differed between the 3 groups (85%, 70%, and 44%, respectively; restricted mean survival time [RMST]: P = 0.0001). When the 319 patients with moderate residual TR were subdivided into mild to moderate (n = 201, 33%) and moderate to severe (n = 118, 19%), the adjusted survival rate was also significantly different between groups (85%, 80%, 55%, and 44%, respectively; RMST: P = 0.001). Survival was significantly lower in patients with moderate to severe residual TR compared to patients with mild to moderate residual TR (P = 0.006). No difference in survival rates was observed between patients with no/mild and mild to moderate residual TR (P = 0.67) or between patients with moderate to severe and severe residual TR (P = 0.96). CONCLUSIONS The moderate residual TR group was heterogeneous and encompassed patients with markedly different clinical outcomes. Refining TR grade classification with a more granular 4-grade scheme improved outcome prediction. Our results highlight the importance of achieving a mild to moderate or lower residual TR grade during TTV repair, which could define a successful intervention.
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Affiliation(s)
- Julien Dreyfus
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France.
| | | | | | - Hazem Omran
- General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Christos Iliadis
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Giulio Russo
- Policlinico Tor Vergata, University of Rome, Rome, Italy
| | | | | | | | - Jörg Hausleiter
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, New York, USA
| | - Lukas Stolz
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Jose Luis Zamorano
- Department of Cardiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - Rebecca Hahn
- Cardiology Department, NewYork-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Edith Lubos
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - John Webb
- St. Paul Hospital, Vancouver, British Columbia, Canada
| | - Joachim Schofer
- MVZ-Department for Structural Heart Disease, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Neil Fam
- Division of Cardiology, Toronto Heart Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Alexander Lauten
- Department of General and Interventional Cardiology and Rhythmology, Helios Klinikum Erfurt, Erfurt, Germany
| | - Giovanni Pedrazzini
- Division of Cardiology, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mohammed Nejjari
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | | | - Horst Sievert
- CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Kerstin Piayda
- CardioVascular Center Frankfurt, Frankfurt, Germany; Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, Gießen, Germany
| | - Erwan Donal
- Cardiology Department, Signal and Image Processing Laboratory UMR1099, French National Institute of Health and Medical Research, University Hospital Center of Rennes, Rennes, France
| | - Thomas Modine
- Department of Cardiology and Cardio-Vascular Surgery, Hôpital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Bordeaux, France
| | | | - Roman Pfister
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Volker Rudolph
- General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Jordan Bernick
- Cardiovascular Research Methods Center, University of Ottawa Heart Institute, Ottawa, Canada
| | - George A Wells
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Philipp Lurz
- Division of Cardiology, University Medical Center, Mainz, Germany
| | | | - Francesco Maisano
- Cardiac Surgery and Heart Valve Center, Ospedale San Raffaele, University Vita Salute, Milano, Italy
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Barbero C, Pocar M, Brenna D, Costamagna A, Aloi V, Capozza C, Filippini C, Trompeo AC, Salizzoni S, Brazzi L, Rinaldi M. Surgical Treatment for Isolated Tricuspid Valve Disease: A Less Invasive Approach for Better Outcomes. J Clin Med 2024; 13:3144. [PMID: 38892855 PMCID: PMC11172979 DOI: 10.3390/jcm13113144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Background. Severe tricuspid valve (TV) disease has a strong association with right ventricle dysfunction, heart failure and mortality. Nevertheless, surgical indications for isolated TV disease are still uncommon. The purpose of this study is to analyze outcomes of patients undergoing minimally invasive isolated TV surgery (ITVS). Methods. Data of patients undergoing right mini-thoracotomy ITVS were prospectively collected. A subgroup analysis was performed on late referral patients. Five-year survival was assessed using the Kaplan-Meier survival estimate. Results. Eighty-one consecutive patients were enrolled; late referral was recorded in 8 out of 81 (9.9%). No cases of major vascular complications nor of stroke were reported. A 30-day mortality was reported in one patient (1.2%). Five-year Kaplan-Meier survival analysis revealed a significant difference between late referral patients and the control group (p = 0.01); late referral and Euroscore II were found to be significantly associated with reduced mid-term survival (p = 0.005 and p = 0.01, respectively). Conclusions. To date, perioperative mortality in patients undergoing ITVS is still consistently high, even in high-volume, high-experienced centres, and this accounts for the low rate of referral. Results from our report show that, with proper multidisciplinary management, appropriate pre-operative screening, and allocation to the safest approach, ITVS may offer better results than expected.
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Affiliation(s)
- Cristina Barbero
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, 10126 Torino, Italy; (M.P.); (D.B.); (V.A.); (C.C.); (S.S.); (M.R.)
| | - Marco Pocar
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, 10126 Torino, Italy; (M.P.); (D.B.); (V.A.); (C.C.); (S.S.); (M.R.)
| | - Dario Brenna
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, 10126 Torino, Italy; (M.P.); (D.B.); (V.A.); (C.C.); (S.S.); (M.R.)
| | - Andrea Costamagna
- Division of Cardiac Intensive Care, Anesthesia, Intensive Care and Emergency Department, Città della Salute e della Scienza, University of Turin, 10126 Torino, Italy; (A.C.); (C.F.); (A.C.T.); (L.B.)
| | - Valentina Aloi
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, 10126 Torino, Italy; (M.P.); (D.B.); (V.A.); (C.C.); (S.S.); (M.R.)
| | - Cecilia Capozza
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, 10126 Torino, Italy; (M.P.); (D.B.); (V.A.); (C.C.); (S.S.); (M.R.)
| | - Claudia Filippini
- Division of Cardiac Intensive Care, Anesthesia, Intensive Care and Emergency Department, Città della Salute e della Scienza, University of Turin, 10126 Torino, Italy; (A.C.); (C.F.); (A.C.T.); (L.B.)
| | - Anna Chiara Trompeo
- Division of Cardiac Intensive Care, Anesthesia, Intensive Care and Emergency Department, Città della Salute e della Scienza, University of Turin, 10126 Torino, Italy; (A.C.); (C.F.); (A.C.T.); (L.B.)
| | - Stefano Salizzoni
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, 10126 Torino, Italy; (M.P.); (D.B.); (V.A.); (C.C.); (S.S.); (M.R.)
| | - Luca Brazzi
- Division of Cardiac Intensive Care, Anesthesia, Intensive Care and Emergency Department, Città della Salute e della Scienza, University of Turin, 10126 Torino, Italy; (A.C.); (C.F.); (A.C.T.); (L.B.)
| | - Mauro Rinaldi
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, 10126 Torino, Italy; (M.P.); (D.B.); (V.A.); (C.C.); (S.S.); (M.R.)
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Thourani VH, Bonnell L, Wyler von Ballmoos MC, Mehaffey JH, Bowdish M, Kurlansky P, Jacobs JP, O'Brien S, Shahian DM, Badhwar V. Outcomes of Isolated Tricuspid Valve Surgery: A Society of Thoracic Surgeons Analysis and Risk Model. Ann Thorac Surg 2024:S0003-4975(24)00339-4. [PMID: 38723881 DOI: 10.1016/j.athoracsur.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND To provide patients and surgeons with clinically relevant information, The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database was queried to develop a risk model for isolated tricuspid valve (TV) operations. METHODS All patients in the STS Adult Cardiac Surgery Database who had undergone isolated TV repair or replacement (N = 13,587; age 48.3 ± 18.4 years) were identified (July 2017 to June 2023). Multivariable logistic regression accounting for TV replacement vs repair was used to model 8 operative outcomes: mortality, morbidity or mortality or both, stroke, renal failure, reoperation, prolonged ventilation, short hospital stay, and prolonged hospital stay. Model discrimination (C-statistic) and calibration were assessed using 9-fold cross-validation. RESULTS The isolated TV study population included 41.1% repairs (N = 5,583; age 52.6 ± 18.1 years) and 58.9% replacements (N = 8,004; age 45.3 ± 18.0 years). The overall predicted risk of operative mortality was 5.6%, and it was similar in TV repairs and replacements (5.5% and 5.7%, respectively), as was the predicted risk of composite morbidity and mortality (28.2% and 26.8%). TV replacements were generally performed in younger patients with a higher endocarditis prevalence than TV repairs (45.7% vs 21.1%). The model yielded a C-statistic of 0.81 for mortality and 0.76 for the composite of morbidity and mortality, with excellent observed-to-expected calibration that was comparable in all subcohorts and predicted risk decile groups. CONCLUSIONS An STS risk model has been developed for isolated TV surgery. The current mortality of isolated TV operations is lower than previously observed. This risk prediction model and these contemporary outcomes provide a new benchmark for current and future isolated TV interventions.
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Affiliation(s)
- Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia.
| | - Levi Bonnell
- The Society of Thoracic Surgeons, Chicago, Illinois
| | - Moritz C Wyler von Ballmoos
- Department of Cardiovascular and Thoracic Surgery, Texas Health Harris Methodist Hospital, Fort Worth, Texas
| | - J Hunter Mehaffey
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Michael Bowdish
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Paul Kurlansky
- Department of Surgery, Columbia University Medical Center, New York, New York
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida
| | - Sean O'Brien
- Duke Clinical Research Institute, Durham, North Carolina
| | - David M Shahian
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
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5
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Kaneyuki D, Jordan AM, Rosen JL, Macmillan TR, Morris RJ, Tchantchaleishvili V. Isolated Tricuspid Valve Surgery for Functional Tricuspid Regurgitation. Thorac Cardiovasc Surg 2024. [PMID: 38580322 DOI: 10.1055/a-2300-6791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
BACKGROUND Severe tricuspid regurgitation (TR) adversely affects long-term survival; however, isolated tricuspid valve (TV) surgery has been rarely performed due to high operative mortality. In addition, the previous literature included heterogeneous TR etiologies. Therefore, we aimed to elucidate early and long-term outcomes of isolated TV surgery for functional TR. METHODS An electronic search was performed to identify all relevant studies. Baseline characteristics, perioperative variables, and clinical outcomes were extracted and pooled for meta-analysis. RESULTS This meta-analysis included seven studies. Pooled analyses showed that 68% (35, 89) of patients had preoperative atrial fibrillation or flutter, and 58% (11, 94) had a history of left-sided valve surgery. Seventy-three percent (65, 80) of patients had at least one physical exam finding of right-sided heart failure, and 57% (44, 69) were in New York Heart Association class III or IV. TV replacement was more common than repair. In TV replacement, bioprosthetic valve (39%, 13, 74) was more common than mechanical prosthesis (22%, 18, 26). The early mortality rate was 7%. Twenty percent of patients required a permanent pacemaker postoperatively. The overall 1- and 5-year survival rates were 84.5 and 69.1%, respectively. CONCLUSION More than half of the patients who underwent isolated TV surgery for functional TR had undergone left-sided valve surgery and had significant heart failure symptoms at the time of surgery. Further studies on the surgical indication for concomitant TV surgery at the time of left-sided valve surgery and the appropriate timing of surgery for isolated functional TR are needed to improve survival.
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Affiliation(s)
- Daisuke Kaneyuki
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Andrew M Jordan
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Jake L Rosen
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Thomas Reese Macmillan
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Rohinton J Morris
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Vakhtang Tchantchaleishvili
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
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6
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Noda K, Kawamoto N, Kainuma S, Tadokoro N, Ikuta A, Fukushima S. Predictors of late outcomes after concomitant tricuspid valve repair with left-sided valve surgery. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02033-x. [PMID: 38649641 DOI: 10.1007/s11748-024-02033-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Concomitant tricuspid valve (TV) repair is a safe and effective procedure to protect against late moderate or greater tricuspid regurgitation (TR) after left-sided valve surgery, but studies regarding its late outcomes and recurrent TR are limited. This study aimed to reveal the late outcomes and explore the predictors of mortality and recurrent TR among patients who underwent concomitant TV repair with left-sided valve surgery. METHODS AND RESULTS This study included 645 patients (mean age, 69.7 years; 44% male) who underwent concomitant TV repair with left-sided valve surgery (mitral valve surgery in 594 cases, aortic valve surgery in 172 cases) from 2006-2020. Preoperative TR was grade 4, 3, and less than 2 in 85, 235, and 325 patients, respectively. The median follow-up period was 4.6 (IQR 1.7-7.8) years. The in-hospital or 30-day mortality was 1.7% (n = 11). Regarding long-term outcomes after TV repair, 90.3% and 80.8% achieved 5- and 10-year survival, respectively, while 96.1% and 88.8% achieved 5- and 10-year freedom from recurrent TR, respectively. The following were independent predictors of overall mortality on multivariate analysis in patients with preoperative TR grade ≥ 3: prior pacemaker implantation, preoperative renal dysfunction, diabetes mellitus and NYHA class ≥ 3. Also, suture annuloplasty and ring type of ring annuloplasty were not independent risk factors for recurrent TR, classified as grade ≥ 3. CONCLUSIONS Concomitant TV repair with left-sided valve surgery had acceptable outcomes in terms of survival and TR durability. In patients with preoperative TR grade ≥ 3, preoperative patient status had negative impacts on prognosis.
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Affiliation(s)
- Kazuki Noda
- Departments of Cardiac Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Naonori Kawamoto
- Departments of Cardiac Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan.
| | - Satoshi Kainuma
- Departments of Cardiac Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Naoki Tadokoro
- Departments of Cardiac Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Ayumi Ikuta
- Departments of Cardiac Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Satsuki Fukushima
- Departments of Cardiac Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
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7
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Kim D, Kim J, Cho I, Kim EK, Hong G, Ha J, Park S, Shim CY. Validation of TRI-SCORE for Outcome Prediction After Isolated Tricuspid Valve Surgery in Asian Patients. J Am Heart Assoc 2024; 13:e032929. [PMID: 38563385 PMCID: PMC11262506 DOI: 10.1161/jaha.123.032929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND TRI-SCORE was recently developed in Europe as a risk model for predicting in-hospital death after isolated tricuspid valve surgery. We aimed to validate TRI-SCORE in an Asian population and investigate its value for predicting long-term outcomes. METHODS AND RESULTS The TRI-SCORE was calculated for 202 patients (65±11 years, 61% women, 81% functional tricuspid regurgitation) who underwent isolated tricuspid valve surgery for severe tricuspid regurgitation at 2 Korean centers and was based on 8 parameters: age, New York Heart Association class, right-sided heart failure signs, furosemide daily dose, glomerular filtration rate, bilirubin, left ventricular ejection fraction, and moderate/severe right ventricular dysfunction. The primary outcome was all-cause death during follow-up; the secondary outcome was in-hospital death. During a median follow-up duration of 50 (interquartile range, 21-82) months after isolated tricuspid valve surgery, 23 (11.4%) patients experienced the primary outcome, and 7 (3.5%) patients experienced the secondary outcome. Observed all-cause death and in-hospital death increased by up to 50% in those with higher scores. Patients with the primary outcome had a higher TRI-SCORE (4.5±2.4 versus 2.9±2.1; P=0.001) than those without. The TRI-SCORE showed a significant association with the primary outcome (concordance index, 0.77, cutoff value, 4) and in-hospital death (area under the curve, 0.84; cutoff value, 3). Using the Kaplan-Meier analysis, patients with a high TRI-SCORE exhibited a poor outcome for all-cause death at follow-up (log-rank P<0.001) and in-hospital death (log-rank P=0.004). CONCLUSIONS TRI-SCORE was validated in an Asian population and helped predict long-term outcomes after isolated tricuspid valve surgery.
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Affiliation(s)
- Dae‐Young Kim
- Division of Cardiology, Department of Internal MedicineInha University College of MedicineIncheonSouth Korea
| | - Jihoon Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Iksung Cho
- Division of CardiologySeverance Cardiovascular Hospital, Yonsei University College of MedicineSeoulSouth Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Geu‐Ru Hong
- Division of CardiologySeverance Cardiovascular Hospital, Yonsei University College of MedicineSeoulSouth Korea
| | - Jong‐Won Ha
- Division of CardiologySeverance Cardiovascular Hospital, Yonsei University College of MedicineSeoulSouth Korea
| | - Sung‐Ji Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Chi Young Shim
- Division of CardiologySeverance Cardiovascular Hospital, Yonsei University College of MedicineSeoulSouth Korea
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8
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Welle GA, Hahn RT, Lindenfeld J, Lin G, Nkomo VT, Hausleiter J, Lurz PC, Pislaru SV, Davidson CJ, Eleid MF. New Approaches to Assessment and Management of Tricuspid Regurgitation Before Intervention. JACC Cardiovasc Interv 2024; 17:837-858. [PMID: 38599687 DOI: 10.1016/j.jcin.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/22/2024] [Accepted: 02/13/2024] [Indexed: 04/12/2024]
Abstract
Severe tricuspid regurgitation (TR) is a progressive condition associated with substantial morbidity, poor quality of life, and increased mortality. Patients with TR commonly have coexisting conditions including congestive heart failure, pulmonary hypertension, chronic lung disease, atrial fibrillation, and cardiovascular implantable electronic devices, which can increase the complexity of medical and surgical TR management. As such, the optimal timing of referral for isolated tricuspid valve (TV) intervention is undefined, and TV surgery has been associated with elevated risk of morbidity and mortality. More recently, an unprecedented growth in TR treatment options, namely the development of a wide range of transcatheter TV interventions (TTVI) is stimulating increased interest and referral for TV intervention across the entire medical community. However, there are no stepwise algorithms for the optimal management of symptomatic severe TR before TTVI. This article reviews the contemporary assessment and management of TR with addition of a medical framework to optimize TR before referral for TTVI.
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Affiliation(s)
- Garrett A Welle
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. https://twitter.com/GarrettWelleMD
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA. https://twitter.com/hahn_rt
| | - Joann Lindenfeld
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Charles J Davidson
- Division of Cardiology, Northwestern University Medical Center, Chicago, Illinois, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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9
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Galloo X, Fortuni F, Meucci MC, Butcher SC, Dietz MF, Prihadi EA, Cosyns B, Delgado V, Bax JJ, Ajmone Marsan N. Association of right atrial strain and long-term outcome in severe secondary tricuspid regurgitation. Heart 2024; 110:448-456. [PMID: 37903557 DOI: 10.1136/heartjnl-2023-323084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/23/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE Severe secondary tricuspid regurgitation (STR) causes significant right atrial (RA) volume overload, resulting in structural and functional RA-remodelling. This study evaluated whether patients with severe STR and reduced RA function, as assessed by RA-reservoir-strain (RASr), show lower long-term prognosis. METHODS Consecutive patients, from a single centre, with first diagnosis of severe STR and RASr measure available, were included. Extensive echocardiographic analysis comprised measures of cardiac chamber size and function, assessed also by two-dimensional speckle-tracking strain analysis. Primary outcome was all-cause mortality, analysed from inclusion until death or last follow-up. The association of RASr with the outcome was evaluated by Cox regression analysis and Akaike information criterion. RESULTS A total of 586 patients with severe STR (age 68±13 years; 52% male) were included. Patients presented with mild right ventricular (RV) dilatation (end-diastolic area 13.8±6.5 cm2/m2) and dysfunction (free-wall strain 16.2±7.2%), and with moderate-to-severe RA dilatation (max area 15.0±5.3 cm2/m2); the median value of RASr was 13%. In the overall population, 10-year overall survival was low (40%, 349 deaths), and was significantly lower in patients with lower RASr (defined by the median value): 36% (195 deaths) for RASr ≤13% compared with 45% (154 deaths) for RASr >13% (log-rank p=0.016). With a median follow-up of 6.6 years, RASr was independently associated with all-cause mortality (HR per 5% RASr increase:0.928; 95% CI 0.864 to 0.996; p=0.038), providing additional value over relevant clinical and echocardiographic covariates (including RA size and RV function/size). CONCLUSIONS Patients with severe STR presented with significant RA remodelling, and lower RA function, as measured by RASr, was independently associated with all-cause mortality, potentially improving risk stratification in these patients.
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Affiliation(s)
- Xavier Galloo
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, UZ Brussel, Brussel, Belgium
| | - Federico Fortuni
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Ospedale Nuovo San Giovanni Battista, Foligno, Umbria, Italy
| | - Maria Chiara Meucci
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Marlieke F Dietz
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Edgard A Prihadi
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Ziekenhuisnetwerk Antwerpen, Antwerpen, Belgium
| | | | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, University Hospital Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Heart Center, TYKS Turku University Hospital, Turku, Varsinais-Suomi, Finland
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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10
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Dreyfus J, Galloo X, Taramasso M, Heitzinger G, Benfari G, Kresoja KP, Juarez-Casso F, Omran H, Bohbot Y, Iliadis C, Russo G, Topilsky Y, Weber M, Nombela-Franco L, Sala A, Eixerés-Esteve A, Iung B, Obadia JF, Estevez Loureiro R, Riant E, Donal E, Hausleiter J, Badano L, Le Tourneau T, Coisne A, Modine T, Latib A, Praz F, Windecker S, Zamorano JL, von Bardeleben RS, Tang GHL, Hahn R, Webb J, Muraru D, Nejjari M, Chan V, De Bonis M, Carnero-Alcazar M, Nickenig G, Pfister R, Tribouilloy C, Rudolph V, Crestanello J, Lurz P, Bartko P, Maisano F, Bax J, Enriquez-Sarano M, Messika-Zeitoun D. TRI-SCORE and benefit of intervention in patients with severe tricuspid regurgitation. Eur Heart J 2024; 45:586-597. [PMID: 37624856 DOI: 10.1093/eurheartj/ehad585] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND AND AIMS Benefit of tricuspid regurgitation (TR) correction and timing of intervention are unclear. This study aimed to compare survival rates after surgical or transcatheter intervention to conservative management according to a TR clinical stage as assessed using the TRI-SCORE. METHODS A total of 2,413 patients with severe isolated functional TR were enrolled in TRIGISTRY (1217 conservatively managed, 551 isolated tricuspid valve surgery, and 645 transcatheter valve repair). The primary endpoint was survival at 2 years. RESULTS The TRI-SCORE was low (≤3) in 32%, intermediate (4-5) in 33%, and high (≥6) in 35%. A successful correction was achieved in 97% and 65% of patients in the surgical and transcatheter groups, respectively. Survival rates decreased with the TRI-SCORE in the three treatment groups (all P < .0001). In the low TRI-SCORE category, survival rates were higher in the surgical and transcatheter groups than in the conservative management group (93%, 87%, and 79%, respectively, P = .0002). In the intermediate category, no significant difference between groups was observed overall (80%, 71%, and 71%, respectively, P = .13) but benefit of the intervention became significant when the analysis was restricted to patients with successful correction (80%, 81%, and 71%, respectively, P = .009). In the high TRI-SCORE category, survival was not different to conservative management in the surgical and successful repair group (61% and 68% vs 58%, P = .26 and P = .18 respectively). CONCLUSIONS Survival progressively decreased with the TRI-SCORE irrespective of treatment modality. Compared to conservative management, an early and successful surgical or transcatheter intervention improved 2-year survival in patients at low and, to a lower extent, intermediate TRI-SCORE, while no benefit was observed in the high TRI-SCORE category.
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Affiliation(s)
- Julien Dreyfus
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Xavier Galloo
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiology, Free University Brussels (VUB), University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | | | - Gregor Heitzinger
- Department for Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Giovanni Benfari
- Cardiovascular Disease Department, Mayo Clinic, Rochester, MN, USA
- Section of Cardiology, Department of Medicine, University of Verona, Italy
| | - Karl-Patrick Kresoja
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | - Hazem Omran
- General and Interventional Cardiology, Heart & Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Christos Iliadis
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Giulio Russo
- Policlinico Tor Vergata, University of Rome, Rome, Italy
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv, Israel
| | | | | | - Alessandra Sala
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Bernard Iung
- Cardiology Department, Bichat Hospital, APHP, and INSERM LVTS U1148, Université de Paris, Paris, France
| | - Jean-François Obadia
- Department of Cardiovascular Surgery and Transplantation, Louis Pradel Cardiovascular Hospital, Claude Bernard University, Bron, France
| | | | - Elisabeth Riant
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Erwan Donal
- Cardiology Department, LTSI UMR1099, INSERM, Université de Rennes-1, CHU de RENNES, Rennes, France
| | - Jörg Hausleiter
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | - Luigi Badano
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Thierry Le Tourneau
- CNRS, INSERM, l'institut du thorax, Université de Nantes, CHU de Nantes, Nantes, France
| | - Augustin Coisne
- Department of Clinical Physiology and Echocardiography-Heart Valve Clinic, CHU Lille, Lille, France
- Institut Pasteur de Lille, U1011- EGID, Univ. Lille, Inserm, CHU Lille, Lille, France
| | - Thomas Modine
- Department of Cardiology and Cardio-Vascular Surgery, Hôpital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Bordeaux, France
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jose Luis Zamorano
- Department of Cardiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Rebecca Hahn
- Cardiology Department, NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - John Webb
- St. Paul Hospital, Vancouver, British Columbia, Canada
| | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Mohammed Nejjari
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Vincent Chan
- Department of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Roman Pfister
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Volker Rudolph
- General and Interventional Cardiology, Heart & Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Philipp Bartko
- Department for Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Francesco Maisano
- Cardiac Surgery and Heart Valve Center, Ospedale San Raffaele, University Vita Salute, Milano, Italy
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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11
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Samim D, Dernektsi C, Brugger N, Reineke D, Praz F. Contemporary Approach to Tricuspid Regurgitation: Knowns, Unknowns, and Future Challenges. Can J Cardiol 2024; 40:185-200. [PMID: 38052301 DOI: 10.1016/j.cjca.2023.11.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023] Open
Abstract
Severe tricuspid regurgitation (TR) worsens heart failure and is associated with impaired survival. In daily clinical practice, patients are referred late, and tricuspid valve interventions (surgical or transcatheter) are underutilised, which may lead to irreversible right ventricular damage and increases risk. This article addresses the appropriate timing and modality for an intervention (surgical or transcatheter), and its potential benefits on clinical outcomes. Ongoing randomised controlled trials will provide further insights into the efficacy of transcatheter valve interventions compared with medical treatment.
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Affiliation(s)
- Daryoush Samim
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
| | - Chrisoula Dernektsi
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiac Surgery, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
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12
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Grapsa J, Praz F, Sorajja P, Cavalcante JL, Sitges M, Taramasso M, Piazza N, Messika-Zeitoun D, Michelena HI, Hamid N, Dreyfus J, Benfari G, Argulian E, Chieffo A, Tchetche D, Rudski L, Bax JJ, Stephan von Bardeleben R, Patterson T, Redwood S, Bapat VN, Nickenig G, Lurz P, Hausleiter J, Kodali S, Hahn RT, Maisano F, Enriquez-Sarano M. Tricuspid Regurgitation: From Imaging to Clinical Trials to Resolving the Unmet Need for Treatment. JACC Cardiovasc Imaging 2024; 17:79-95. [PMID: 37731368 DOI: 10.1016/j.jcmg.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023]
Abstract
Tricuspid regurgitation (TR) is a highly prevalent and heterogeneous valvular disease, independently associated with excess mortality and high morbidity in all clinical contexts. TR is profoundly undertreated by surgery and is often discovered late in patients presenting with right-sided heart failure. To address the issue of undertreatment and poor clinical outcomes without intervention, numerous structural tricuspid interventional devices have been and are in development, a challenging process due to the unique anatomic and physiological characteristics of the tricuspid valve, and warranting well-designed clinical trials. The path from routine practice TR detection to appropriate TR evaluation, to conduction of clinical trials, to enriched therapeutic possibilities for improving TR access to treatment and outcomes in routine practice is complex. Therefore, this paper summarizes the key points and methods crucial to TR detection, quantitation, categorization, risk-scoring, intervention-monitoring, and outcomes evaluation, particularly of right-sided function, and to clinical trial development and conduct, for both interventional and surgical groups.
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Affiliation(s)
- Julia Grapsa
- Cardiology Department, Guys and St Thomas National Health Service Trust, London, United Kingdom.
| | - Fabien Praz
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Joao L Cavalcante
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Marta Sitges
- Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Centro de Investigación Biomedica en Red Enfermedades Cardiovasculares, Barcelona, Spain
| | - Maurizio Taramasso
- Cardiac Surgery Department, University Heart Center of Zurich, Zurich, Switzerland
| | - Nicolo Piazza
- Azrieli Heart Center, Division of Cardiology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Canada
| | - David Messika-Zeitoun
- Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, USA
| | - Nadira Hamid
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | - Giovanni Benfari
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, USA; Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Edgar Argulian
- Cardiology Department, Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA
| | - Alaide Chieffo
- Interventional Cardiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
| | | | - Lawrence Rudski
- Azrieli Heart Center, Division of Cardiology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Canada
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Tiffany Patterson
- Cardiology Department, Guys and St Thomas National Health Service Trust, London, United Kingdom
| | - Simon Redwood
- Cardiology Department, Guys and St Thomas National Health Service Trust, London, United Kingdom
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Susheel Kodali
- Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York City, New York, USA
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York City, New York, USA
| | - Francesco Maisano
- Interventional Cardiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy; Department of Cardiac Surgery, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele University Hospital, Milan, Italy
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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13
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Färber G, Marx J, Scherag A, Saqer I, Diab M, Sponholz C, Doenst T. Risk stratification for isolated tricuspid valve surgery assisted using the Model for End-Stage Liver Disease score. J Thorac Cardiovasc Surg 2023; 166:1433-1441.e1. [PMID: 35431033 DOI: 10.1016/j.jtcvs.2021.11.102] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Isolated tricuspid valve surgery is perceived as high-risk. This perception is nurtured by patients who often present with substantial liver dysfunction, which is inappropriately reflected in current surgical risk scores (eg, the Society of Thoracic Surgeons [STS] score has no specific tricuspid model). The Model for End-Stage Liver Disease (MELD) has was developed as a measure for the severity of liver dysfunction. We report scores and outcomes for our patient population. METHODS We calculated STS, European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (ESII), and MELD scores for all of our patients who received isolated tricuspid valve surgery between 2011 and 2020 (n = 157). We determined the MELD score, stratified patients into 3 groups (MELD <10: low, n = 53; 10 to <20: intermediate, n = 78; ≥20: high, n = 26) and describe associated outcomes. RESULTS Patients were 72 ± 10 years old and 43% were male. Mean STS score was 4.9 ± 3.5% and ESII was 7.2 ± 6.6%. Mortality was 8.9% at 30 days and 65% at latest follow-up (95% CI, 51%-76%). Median follow-up was 4.4 years (range, 0-9.7 years). Although ESII and STS score accurately predicted 30-day mortality at low MELD scores (observed to expected [O/E] for ESII score = 0.8 and O/E for STS score = 1.0) and intermediate MELD (O/E for ESII score = 0.7, O/E for STS score = 1.0), mortality was underestimated at high MELD (O/E for ESII score = 3.0, O/E for STS score = 4.7). This subgroup also had higher incidence of new-onset hemodialysis. Besides MELD category, recent congestive heart failure, endocarditis, and hemodialysis were also associated with 30-day mortality. CONCLUSIONS For isolated tricuspid valve regurgitation, classic surgical risk stratification with STS or ESII scores failed to predict perioperative mortality if there was evidence of severe liver dysfunction. Preoperative MELD assessment might be useful to assist in proper risk assessment for isolated tricuspid valve surgery.
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Affiliation(s)
- Gloria Färber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Jonas Marx
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - André Scherag
- Institute of Medical Statistics, Computer and Data Sciences (IMSID), Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Ibrahim Saqer
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Christoph Sponholz
- Department of Anesthesiology and Critical Care Medicine, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany.
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14
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Lee C, Tully A, Fang JC, Sugeng L, Elmariah S, Grubb KJ, Young MN. Building and Optimizing the Interdisciplinary Heart Team. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101067. [PMID: 39129880 PMCID: PMC11308725 DOI: 10.1016/j.jscai.2023.101067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 08/13/2024]
Abstract
A multidisciplinary care team model, or Heart Team approach, has become a central tenet of cardiovascular care. Though initially applied to the management of heart transplantation and subsequently complex coronary artery disease, the Heart Team is now utilized broadly across cardiovascular medicine, including in the treatment of valvular disease, pulmonary embolism, cardiogenic shock, high-risk pregnancies in patients with pre-existing cardiovascular disease, and adult congenital heart disease. The Heart Team model improves interdisciplinary collaboration among specialties, adherence to societal guidelines, and shared decision-making with patients and families. In this review, we highlight the development and rationale supporting the Heart Team model, address the challenges of implementing a multidisciplinary care team, and discuss the optimal methods to continue to build, optimize, and implement this approach.
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Affiliation(s)
- Christopher Lee
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Andrew Tully
- Department of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - James C. Fang
- Division of Cardiology, University of Utah Health, Salt Lake City, Utah
| | - Lissa Sugeng
- Department of Cardiology, Northwell Health, Manhasset, New York
| | - Sammy Elmariah
- Division of Cardiology, University of California San Francisco, San Francisco, California
| | - Kendra J. Grubb
- Department of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - Michael N. Young
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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15
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Forado-Benatar I, Caravaca-Pérez P, Rodriguez-Espinosa D, Guzman-Bofarull J, Cuadrado-Payán E, Moayedi Y, Broseta JJ, Farrero M. Tricuspid regurgitation, right ventricular function, and renal congestion: a cardiorenal triangle. Front Cardiovasc Med 2023; 10:1255503. [PMID: 37859684 PMCID: PMC10583553 DOI: 10.3389/fcvm.2023.1255503] [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: 07/08/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
There is a growing interest in the evaluation of tricuspid regurgitation due to its increasing prevalence and detrimental impact on clinical outcomes. Historically, it has been coined the "forgotten" defect in the field of valvular heart disease due to the lack of effective treatments to improve prognosis. However, the development of percutaneous treatment techniques has led to a new era in its management, with promising results and diminished complication risk. In spite of these advances, a comprehensive exploration of the pathophysiological mechanisms is essential to establish clear indications and optimal timing for medical and percutaneous intervention. This review will address the most important aspects related to the diagnosis, pathophysiology and treatment of tricuspid regurgitation from a cardiorenal perspective, with a special emphasis on the interaction between right ventricular dysfunction and the development of hepatorenal congestion.
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Affiliation(s)
| | | | - Diana Rodriguez-Espinosa
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
| | | | - Elena Cuadrado-Payán
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Yasbanoo Moayedi
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - José Jesús Broseta
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Marta Farrero
- Department of Cardiology, Hospital Clínic of Barcelona, Barcelona, Spain
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16
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Carrel T. Commentary: Isolated tricuspid valve surgery time has changed: From futile to a must. J Thorac Cardiovasc Surg 2023; 166:753-754. [PMID: 34862062 DOI: 10.1016/j.jtcvs.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Thierry Carrel
- Department for Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland.
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17
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Anguita-Gámez M, Giraldo MA, Nombela-Franco L, Eixeres Esteve A, Cuerpo G, Lopez-Menendez J, Gomez-Polo JC, Tirado-Conte G, Torres B, Pedraz Prieto A, Jimenez-Quevedo P, Lopez-Gude MJ, Mahia P, Cobiella J, Zamorano JL, Vilacosta I, Maroto L, Carnero-Alcázar M. Validation of the TRI-SCORE in patients undergoing surgery for isolated tricuspid regurgitation. Heart 2023; 109:1401-1406. [PMID: 37217297 DOI: 10.1136/heartjnl-2022-322067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 05/04/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Estimation of peri-procedural risk in patients with tricuspid regurgitation (TR) undergoing isolated tricuspid valve surgery (ITVS) is of paramount importance. The TRI-SCORE is a new surgical risk scale specifically developed for this purpose, which ranged from 0 to 12 points and included eight parameters: right-sided heart failure signs, daily dose of furosemide ≥125 mg, glomerular filtration rate <30 mL/min, elevated bilirubin (with a value of 2 points), age ≥70 years, New York Heart Association Class III-IV, left ventricular ejection fraction <60% and moderate/severe right ventricular dysfunction (with a value of 1 point). The objective of the study was to evaluate the performance of the TRI-SCORE in an independent cohort of patients undergoing ITVS. METHODS A retrospective observational study was performed in four centres, including consecutive adult patients undergoing ITVS for TR between 2005 and 2022. The TRI-SCORE and the traditional risk scores used in cardiac surgery (Logistic EuroScore (Log-ES) and EuroScore-II (ES-II)) were applied for each patient, and discrimination and calibration of the three scores were evaluated in the entire cohort. RESULTS A total of 252 patients were included. The mean age was 61.5±11.2 years, 164 (65.1%) patients were female, and TR mechanism was functional in 160 (63.5%) patients. The observed in-hospital mortality was 10.3%. The estimated mortality by the Log-ES, ES-II and TRI-SCORE was 8.7±7.3%, 4.7±5.3% and 11.0±16.6%, respectively. Patients with a TRI-SCORE ≤4 and >4 had an in-hospital mortality of 1.3% and 25.0%, p=0.001, respectively. The discriminatory capacity of the TRI-SCORE had a C-statistic of 0.87 (0.81-0.92), which was significantly higher than both the Log-ES (0.65 (0.54-0.75)) and ES-II (0.67 (0.58-0.79)), p=0.001 (for both comparisons). CONCLUSION This external validation of the TRI-SCORE demonstrated good performance to predict in-hospital mortality in patients undergoing ITVS, which was significantly better than the Log-ES and ES-II, which underestimated the observed mortality. These results support the widespread use of this score as a clinical tool.
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Affiliation(s)
- María Anguita-Gámez
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - María A Giraldo
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - Gregorio Cuerpo
- Department of Cardiac Surgery, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Jose Lopez-Menendez
- Department of Cardiac Surgery, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Juan Carlos Gomez-Polo
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Gabriela Tirado-Conte
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Berenice Torres
- Department of Cardiac Surgery, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Alvaro Pedraz Prieto
- Department of Cardiac Surgery, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Pilar Jimenez-Quevedo
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - Patricia Mahia
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Javier Cobiella
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - José Luis Zamorano
- Department of Cardiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Isidre Vilacosta
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Luis Maroto
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Manuel Carnero-Alcázar
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Dimitriadis K, Pyrpyris N, Aznaouridis K, Iliakis P, Valatsou A, Tsioufis P, Beneki E, Mantzouranis E, Aggeli K, Tsiamis E, Tsioufis K. Transcatheter Tricuspid Valve Interventions: A Triumph for Transcatheter Procedures? Life (Basel) 2023; 13:1417. [PMID: 37374199 DOI: 10.3390/life13061417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/30/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Tricuspid regurgitation (TR) is a common valvular pathology, estimated to affect 1.6 million people in the United States alone. Even though guidelines recommend either medical therapy or surgical treatment for TR, the misconception of TR as a benign disease along with the high mortality rates of surgical intervention led to undertreating this disease and commonly describing it as a "forgotten" valve. Recently, the development of transcatheter interventions for TR show promising potential for use in the clinical setting. There are currently few approved and numerous tested percutaneously delivered devices, which can be categorized, based on their mechanism of action, to either valve repair or valve replacement procedures. Both procedures were tested in clinical trials and show an echocardiographic reduction in TR sustained for at least 1 year after the procedure, as well as symptom relief and functional improvement of the patients. Device selection should be personalized, taking into consideration the anatomy of each valve and the available options at each heart center. Moreover, appropriate patient selection and timing of the procedure are also crucial for the success of the procedure. In this review, we analyze the clinical trials available for all devices currently approved or tested, aiming to provide a comprehensive summary of the most recent evidence in the field of transcatheter TR interventions.
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Affiliation(s)
- Kyriakos Dimitriadis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | - Nikolaos Pyrpyris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | - Konstantinos Aznaouridis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | - Panagiotis Iliakis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | - Aggeliki Valatsou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | - Panagiotis Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | - Eirini Beneki
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | - Emmanouil Mantzouranis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | - Konstantina Aggeli
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | - Eleftherios Tsiamis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
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19
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Bieliauskienė G, Kažukauskienė I, Janušauskas V, Zorinas A, Ručinskas K, Mainelis A, Zakarkaitė D. The Early Effects on Tricuspid Annulus and Right Chambers Dimensions in Successful Tricuspid Valve Bicuspidization. J Clin Med 2023; 12:4093. [PMID: 37373786 DOI: 10.3390/jcm12124093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/10/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND It is unclear to what degree of tricuspid annulus (TA) reduction is necessary to achieve good postoperative results in surgical bicuspidization. The study aimed to evaluate TA and right heart chamber's dimensions before and after heart surgery; and to compare TA parameters assessed by different modalities. METHODS Forty patients underwent mitral valve surgery with or without concomitant tricuspid valve (TV) bicuspidization. Preoperative and postoperative measurements of TA dimensions were performed prospectively using two-dimensional (2D) and three-dimensional (3D) transthoracic echocardiography (TTE). Additionally, preoperative transesophageal echocardiography (TOE) was performed in the operating room prior to surgery. RESULTS All patients had no or mild TR immediately after surgery. There was a significant reduction in 2D and 3D parameters of the TV and right chambers in the TV bicuspidization group. However, TV leaflets' tethering parameters did not change significantly. Preoperative 3D TTE measurements were smaller than those obtained through 3D TOE in the operation room, before surgery under general anesthesia. The 2D systolic apical 4Ch diameter and the parasternal short axis diameter mainly represent the 3D minor axis of the TA and are smaller than its 3D major axis. CONCLUSIONS Although bicuspidization results in a one-third reduction of the TV area, tethering of the TV leaflets remains unchanged. Moreover, 3D TOE parameters of the TV under general anesthesia are larger than preoperative 3D TTE measurements. Conventional 2D measurements are insufficient for evaluating the maximum diameter of the TA.
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Affiliation(s)
- Gintarė Bieliauskienė
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio 21, 03101 Vilnius, Lithuania
| | - Ieva Kažukauskienė
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio 21, 03101 Vilnius, Lithuania
| | - Vilius Janušauskas
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio 21, 03101 Vilnius, Lithuania
| | - Aleksejus Zorinas
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio 21, 03101 Vilnius, Lithuania
| | - Kęstutis Ručinskas
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio 21, 03101 Vilnius, Lithuania
| | - Antanas Mainelis
- Faculty of Mathematics and Informatics, Vilnius University, Naugarduko 24, 03225 Vilnius, Lithuania
| | - Diana Zakarkaitė
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio 21, 03101 Vilnius, Lithuania
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20
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Chen Q, Bowdish ME, Malas J, Roach A, Gill G, Rowe G, Thomas J, Emerson D, Trento A, Egorova N, Chikwe J. Isolated Tricuspid Operations: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis. Ann Thorac Surg 2023; 115:1162-1170. [PMID: 36696939 PMCID: PMC11181751 DOI: 10.1016/j.athoracsur.2022.12.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Population-level data are limited regarding contemporary practice and outcomes of isolated tricuspid operations. We evaluated this using The Society of Thoracic Surgeons Adult Cardiac Surgery Database. METHODS We identified 14,704 isolated tricuspid operations from The Society of Thoracic Surgeons Adult Cardiac Surgery Database from July 1, 2011 to June 30, 2020. After excluding patients with endocarditis, tricuspid stenosis, emergent/emergent salvage status, previous heart transplants, and missing tricuspid operation type, 6507 patients remained. Endpoints were operative mortality and composite major comorbidities (permanent stroke, renal failure, prolonged ventilation > 24 hours, deep sternal wound infection, cardiac reoperations, and new permanent pacemaker implantation). RESULTS Isolated tricuspid operations increased from 2012 (983 cases) to 2019 (2155 cases, P < .001). Median annual center volume was 2 cases (range, 1-81). In the final cohort (n = 6507; median age, 65 years; 38.5% men), 40% had New York Heart Association class III/IV heart failure and 24% had nonelective operations. The operative mortality was 7.3% (1.7% in patients without these risk factors), and new permanent pacemaker implant rate was 10.8%. In the multivariable analysis, factors associated with operative mortality included New York Heart Association class III/IV heart failure (odds ratio [OR], 1.57), nonelective operations (OR, 1.91), tricuspid replacement (OR, 1.56), annual center volume ≤ 5 cases (OR, 1.37), and higher model for end-stage liver disease scores (all P < .05). Beating heart operation was associated with a lower adjusted risk of pacemaker implant (OR, 0.69), renal failure (OR, 0.75), and blood transfusions (OR, 0.8) compared with full cardioplegic arrest (all P < .05). CONCLUSIONS Isolated tricuspid repair was associated with lower adjusted mortality and morbidities than replacement. Beating heart operation was associated with lower adjusted major morbidities. The preoperative model for end-stage liver disease scores may identify high-risk patients, and early referral to higher volume centers may help improve outcomes.
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Affiliation(s)
- Qiudong Chen
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Michael E Bowdish
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jad Malas
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Amy Roach
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - George Gill
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Georgina Rowe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jason Thomas
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dominic Emerson
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alfredo Trento
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Natalia Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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21
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Nakashima M, Miyoshi T, Tanakaya M, Saito T, Katayama Y, Sakuragi S, Takaya Y, Ito H. Prognostic value of the liver fibrosis marker fibrosis-5 index in patients with severe isolated tricuspid regurgitation: comparison with fibrosis-4 index. Heart Vessels 2023:10.1007/s00380-023-02268-3. [PMID: 37087702 PMCID: PMC10371954 DOI: 10.1007/s00380-023-02268-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/12/2023] [Indexed: 04/24/2023]
Abstract
The fibrosis-4 index (FIB4), a liver fibrosis maker, has been shown to be associated with the prognosis in patients with severe isolated tricuspid regurgitation (TR). Recent study showed that the fibrosis-5 index (FIB5), which was calculated by albumin, alkaline phosphatase, aspartate transaminase, alanine aminotransferase and platelet count, had better prognostic value than FIB4 in patients with heart failure. The aim of this study was to evaluate the usefulness of FIB5 index for predicting prognosis in patients with severe isolated TR and compare the prognostic value between the FIB4 and the FIB5 in those patients. This was a dual-center, retrospective study. 113 consecutive outpatients with severe isolated TR (mean age, 65.8 years; 47.8% male) were analyzed. Major adverse cardiovascular events (MACEs) were defined as the composite of cardiovascular death, hospitalization for heart failure, myocardial infarction, and stroke. During a median follow-up of 3.0 years, 41 MACEs occurred. Patients with MACEs had a lower the FIB5 than patients without MACEs. The multivariate Cox analysis revealed that the FIB5 < -4.30 was significantly associated with higher incidence of MACEs after adjusted by confounding factors. Receiver-operating characteristic curve analyses showed that prognostic values did not differ between the FIB5 and the FIB4 in whole patients and in patients aged ≥ 70 years; while, in patients aged < 70 years, the FIB5 had better prognostic value than the FIB4. The FIB5 may be a useful predictor of MACEs in patients with severe isolated TR.
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Affiliation(s)
- Mitsutaka Nakashima
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
- Department of Cardiovascular Medicine, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan.
| | - Machiko Tanakaya
- Department of Cardiovascular Medicine, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
| | - Takaaki Saito
- Department of Cardiovascular Medicine, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
| | - Yusuke Katayama
- Department of Cardiovascular Medicine, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
| | - Satoru Sakuragi
- Department of Cardiovascular Medicine, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
| | - Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
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22
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Lawlor MK, Ng V, Ahmed S, Dershowitz L, Brener MI, Kampaktsis P, Pitts A, Vahl T, Nazif T, Leon M, George I, Hahn RT, Kodali S. Baseline Characteristics and Clinical Outcomes of a Tricuspid Regurgitation Referral Population. Am J Cardiol 2023; 196:22-30. [PMID: 37058874 DOI: 10.1016/j.amjcard.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 02/22/2023] [Accepted: 03/08/2023] [Indexed: 04/16/2023]
Abstract
Adverse outcomes in tricuspid regurgitation (TR) have been associated with advanced regurgitation severity and right-sided cardiac remodeling, and late referrals for tricuspid valve surgery in TR have been associated with increase in postoperative mortality. The purpose of this study was to evaluate baseline characteristics, clinical outcomes, and procedural utilization of a TR referral population. We analyzed patients with a diagnosis of TR referred to a large TR referral center between 2016 and 2020. We evaluated baseline characteristics stratified by TR severity and analyzed time-to-event outcomes for a composite of overall mortality or heart-failure hospitalization. In total, 408 patients were referred with a diagnosis of TR: the median age of the cohort was 79 years (interquartile range 70 to 84), and 56% were female. In patients evaluated on a 5-grade scale, 10.2% had ≤moderate TR; 30.7% had severe TR; 11.4% had massive TR, and 47.7% had torrential TR. Increasing TR severity was associated with right-sided cardiac remodeling and altered right ventricular hemodynamics. In multivariable Cox regression analysis, New York Heart Association class symptoms, history of heart failure hospitalization, and right atrial pressure were associated with the composite outcome. One-third of patients referred underwent transcatheter tricuspid valve intervention (19%) or surgery (14%); patients who underwent transcatheter tricuspid valve intervention had greater preoperative risk than that of patients who underwent surgery. In conclusion, in patients referred for evaluation of TR, there were high rates of massive and torrential regurgitation and advanced right ventricle remodeling. Symptoms and right atrial pressure are associated with clinical outcomes in follow-up. There were significant differences in baseline procedural risk and eventual therapeutic modality.
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Affiliation(s)
| | - Vivian Ng
- Division of Cardiology; Structural Heart and Valve Center
| | | | | | | | | | - Amy Pitts
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Torsten Vahl
- Division of Cardiology; Structural Heart and Valve Center
| | - Tamim Nazif
- Division of Cardiology; Structural Heart and Valve Center
| | - Martin Leon
- Division of Cardiology; Structural Heart and Valve Center; Cardiovascular Research Foundation, New York, New York
| | - Isaac George
- Structural Heart and Valve Center; Division of Cardiothoracic & Vascular Surgery, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York
| | - Rebecca T Hahn
- Division of Cardiology; Structural Heart and Valve Center; Cardiovascular Research Foundation, New York, New York
| | - Susheel Kodali
- Division of Cardiology; Structural Heart and Valve Center.
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23
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Dreyfus J, Bohbot Y, Coisne A, Lavie-Badie Y, Flagiello M, Bazire B, Eggenspieler F, Viau F, Riant E, Mbaki Y, Eyharts D, Sénage T, Modine T, Nicol M, Doguet F, Le Tourneau T, Tribouilloy C, Donal E, Tomasi J, Habib G, Selton-Suty C, Radu C, Lim P, Raffoul R, Iung B, Obadia JF, Audureau E, Messika-Zeitoun D. Predictive value of the TRI-SCORE for in-hospital mortality after redo isolated tricuspid valve surgery. Heart 2023; 109:951-958. [PMID: 36828623 DOI: 10.1136/heartjnl-2022-322167] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/02/2023] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVES The TRI-SCORE reliably predicts in-hospital mortality after isolated tricuspid valve surgery (ITVS) on native valve but has not been tested in the setting of redo interventions. We aimed to evaluate the predictive value of the TRI-SCORE for in-hospital mortality in patients with redo ITVS and to compare its accuracy with conventional surgical risk scores. METHODS Using a mandatory administrative database, we identified all consecutive adult patients who underwent a redo ITVS at 12 French tertiary centres between 2007 and 2017. Baseline characteristics and outcomes were collected from chart review and surgical scores were calculated. RESULTS We identified 70 patients who underwent a redo ITVS (54±15 years, 63% female). Prior intervention was a tricuspid valve repair in 51% and a replacement in 49%, and was combined with another surgery in 41%. A tricuspid valve replacement was performed in all patients for the redo surgery. Overall, in-hospital mortality and major postoperative complication rates were 10% and 34%, respectively. The TRI-SCORE was the only surgical risk score associated with in-hospital mortality (p=0.005). The area under the receiver operating characteristic curve for the TRI-SCORE was 0.83, much higher than for the logistic EuroSCORE (0.58) or EuroSCORE II (0.61). The TRI-SCORE was also associated with major postoperative complication rates and survival free of readmissions for heart failure. CONCLUSION Redo ITVS was rarely performed and was associated with an overall high in-hospital mortality and morbidity, but hiding important individual disparities. The TRI-SCORE accurately predicted in-hospital mortality after redo ITVS and may guide clinical decision-making process (www.tri-score.com).
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Affiliation(s)
- Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint Denis, France
| | - Yohann Bohbot
- Cardiology Department, University Hospital Centre Amiens-Picardie South Site, Amiens, France
| | - Augustin Coisne
- Department of Echocardiography and Cardiovascular Explorations, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | - Yoan Lavie-Badie
- Cardiology Department, University Hospital Centre Toulouse, Toulouse, France
| | - Michele Flagiello
- Department of Cardiovascular Surgery and Transplantation, Hopital Cardio-Vasculaire et Pneumologique Louis Pradel, Lyon, France
| | - Baptiste Bazire
- Cardiology Department, Bichat - Claude-Bernard Hospital Cardiology Service, Paris, France
| | | | - Florence Viau
- Cardiology Department, Hôpital de la Timone, Marseille, France
| | - Elisabeth Riant
- Cardiology Department, Centre Cardiologique du Nord, Saint Denis, France.,Cardiology Department, Hospital Henri Mondor, Creteil, France
| | - Yannick Mbaki
- Cardiology Department, University Hospital Centre Rennes, Rennes, France
| | - Damien Eyharts
- Cardiology Department, University Hospital Centre Toulouse, Toulouse, France
| | - Thomas Sénage
- Cardiac Surgery Department, University Hospital Centre Nantes, Nantes, France
| | - Thomas Modine
- Cardiac Surgery Department, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | - Martin Nicol
- Cardiology Department, Centre Cardiologique du Nord, Saint Denis, France
| | - Fabien Doguet
- Cardiac Surgery Department, University Hospital Centre Rouen, Rouen, France
| | | | - Christophe Tribouilloy
- Cardiology Department, University Hospital Centre Amiens-Picardie South Site, Amiens, France
| | - Erwan Donal
- Cardiology Department, University Hospital Centre Rennes, Rennes, France
| | - Jacques Tomasi
- Cardiac Surgery Department, University Hospital Centre Rennes, Rennes, France
| | - Gilbert Habib
- Cardiology Department, Hôpital de la Timone, Marseille, France
| | | | - Costin Radu
- Cardiology Department, Hospital Henri Mondor, Creteil, France
| | - Pascal Lim
- Cardiology Department, Hospital Henri Mondor, Creteil, France
| | - Richard Raffoul
- Cardiology Department, Bichat - Claude-Bernard Hospital Cardiology Service, Paris, France
| | - Bernard Iung
- Cardiology Department, Bichat - Claude-Bernard Hospital Cardiology Service, Paris, France
| | - Jean-Francois Obadia
- Department of Cardiovascular Surgery and Transplantation, Hopital Cardio-Vasculaire et Pneumologique Louis Pradel, Lyon, France
| | | | - David Messika-Zeitoun
- Cardiology Department, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Dreyfus J, Messika-Zeitoun D. Cardiac implantable electronic devices: Leads can lead to tricuspid regurgitation and death! Int J Cardiol 2023; 372:91-92. [PMID: 36496038 DOI: 10.1016/j.ijcard.2022.12.011] [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: 11/25/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, 32-36 rue des moulins gémeaux, 93200 Saint-Denis, France.
| | - David Messika-Zeitoun
- Department of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, Canada
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Alipour Symakani RS, Bartelds B, Merkus D, Bogers AJJC, Taverne YJHJ. Guiding Interventions for Secondary Tricuspid Regurgitation: Follow the Intricate Interplay Between Form and Function. Cardiol Rev 2023; 31:7-15. [PMID: 34495894 DOI: 10.1097/crd.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Secondary tricuspid regurgitation (TR) has long been considered a benign and well-tolerated valvular lesion that resolves after treatment of the underlying disease. This view has been challenged by data indicating that long-standing TR can be a progressive disorder, contributing to right ventricular failure and end-organ damage, despite adequate treatment of the underlying disease. Surgical correction is curative, but infrequently performed and historically associated with poor outcomes. This may be due to delayed diagnosis, lack of well-defined surgical indications, and, consequently, late intervention in patients in poor clinical condition with failing right ventricles. Because of limited evidence about timing and corresponding outcome of tricuspid valve surgery, current guideline recommendations are rather conservative and show several inconsistencies. Nevertheless, there has been a trend toward a more aggressive approach in the surgical treatment of TR with improved outcomes. Moreover, emerging transcatheter options claim to provide a lower-risk alternative for selected patients. This may facilitate earlier treatment and improve the attitude toward an early treatment strategy of secondary TR, yet is not reflected in the guidelines. Future research is needed for risk stratification to determine inclusion criteria and optimal timing for intervention.
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Affiliation(s)
- Rahi S Alipour Symakani
- From the Division of Experimental Cardiology, Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Beatrijs Bartelds
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Daphne Merkus
- From the Division of Experimental Cardiology, Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Nishiura N, Kitai T, Okada T, Sano M, Miyawaki N, Kim K, Murai R, Toyota T, Sasaki Y, Ehara N, Kobori A, Kinoshita M, Koyama T, Furukawa Y. Long-Term Clinical Outcomes in Patients With Severe Tricuspid Regurgitation. J Am Heart Assoc 2022; 12:e025751. [PMID: 36565178 PMCID: PMC9973603 DOI: 10.1161/jaha.122.025751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The natural history and optimal interventional timing in patients with isolated severe tricuspid regurgitation (TR) have not been well studied. This study aimed to investigate long-term clinical outcomes and risk factors associated with poor prognosis in patients with isolated severe TR. Methods and Results Consecutive transthoracic echocardiographic examinations in 2877 patients with isolated severe TR were retrospectively reviewed. Patients with significant left-sided valve disease or repeated examinations were excluded. Primary outcome was defined as a composite of all-cause death and hospitalization for heart failure. Among the 613 enrolled patients (mean age, 74±13 years; men, 38%), 141 died, and 62 were hospitalized for heart failure during the median follow-up period of 26.5 (interquartile range, 6.0-57.9) months. The 5-year event-free rate was 60.1%. TR pressure gradient (adjusted hazard ratio [HR], 1.03 [95% CI, 1.01-1.04]), blood urea nitrogen (adjusted HR, 1.02 [95% CI, 1.01-1.04]), left atrial volume index (adjusted HR, 1.01 [95% CI, 1.002-1.02]), and serum albumin (adjusted HR, 0.56 [95% CI, 0.36-0.95]) were identified as independent predictors of adverse events. A risk model based on the 4 clinical factors that included pulmonary hypertension (TR pressure gradient >40 mm Hg), elevated blood urea nitrogen levels (>25 mg/dL), decreased albumin levels (<3.7 g/dL), and left atrial enlargement (left atrial volume index <34 mL/m2) revealed a graded increase in the risk of adverse events (P<0.001). Conclusions The prognosis of isolated severe TR is not always favorable. Careful attention should be paid to patients with concomitant risk factors, such as pulmonary hypertension, elevated blood urea nitrogen levels, decreased albumin levels, and left atrial enlargement.
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Affiliation(s)
- Naoki Nishiura
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Takeshi Kitai
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan,Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Taiji Okada
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Madoka Sano
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Norihisa Miyawaki
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Kitae Kim
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Ryosuke Murai
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Toshiaki Toyota
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Yasuhiro Sasaki
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Natsuhiko Ehara
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Atsushi Kobori
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Makoto Kinoshita
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Tadaaki Koyama
- Department of Cardiothoracic SurgeryKobe City Medical Center General HospitalKobeJapan
| | - Yutaka Furukawa
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
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Nuzhdin MD, Komarov RN, Matsuganov DA, Nadtochiy NB. Original technique for tricuspid valve replacement by mitral homograft: Step-by-step approach and initial results. J Card Surg 2022; 37:5195-5201. [PMID: 36378863 DOI: 10.1111/jocs.17228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Severe tricuspid regurgitation is associated with the progression of heart failure symptoms and poor survival. Surgical treatment of infective and prosthetic tricuspid valve endocarditis using homografts gives promising early and midterm results. Tricuspid valve replacement with a mitral homograft is a reasonable procedure with a challenging technique. MATERIAL AND METHODS A total of 15 patients underwent tricuspid valve replacement by mitral homograft in two departments from October 2020 to May 2022. The mean age was 36 [31-40.5]. In this article, we describe our original step-by-step technique and initial experience of successful use of native or cryopreserved mitral homografts for surgical treatment of tricuspid valve disease. RESULTS There were no in-hospital and 30-day mortality, no postoperative bleeding, myocardium infarction, stroke, or sternal wound infection. Only one patient required permanent pacemaker implantation after redo surgery before discharge. The predischarge echocardiogram showed no residual tricuspid regurgitation (TR) in 14 cases (93.3%) and mild TR in 1 (6.7%) patient. All patients were discharged from the hospital without symptoms of endocarditis, with negative blood culture samples. CONCLUSION Satisfactory initial clinical and hemodynamic results were achieved utilizing our technique. Mid- and long-term results are required to understand the place of homografts in tricuspid valve surgery.
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Affiliation(s)
- Mikhail D Nuzhdin
- Department of Cardiac Surgery, State Budgetary Healthcare Institution "Chelyabinsk Regional Clinical Hospital", Chelyabinsk, Russian Federation
| | - Roman N Komarov
- Clinic of Aortic and Cardio-Vascular Surgery, Federal State Autonomous Educational Institution of Higher Education First Moscow State Medical University named I. M. Sechenova of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Denis A Matsuganov
- Department of Cardiac Surgery, State Budgetary Healthcare Institution "Chelyabinsk Regional Clinical Hospital", Chelyabinsk, Russian Federation
| | - Nikita B Nadtochiy
- Department of Radiology, State Budgetary Healthcare Institution "Chelyabinsk Regional Clinical Hospital", Chelyabinsk, Russian Federation
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Liu Y, Li W, Zhou D, Zhang X, Kong D, Ge Z, Chen H, Shu X, Pan C, Ge J. Real-Time Monitoring and Step-by-Step Guidance for Transcatheter Tricuspid Annuloplasty Using Transesophageal Echocardiography. J Cardiovasc Dev Dis 2022; 9:jcdd9120415. [PMID: 36547412 PMCID: PMC9781931 DOI: 10.3390/jcdd9120415] [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: 10/25/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 11/29/2022] Open
Abstract
Transcatheter tricuspid valve intervention (TTVI) is a novel alternative to functional tricuspid regurgitation (FTR) for patients with prohibitive surgical risk. Devices have been designed according to different pathophysiological mechanisms of FTR, including ones to achieve an edge-to-edge repair and others aiming at direct annuloplasty. Recently, a transcatheter tricuspid valve repair system mimicking a surgical Kay procedure (K-Clip™ system, Huihe Medical Technology, Shanghai, China) completed its salvage-use trial. The system, which clips the posterior annulus to achieve bicuspidization of the TV, demonstrated acceptable procedural safety and efficacy. Each TTVI system has distinct characteristics for echocardiographic imaging and special consideration for intraoperative guidance. This review focuses on elaborating how two-dimensional and three-dimensional transesophageal echocardiography (TEE) are used in clinical practice to guide K-Clip™ implantation in comparison to other direct annular reduction devices. A limited number of TEE work planes are proposed for the procedure with the aim to provide a steeper learning curve for the echocardiographer and interventionalist while simplifying the implantation steps.
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Affiliation(s)
- Yu Liu
- Shanghai Institute of Medical Imaging, Shanghai 200032, China
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wei Li
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research Center for Interventional Therapy, Shanghai 200032, China
| | - Daxin Zhou
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research Center for Interventional Therapy, Shanghai 200032, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiaochun Zhang
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research Center for Interventional Therapy, Shanghai 200032, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Dehong Kong
- Shanghai Institute of Medical Imaging, Shanghai 200032, China
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research Center for Interventional Therapy, Shanghai 200032, China
| | - Zhenyi Ge
- Shanghai Institute of Medical Imaging, Shanghai 200032, China
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research Center for Interventional Therapy, Shanghai 200032, China
| | - Haiyan Chen
- Shanghai Institute of Medical Imaging, Shanghai 200032, China
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research Center for Interventional Therapy, Shanghai 200032, China
| | - Xianhong Shu
- Shanghai Institute of Medical Imaging, Shanghai 200032, China
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research Center for Interventional Therapy, Shanghai 200032, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Cuizhen Pan
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research Center for Interventional Therapy, Shanghai 200032, China
- Correspondence:
| | - Junbo Ge
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research Center for Interventional Therapy, Shanghai 200032, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Hochstadt A, Maor E, Ghantous E, Merdler I, Granot Y, Rubinshtein R, Banai S, Segev A, Kuperstein R, Topilsky Y. A validated score to predict one-year and long-term mortality in patients with significant tricuspid regurgitation. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac067. [PMID: 36452184 PMCID: PMC9703580 DOI: 10.1093/ehjopen/oeac067] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/12/2022] [Indexed: 06/17/2023]
Abstract
Aims Most patients with significant (defined as ≥ moderate) tricuspid regurgitation (TR) are treated conservatively. Individual mortality rates are markedly variable. We developed a risk score based on comprehensive clinical and echocardiographic evaluation, predicting mortality on an individual patient level. Methods and results The cohort included 1701 consecutive patients with significant TR, half with isolated TR, admitted to a single hospital, treated conservatively. We derived a scoring system predicting 1-year mortality and validated it using k-fold cross-validation and with external validation on another cohort of 5141 patients. Score utility was compared with matched patients without significant TR. One-year mortality rate was 31.3%. The risk score ranged 0-17 points and included 11 parameters: age (0-3), body mass index ≤ 25 (0-1), history of liver disease (0-2), history of chronic lung disease (0-2), estimated glomerular filtration rate (0-5), haemoglobin (0-2), left-ventricular ejection fraction (0-1), right-ventricular dysfunction (0-1), right atrial pressure (0-2), stroke volume index (SVI) (0-1) and left-ventricular end-diastolic diameter (0-1). One-year mortality rates increased from 0 to 100%, as the score increased up to ≥16. Areas under the receiver operating curves were 0.78, 0.70, and 0.73, for the original, external validation, and external validation with SVI measured cohorts. The score remained valid in subpopulations of patients with quantified RV function, quantified TR and isolated TR. Significant TR compared to no TR, affected 1-year mortality stronger with higher scores, with a significantly positive interaction term. Conclusion We suggest a robust risk score for inpatients with significant TR, assisting risk stratification and decision-making. Our findings underscore the burden of TR providing benchmarks for clinical trial design.
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Affiliation(s)
- Aviram Hochstadt
- Edith Wolfson Medical Center, Heart Institute, Holon, Israel and The
Sackler school of medicine, The Tel-Aviv University,
Ha-Lokhamim St 62, Holon, 5822012, Tel Aviv, Israel
| | - Elad Maor
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer. Sackler Faculty of
Medicine, Tel Aviv University, Derech Sheba 2, Ramat Gan
526264239061, Tel Aviv, Israel
| | - Eihab Ghantous
- Division of Cardiology, Tel-Aviv Sourasky Medical Center and the Sackler
School of Medicine of The Tel Aviv University, Weizmann St 6,
Tel Aviv-Yafo, 6423906, Tel Aviv, Israel
| | - Ilan Merdler
- Division of Cardiology, Tel-Aviv Sourasky Medical Center and the Sackler
School of Medicine of The Tel Aviv University, Weizmann St 6,
Tel Aviv-Yafo, 6423906, Tel Aviv, Israel
| | - Yoav Granot
- Division of Cardiology, Tel-Aviv Sourasky Medical Center and the Sackler
School of Medicine of The Tel Aviv University, Weizmann St 6,
Tel Aviv-Yafo, 6423906, Tel Aviv, Israel
| | - Ronen Rubinshtein
- Edith Wolfson Medical Center, Heart Institute, Holon, Israel and The
Sackler school of medicine, The Tel-Aviv University,
Ha-Lokhamim St 62, Holon, 5822012, Tel Aviv, Israel
| | - Shmuel Banai
- Division of Cardiology, Tel-Aviv Sourasky Medical Center and the Sackler
School of Medicine of The Tel Aviv University, Weizmann St 6,
Tel Aviv-Yafo, 6423906, Tel Aviv, Israel
| | - Amit Segev
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer. Sackler Faculty of
Medicine, Tel Aviv University, Derech Sheba 2, Ramat Gan
526264239061, Tel Aviv, Israel
| | - Rafael Kuperstein
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer. Sackler Faculty of
Medicine, Tel Aviv University, Derech Sheba 2, Ramat Gan
526264239061, Tel Aviv, Israel
| | - Yan Topilsky
- Division of Cardiology, Tel-Aviv Sourasky Medical Center and the Sackler
School of Medicine of The Tel Aviv University, Weizmann St 6,
Tel Aviv-Yafo, 6423906, Tel Aviv, Israel
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30
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Nakashima M, Tanakaya M, Miyoshi T, Saito T, Katayama Y, Sakuragi S, Ito H. The Fibrosis-4 Index Predicts Cardiovascular Prognosis in Patients With Severe Isolated Tricuspid Regurgitation. Circ J 2022; 86:1777-1784. [PMID: 35922937 DOI: 10.1253/circj.cj-22-0109] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The fibrosis-4 (FIB-4) index is used to evaluate liver disease patients. It can also be used to evaluate the prognosis for heart disease patients; however, its ability to determine the prognosis of severe isolated tricuspid regurgitation (TR) patients is unclear. This study aimed to clarify the association between FIB-4 index scores and the cardiovascular prognosis for severe isolated TR patients. METHODS AND RESULTS This was a dual-center, retrospective study. From 2011 to 2019, 111 consecutive outpatients with severe isolated TR (mean age, 68.6 years; 53.2% male) were evaluated. Major adverse cardiovascular events (MACEs) were defined as the composite of cardiovascular death, hospitalization for heart failure, myocardial infarction, and stroke. The association between FIB-4 index scores and echocardiography was also evaluated. During a median follow up of 3.0 years, 24 patients were lost to follow up and 40 MACEs occurred. Baseline FIB-4 index scores for patients with MACEs were significantly higher than those for patients without MACEs. A multivariate analysis revealed that FIB-4 index scores are significantly associated with MACEs (hazard ratio, 1.89; 95% confidence interval, 1.01-3.54; P=0.046). A linear regression analysis indicated that FIB-4 index scores were correlated with echocardiographic parameters, including the left atrial volume index and left ventricular end-diastolic diameter. CONCLUSIONS The FIB-4 index score may be a useful predictor of MACEs for patients with severe isolated TR.
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Affiliation(s)
- Mitsutaka Nakashima
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
- Department of Cardiovascular Medicine, National Hospital Organization Iwakuni Clinical Center
| | - Machiko Tanakaya
- Department of Cardiovascular Medicine, National Hospital Organization Iwakuni Clinical Center
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takaaki Saito
- Department of Cardiovascular Medicine, National Hospital Organization Iwakuni Clinical Center
| | - Yusuke Katayama
- Department of Cardiovascular Medicine, National Hospital Organization Iwakuni Clinical Center
| | - Satoru Sakuragi
- Department of Cardiovascular Medicine, National Hospital Organization Iwakuni Clinical Center
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
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Sala A, Beneduce A, Maisano F. Transcatheter and surgical treatment of tricuspid regurgitation: Predicting right ventricular decompensation and favorable responders. Front Cardiovasc Med 2022; 9:980639. [PMID: 36237912 PMCID: PMC9551023 DOI: 10.3389/fcvm.2022.980639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/12/2022] [Indexed: 12/03/2022] Open
Abstract
Isolated tricuspid regurgitation (TR) has gained increasing recognition in recent years both in the surgical and in the cardiological community. Left untreated, isolated TR significantly worsens survival. Despite being a strong predictor of negative prognosis, interventions to correct TR are rarely performed due to increased surgical risk and late patient presentation. Recently, the ultimate focus has been on patient selection, surgical or transcatheter indication, and correct timing. Furthermore, of paramount importance is the identification of predictors of outcome following treatment, in order to discriminate between favorable and unfavorable responders and guide the decision-making process of the most adequate treatment for every patient.
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Affiliation(s)
- Alessandra Sala
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Beneduce
- Department of Cardiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Maisano
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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32
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Liu QQ, Du Y, Zhang R, Shen WQ, Du GQ. Evaluation of longitudinal trajectory of functional tricuspid regurgitation on the risk of right ventricular dysfunction after mitral valve replacement. J Card Surg 2022; 37:3995-4001. [PMID: 36057976 DOI: 10.1111/jocs.16891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/12/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Functional tricuspid regurgitation (FTR) levels can vary over time and its longitudinal changing patterns may predict right ventricular dysfunction (RVD) risk. We aim to identify different trajectories of FTR in those who received mitral valve replacement (MVR) and investigate the association between longitudinal trajectory groups and RVD risk in a cohort study. METHODS AND RESULTS A prospective cohort study, reported usual FTR levels at baseline in 2005-2015 and the participants of MVR have been followed up for 5-6 years, approximately every 1 year, and so far, the data have been collected across five subsequent phases. Five-year longitudinal trajectories of FTR were identified using group-based trajectory modeling (GBTM). We identified 3 distinct trajectories using a GBTM, labeled by initial value and changing pattern: stable group (258/378, 68.2%), increasing-slow group (67/378, 17.6%) and increasing-fast group (53/378, 14.2%). Treating the stable group as the reference, the age- and sex-adjusted odds ratio (OR) was 25.84 (95% confidence interval [CI]: 11.78-56.65) for the increasing-slow group and 139.94 (95% CI: 45.47-430.68) for the increasing-fast group by logistic regression model. After adjustment for every potential confounding factors, the OR is 14.21 (95% CI: 4.36-46.33) and 49.34 (95% CI: 8.88-273.87), respectively. CONCLUSIONS The longitudinal trajectories of worsening FTR were mostly associated with increased risk of RVD outcomes, which is independent of other factors including FTR levels. These findings have implications for intervention and prevention of RVD among individuals who received MVR.
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Affiliation(s)
- Qi-Qi Liu
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Department of Ultrasound, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Yi Du
- Department of Cardiology, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Rui Zhang
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wen-Qian Shen
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guo-Qing Du
- Department of Ultrasound, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Rodriguez Torres D, Torres Quintero L, Segura Rodríguez D, Garrido Jimenez JM, Esteban Molina M, Gomera Martínez F, Moreno Escobar E, Garcia Orta R. Surgical management of tricuspid regurgitation: a new algorithm to minimise recurrent tricuspid regurgitation. Open Heart 2022; 9:openhrt-2022-002011. [PMID: 35878960 PMCID: PMC9328083 DOI: 10.1136/openhrt-2022-002011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Recurrent tricuspid regurgitation (TR) is frequently observed after cardiac surgery; however, the correct approach remains controversial. We developed an algorithm for action on the tricuspid valve (TV) and conducted a 1-year follow-up study. The aim was to assess the efficacy of the algorithm to minimise residual TR after TV surgery. The hypothesis was that the TR rate at 1 year would be reduced by selecting the surgical approach in accordance with a set of preoperative clinical and echocardiographic variables. Methods A prospective, observational, single-centre study was performed in 76 consecutive patients with TV involvement. A protocol was designed for their inclusion, and data on their clinical and echocardiographic characteristics were gathered at 3 months and 1-year postsurgery. The treatment of patients depended on the degree of TR. Surgery was performed in all patients with severe or moderate-to-severe TR and in those with mild or moderate TR alongside the presence of certain clinical or echocardiographic factors. They underwent annuloplasty or extended valve repair when the TV was distorted. If repair techniques were not feasible, a prosthesis was implanted. Residual TR rates were compared with published reports, and predictors of early/late mortality and residual TR were evaluated. Results TR was functional in 69.9% of patients. Rigid ring annuloplasty was performed in 35.7% of patients, De Vega annuloplasty in 27.1%, extended repair in 11.4% and prosthetic replacement in 25.7%. TR was moderate or worse in 8.19% of patients (severe in 3.27%) at 1 year postintervention. No clinical, surgical or epidemiological variables were significantly associated with residual TR persistence, although annulus diameter showed a close-to-significant association. Total mortality was 12.85% for all causes and 10% for cardiovascular causes. In multivariate analysis, left ventricular ejection fraction was related to both early and late mortality. Conclusions Severe residual TR was significantly less frequent than reported in other series, being observed in less than 4% of patients at 1-year postsurgery.
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Affiliation(s)
| | | | | | | | - Maria Esteban Molina
- Cardiovascular Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | | | - Rocio Garcia Orta
- Cardiology, Hospital Universitario Virgen de las Nieves, Granada, Spain
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Martín Gutiérrez E, Castaño Ruiz M, Hornero Sos F, Laguna Núñez G, Barquero Aroca JM, Rodríguez-Roda Stuart J, Berastegui García E, Cuerpo Caballero G, Carnero Alcázar M, Dalmau Sorlí MJ, García Fuster R, Gutiérrez Carretero E, Garrido Jiménez JM, Gualis Cardona J, Bautista Hernández V, Sánchez Pérez R, López Menéndez J, Ortiz Berbel D. Criterios de ordenación temporal de las intervenciones quirúrgicas en patología cardiovascular y endovascular adquirida. Versión 2022. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Bhardwaj B, Cigarroa JE, Zahr F. Tricuspid Valve Percutaneous Therapies. Curr Cardiol Rep 2022; 24:1209-1226. [PMID: 35767178 DOI: 10.1007/s11886-022-01739-9] [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] [Accepted: 06/13/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW In this review, we have focused on the currently available transcatheter tricuspid valve therapies, device selection, as well as role and management of tricuspid regurgitation (TR) in the setting of other transcatheter valvular procedures. RECENT FINDINGS In this review, we have enlisted the recently finished as well as ongoing trials in the percutaneous tricuspid valve therapies. TR is highly prevalent yet remains underrecognized and is often untreated. TR has traditionally been managed conservatively with medical therapies including diuretics for volume management, whereas surgical therapies are reserved for those undergoing left-sided valvular surgery. Although the transcatheter devices for tricuspid repair and replacement are in clinical trials, the experience to date for their effectiveness and safety has been reassuring.
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Affiliation(s)
- Bhaskar Bhardwaj
- Division of Cardiology, Knight Cardiovascular Institute, OHSU, Portland, OR, United States
| | - Joaquin E Cigarroa
- Division of Cardiology, Knight Cardiovascular Institute, OHSU, Portland, OR, United States
| | - Firas Zahr
- Division of Cardiology, Knight Cardiovascular Institute, OHSU, Portland, OR, United States.
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Dreyfus J, Dreyfus GD, Taramasso M. Tricuspid valve replacement: The old and the new. Prog Cardiovasc Dis 2022; 72:102-113. [PMID: 35738423 DOI: 10.1016/j.pcad.2022.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
Tricuspid regurgitation is a frequent and serious condition but tricuspid valve (TV) surgery, that may be a valve replacement when a repair is not feasible, is rarely performed. Recent development of transcatheter TV interventions offers new options for those high-surgical risk patients, especially TV replacement for patients who are not eligible for transcatheter TV repair. In this review, we describe indications and outcome after surgical TV replacement, and devices available or in development for transcatheter TV replacement.
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Affiliation(s)
- Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France.
| | - Gilles D Dreyfus
- Department of Cardiac Surgery, Montsouris Institute, Paris, France
| | - Maurizio Taramasso
- Cardiovascular Surgical Department, University Hospital of Zurich, Zurich, Switzerland
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Haji-Zeinali AM, Etesamifard N, Mohammadi Z, Haji-Zeinali MM, Sahebjam M, Abbasi K. Transcatheter tricuspid valve-in-valve implantation with bioprosthetic balloon expandable valve. Gen Thorac Cardiovasc Surg 2022; 70:947-953. [PMID: 35622220 DOI: 10.1007/s11748-022-01829-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/02/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study was conducted to evaluate the outcome of the transcatheter valve-in-valve implantation for degenerated tricuspid bioprosthetic valves with transcatheter aortic valves. METHODS This retrospective study enrolled all consecutive patients who were considered high risk for reoperations by the heart team and who underwent transcatheter valve-in-valve implantation for degenerated tricuspid bioprosthetic valves in Tehran Heart Center, Tehran, Iran. All the procedures were performed via the transfemoral venous route under echocardiography and fluoroscopy guidance with Edwards SAPIEN transcatheter heart valves (Edwards Lifesciences, Irvine, CA). RESULTS Ten patients underwent successful transcatheter valve-in-valve implantation in the tricuspid position without any major complications or need for emergency surgical interventions. The mean age was 54.1 ± 17.1 years, and 8 patients were female. The median follow-up was 19.5 months (16-32.25 mon). The mean period between the last tricuspid valve replacement and transcatheter valve-in-valve implantation was 4.9 ± 2.2 years. The bioprosthetic valves were Hancock in three patients, Mosaic in the other three patients, and Biocor, Pericarbon, Perimount, and Epic in the other patients. After the procedure, the clinical and functional status improved significantly in all the patients. The mean transvalvular gradient decreased from 6.75 ± 2.66 mm Hg to 2.85 ± 0.89 (P < 0.001), and the postoperative tricuspid regurgitation severity decreased significantly in almost all the patients. The hospitalization period after the procedure was 4.4 ± 1.7 days. CONCLUSIONS In high-risk patients, transcatheter valve-in-valve implantation seems to be a safe and minimally invasive alternative to reoperations for degenerated tricuspid bioprosthetic valves.
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Affiliation(s)
- Ali-Mohammad Haji-Zeinali
- Interventional Cardiology, Head of the Endovascular and Structural Heart Intervention Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nasrin Etesamifard
- Interventional Cardiology, Head of the Endovascular and Structural Heart Intervention Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohre Mohammadi
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Sahebjam
- Department of Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kiomars Abbasi
- Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Nakayama R, Takaya Y, Nakamura K, Takemoto R, Toh N, Ito H. Efficacy of shear wave elasticity for predicting clinical outcomes in patients with significant tricuspid regurgitation. Heart Vessels 2022; 37:1866-1872. [PMID: 35562505 DOI: 10.1007/s00380-022-02084-1] [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: 01/12/2022] [Accepted: 04/15/2022] [Indexed: 11/28/2022]
Abstract
This study aimed to evaluate the efficacy of shear wave (SW) elasticity for assessing clinical outcomes in patients with significant tricuspid regurgitation (TR). Significant TR develops right heart failure (HF) with organ congestion, resulting in adverse outcomes, but appropriate therapeutic strategies remain unclear. The assessment of the degree of hepatic congestion using SW elasticity may be effective for determining therapeutic strategies. We prospectively enrolled 77 patients with moderate or severe TR who underwent SW elastography. Patients were divided into three groups according to the value of SW elasticity: low group (SW elasticity < 6.4 kPa, n = 26), medium group (6.4 ≤ SW elasticity < 9.5 kPa, n = 26), and high group (SW elasticity ≥ 9.5 kPa, n = 25). The endpoint was cardiovascular death or hospitalization for HF. During the median follow-up period of 17 months (range 7-39 months), cardiovascular death or hospitalization for HF occurred in seven patients of high group, in three patients of medium group, and in no patients of low group. In high group, three patients died and seven patients were hospitalized for HF. In medium group, two patients died and one patient was hospitalized. Kaplan-Meier analysis showed that the event-free survival rate was worse in high group than in other groups (log-rank test, p = 0.02). High SW elasticity was independently related to cardiac events as well as right ventricular and left ventricular dysfunction. SW elasticity was a predictor of cardiac events in patients with significant TR by assessing hepatic congestion. SW elasticity can be valuable for determining therapeutic strategies for TR.
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Affiliation(s)
- Rie Nakayama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Rika Takemoto
- Division of Medical Support, Okayama University Hospital, Okayama, Japan
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Rafael Sádaba J, Tribouilloy C, Wojakowski W. Guía ESC/EACTS 2021 sobre el diagnóstico y tratamiento de las valvulopatías. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sala A, Lorusso R, Alfieri O. Isolated tricuspid valve surgery: beyond the idea of a high-mortality surgery. Eur J Cardiothorac Surg 2022; 62:6542522. [PMID: 35244688 DOI: 10.1093/ejcts/ezac151] [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: 02/10/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alessandra Sala
- Vita-Salute San Raffaele University, Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Milan, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - Ottavio Alfieri
- Vita-Salute San Raffaele University, Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Milan, Italy
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Dreyfus J, Obadia JF, Messika-Zeitoun D. Tricuspid regurgitation: Light at the end of the tunnel? Arch Cardiovasc Dis 2022; 115:117-121. [DOI: 10.1016/j.acvd.2021.12.008] [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: 11/06/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 11/24/2022]
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Dreyfus J, Audureau E, Bohbot Y, Coisne A, Lavie-Badie Y, Bouchery M, Flagiello M, Bazire B, Eggenspieler F, Viau F, Riant E, Mbaki Y, Eyharts D, Senage T, Modine T, Nicol M, Doguet F, Nguyen V, Le Tourneau T, Tribouilloy C, Donal E, Tomasi J, Habib G, Selton-Suty C, Raffoul R, Iung B, Obadia JF, Messika-Zeitoun D. TRI-SCORE: a new risk score for in-hospital mortality prediction after isolated tricuspid valve surgery. Eur Heart J 2022; 43:654-662. [PMID: 34586392 PMCID: PMC8843795 DOI: 10.1093/eurheartj/ehab679] [Citation(s) in RCA: 123] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/09/2021] [Accepted: 09/13/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Isolated tricuspid valve surgery (ITVS) is considered to be a high-risk procedure, but in-hospital mortality is markedly variable. This study sought to develop a dedicated risk score model to predict the outcome of patients after ITVS for severe tricuspid regurgitation (TR). METHODS AND RESULTS All consecutive adult patients who underwent ITVS for severe non-congenital TR at 12 French centres between 2007 and 2017 were included. We identified 466 patients (60 ± 16 years, 49% female, functional TR in 49%). In-hospital mortality rate was 10%. We derived and internally validated a scoring system to predict in-hospital mortality using multivariable logistic regression and bootstrapping with 1000 re-samples. The final risk score ranged from 0 to 12 points and included eight parameters: age ≥70 years, New York Heart Association Class III-IV, right-sided heart failure signs, daily dose of furosemide ≥125 mg, glomerular filtration rate <30 mL/min, elevated bilirubin, left ventricular ejection fraction <60%, and moderate/severe right ventricular dysfunction. Tricuspid regurgitation mechanism was not an independent predictor of outcome. Observed and predicted in-hospital mortality rates increased from 0% to 60% and from 1% to 65%, respectively, as the score increased from 0 up to ≥9 points. Apparent and bias-corrected areas under the receiver operating characteristic curves were 0.81 and 0.75, respectively, much higher than the logistic EuroSCORE (0.67) or EuroSCORE II (0.63). CONCLUSION We propose TRI-SCORE as a dedicated risk score model based on eight easy to ascertain parameters to inform patients and physicians regarding the risk of ITVS and guide the clinical decision-making process of patients with severe TR, especially as transcatheter therapies are emerging (www.tri-score.com).
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Affiliation(s)
- Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, 32-36 rue des moulins gémeaux, Saint-Denis 93200, France
| | - Etienne Audureau
- Public Health Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
- Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, Creteil 94010, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, 1 Rue du Professeur Christian Cabrol, Amiens 80054, France
- UR UPJV 7517, Jules Verne University of Picardie, 51 Boulevard de Châteaudun, Amiens 80000, France
| | - Augustin Coisne
- CHU Lille, Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, 2 Avenue Oscar Lambret, Lille 59000, France
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, Lille 59000, France
| | - Yoan Lavie-Badie
- Department of Cardiology, Rangueil University Hospital, 9 Place Lange, Toulouse 31000, France
| | - Maxime Bouchery
- AP-HP (Assistance Publique-Hôpitaux de Paris), Clinical Research Unit (URC Mondor), Henri Mondor University Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
| | - Michele Flagiello
- Department of Cardiovascular Surgery and Transplantation, Louis Pradel Cardiovascular Hospital, Claude Bernard University, 59 Boulevard Pinel, Bron 69500, France
| | - Baptiste Bazire
- Department of Cardiology, Bichat Claude Bernard Hospital, 46 Rue Henri Huchard, Paris 75018, France
| | - Florian Eggenspieler
- Department of Cardiology, University Hospital of Nancy-Brabois, 29 Avenue du Maréchal de Lattre de Tassigny, Nancy 54000, France
| | - Florence Viau
- Cardiology Department, APHM, La Timone Hospital, 278 Rue Saint-Pierre, Marseille 13005, France
| | - Elisabeth Riant
- Cardiology Department, Centre Cardiologique du Nord, 32-36 rue des moulins gémeaux, Saint-Denis 93200, France
- Cardiology Department, Expert Valve Center, Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
| | - Yannick Mbaki
- Cardiology Department, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes-1, 2 Rue Henri le Guilloux, Rennes 35000, France
| | - Damien Eyharts
- Department of Cardiology, Rangueil University Hospital, 9 Place Lange, Toulouse 31000, France
| | - Thomas Senage
- Department of Cardiac Surgery, INSERM 1246, Université de Nantes, CHU de Nantes, 8 Quai Moncousu, Nantes 44007, France
| | - Thomas Modine
- CHU Lille, Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, 2 Avenue Oscar Lambret, Lille 59000, France
| | - Martin Nicol
- Cardiology Department, Centre Cardiologique du Nord, 32-36 rue des moulins gémeaux, Saint-Denis 93200, France
| | - Fabien Doguet
- Service de chirurgie cardiovasculaire et thoracique, CHU Charles Nicolle, 37 Boulevard Gambetta, Rouen 76000, France
- Normandie Univ, Unirouen, INSERM U1096, Rouen 76000, France
| | - Virginia Nguyen
- Cardiology Department, Centre Cardiologique du Nord, 32-36 rue des moulins gémeaux, Saint-Denis 93200, France
| | - Thierry Le Tourneau
- Université de Nantes, CHU de Nantes, CNRS, INSERM, L’institut du thorax, Nantes 44000, France
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, 1 Rue du Professeur Christian Cabrol, Amiens 80054, France
- UR UPJV 7517, Jules Verne University of Picardie, 51 Boulevard de Châteaudun, Amiens 80000, France
| | - Erwan Donal
- Cardiology Department, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes-1, 2 Rue Henri le Guilloux, Rennes 35000, France
| | - Jacques Tomasi
- Department of Cardiac Surgery, CHU de RENNES, Université de Rennes-1, 2 Rue Henri le Guilloux, Rennes 35000, France
| | - Gilbert Habib
- Cardiology Department, APHM, La Timone Hospital, 278 Rue Saint-Pierre, Marseille 13005, France
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille 13005, France
| | - Christine Selton-Suty
- Department of Cardiology, University Hospital of Nancy-Brabois, 29 Avenue du Maréchal de Lattre de Tassigny, Nancy 54000, France
| | - Richard Raffoul
- Department of Cardiac Surgery, AP-HP, Bichat Hospital, 46 Rue Henri Huchard, Paris 75018, France
| | - Bernard Iung
- Cardiology Department, AP-HP, Bichat Hospital, Université de Paris, 46 Rue Henri Huchard, Paris 75018, France
| | - Jean-François Obadia
- Department of Cardiovascular Surgery and Transplantation, Louis Pradel Cardiovascular Hospital, Claude Bernard University, 59 Boulevard Pinel, Bron 69500, France
| | - David Messika-Zeitoun
- Department of Cardiology, University of Ottawa Heart Institute, 40 ruskin street, Ottawa, Ontario, Canada
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. EUROINTERVENTION 2022; 17:e1126-e1196. [PMID: 34931612 PMCID: PMC9725093 DOI: 10.4244/eij-e-21-00009] [Citation(s) in RCA: 146] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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44
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Tricuspid Transcatheter Edge-to-Edge Valve Repair: Sooner Rather Than Later. JACC Cardiovasc Interv 2022; 15:190-192. [PMID: 35057990 DOI: 10.1016/j.jcin.2021.11.014] [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: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 11/23/2022]
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6546234. [DOI: 10.1093/ejcts/ezac172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/10/2022] [Accepted: 02/19/2022] [Indexed: 11/14/2022] Open
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46
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2021; 60:727-800. [PMID: 34453161 DOI: 10.1093/ejcts/ezab389] [Citation(s) in RCA: 314] [Impact Index Per Article: 104.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Transcatheter Tricuspid Valve-in-Valve Procedure-An Illustrative Case Report and Review. J Clin Med 2021; 10:jcm10174004. [PMID: 34501452 PMCID: PMC8432540 DOI: 10.3390/jcm10174004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/21/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022] Open
Abstract
Severe tricuspid commitment is no longer understood as merely a marker of disease but is now widely thought of as a significant contributor to cardiac morbidity and mortality. However, isolated tricuspid valve surgery remains rare and to this day continues to be associated with the highest surgical risk among all valve procedures and high operative mortality rates, especially in reoperations. Therefore, the development of tricuspid transcatheter procedures is as necessary as it was for the other valves a couple of years ago. Recently, multiple percutaneous therapies have been developed for the management of severe tricuspid disease, initially only repair and more recently replacement, thus creating a new branch for the management of patients who have already undergone surgery and who present with dysfunctional bioprostheses. The purpose of this review and report is to demonstrate current and possible future challenges, and to show that the valve-in-valve procedure of the tricuspid valve is feasible and safe, and now can be performed in all its range, in the smallest to the largest sizes of presentation, without incurring the untoward risks of conventional surgery.
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Cirugía valvular tricúspide aislada. Resultados perioperatorios y supervivencia a medio plazo. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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49
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2021; 43:561-632. [PMID: 34453165 DOI: 10.1093/eurheartj/ehab395] [Citation(s) in RCA: 2236] [Impact Index Per Article: 745.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Chorin E, Rozenbaum Z, Topilsky Y, Konigstein M, Ziv-Baran T, Richert E, Keren G, Banai S. Tricuspid regurgitation and long-term clinical outcomes. Eur Heart J Cardiovasc Imaging 2021; 21:157-165. [PMID: 31544933 DOI: 10.1093/ehjci/jez216] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/30/2019] [Accepted: 08/21/2019] [Indexed: 11/15/2022] Open
Abstract
AIMS Tricuspid regurgitation (TR) is a frequent echocardiographic finding; however, its effect on outcome is unclear. The objectives of current study were to evaluate the impact of TR severity on heart failure hospitalization and mortality. METHODS AND RESULTS We retrospectively reviewed consecutive echocardiograms performed between 2011 and 2016 at the Tel-Aviv Medical Center. TR severity was determined using semi-quantitative approach including colour jet area, vena contracta width, density of continuous Doppler jet, hepatic vein flow pattern, trans-tricuspid inflow pattern, annular diameter, right ventricle, and right atrial size. Major comorbidities, re-admissions and all-cause mortality were extracted from the electronic health records. The final analysis included 33 305 patients with median follow-up period of 3.34 years (interquartile range 2.11-4.54). TR (≥mild) was present in 31% of our cohort. One-year mortality rates were 7.7% for patients with no/trivial TR, 16.8% for patients with mild TR, 29.5% for moderate TR, and 45.6% for patients with severe TR (P < 0.001). Univariate and multivariate analyses demonstrated a positive correlation between TR severity and overall mortality and rates of heart failure re-admission after adjustment for potential confounders. The proportional hazards method for overall mortality showed that patients with moderate [hazard ratio (HR) 1.15, 95% confidence interval (CI) 1.02-1.3, P = 0.024] and severe TR (HR 1.43, 95% CI 1.08-1.88, P = 0.011) had a worse prognosis than those with no or minimal TR. CONCLUSIONS The presence of any degree of TR is associated with adverse clinical outcome. At least moderate TR is independently associated with increased mortality.
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Affiliation(s)
- Ehud Chorin
- Department of Cardiology, Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Zach Rozenbaum
- Department of Cardiology, Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Maayan Konigstein
- Department of Cardiology, Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Richert
- Department of Cardiology, Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Gad Keren
- Department of Cardiology, Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
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