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Madhavan MV, Agarwal V, Hahn RT. Transcatheter Therapy for the Tricuspid Valve: A Focused Review of Edge-to-Edge Repair and Orthotopic Valve Replacement. Curr Cardiol Rep 2024; 26:459-474. [PMID: 38884853 PMCID: PMC11199311 DOI: 10.1007/s11886-024-02051-4] [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] [Accepted: 03/20/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE OF REVIEW Patients with severe tricuspid regurgitation (TR) are at risk for significant morbidity and mortality. Transcatheter tricuspid valve interventions (TTVI) may offer patients less invasive treatment alternatives to surgery. This review evaluates the most common class of device currently used worldwide to treat TR, tricuspid transcatheter edge-to-edge repair (T-TEER) and orthotopic transcatheter tricuspid valve replacement (TTVR), both of which are now approved in the USA and Europe. RECENT FINDINGS The first pivotal randomized clinical trial, TRILUMINATE, demonstrated that T-TEER can safely reduce TR and is associated with improved health status outcomes. However, results of this trial have raised questions about whether this device can provide sufficient TR reduction to impact clinical outcomes. Orthotopic TTVR has recently gained attention with initial data suggesting near-complete TR elimination. The current review examines the technical features and anatomic limitations of the most commonly used devices for T-TEER and orthotopic TTVR, discusses the current clinical data for these devices, and offers a theoretical construct for device selection.
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Affiliation(s)
- Mahesh V Madhavan
- NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Vratika Agarwal
- NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA
| | - Rebecca T Hahn
- NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA.
- Cardiovascular Research Foundation, New York, NY, USA.
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2
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Jain A, Gebhardt B, Subramani S, Mehrotra M, Gaber M, Ramakrishna H. Tricuspid Regurgitation: Analysis of Outcomes and Risk Assessment. J Cardiothorac Vasc Anesth 2024; 38:1397-1408. [PMID: 38523023 DOI: 10.1053/j.jvca.2024.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Ankit Jain
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | - Brian Gebhardt
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Medical Center, Worcester, MA
| | - Sudhakar Subramani
- Department of Anesthesiology and Perioperative Medicine, University of Iowa, Iowa City, IA
| | - Mayank Mehrotra
- Department of Anesthesiology and Perioperative Medicine (Mehrotra) Mercy Health, Rockford, IL
| | - Mohamed Gaber
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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3
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Sohn SH, Kang Y, Kim JS, Hwang HY, Kim KH, Choi JW. Early and long-term outcomes of bioprosthetic versus mechanical tricuspid valve replacement: A nationwide population-based study. J Thorac Cardiovasc Surg 2024; 167:2117-2128.e11. [PMID: 36894350 DOI: 10.1016/j.jtcvs.2023.01.025] [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: 09/10/2022] [Revised: 01/09/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We compared early and long-term clinical outcomes of bioprosthetic versus mechanical tricuspid valve replacement in a nationwide study based on the database from the National Health Insurance Service. METHODS Of 1425 patients who underwent tricuspid valve replacement from 2003 to 2018, 1241 patients were enrolled after excluding retricuspid valve replacement, complex congenital heart disease, Ebstein anomaly, and age less than 18 years at operation. Bioprostheses (group B) and mechanical prostheses (group M) were used in 562 patients (45.3%) and 679 patients (54.7%), respectively. The median follow-up duration was 5.6 years. Propensity score matching was performed. Subgroup analysis was performed in patients aged 50 to 65 years. RESULTS There was no difference in operative mortality or postoperative complications between the groups. All-cause mortality was higher in group B (7.8 vs 4.6 per 100 patient-years, hazard ratio, 1.75, 95% confidence interval, 1.33-2.30, P < .001). The cumulative incidence of stroke was higher in group M (hazard ratio, 0.65, 95% confidence interval, 0.43-0.99, P = .043), whereas the cumulative incidence of reoperation was higher in group B (hazard ratio, 4.20, 95% confidence interval, 1.53-11.54, P = .005). In terms of the age-dependent hazard of all-cause mortality, group B demonstrated a higher hazard than group M below the age of 75 years, and it was statistically significant between 54 and 65 years of age. In the subgroup analysis, all-cause mortality was also higher in group B. CONCLUSIONS Mechanical tricuspid valve replacement demonstrated higher long-term survival than bioprosthetic tricuspid valve replacement. In particular, mechanical tricuspid valve replacement showed significantly higher overall survival between 54 and 65 years of age.
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Affiliation(s)
- Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Seong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Davidson LJ, Tang GHL, Ho EC, Fudim M, Frisoli T, Camaj A, Bowers MT, Masri SC, Atluri P, Chikwe J, Mason PJ, Kovacic JC, Dangas GD. The Tricuspid Valve: A Review of Pathology, Imaging, and Current Treatment Options: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1223-e1238. [PMID: 38660790 DOI: 10.1161/cir.0000000000001232] [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] [Indexed: 04/26/2024]
Abstract
Tricuspid valve disease is an often underrecognized clinical problem that is associated with significant morbidity and mortality. Unfortunately, patients will often present late in their disease course with severe right-sided heart failure, pulmonary hypertension, and life-limiting symptoms that have few durable treatment options. Traditionally, the only treatment for tricuspid valve disease has been medical therapy or surgery; however, there have been increasing interest and success with the use of transcatheter tricuspid valve therapies over the past several years to treat patients with previously limited therapeutic options. The tricuspid valve is complex anatomically, lying adjacent to important anatomic structures such as the right coronary artery and the atrioventricular node, and is the passageway for permanent pacemaker leads into the right ventricle. In addition, the mechanism of tricuspid pathology varies widely between patients, which can be due to primary, secondary, or a combination of causes, meaning that it is not possible for 1 type of device to be suitable for treatment of all cases of tricuspid valve disease. To best visualize the pathology, several modalities of advanced cardiac imaging are often required, including transthoracic echocardiography, transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, to best visualize the pathology. This detailed imaging provides important information for choosing the ideal transcatheter treatment options for patients with tricuspid valve disease, taking into account the need for the lifetime management of the patient. This review highlights the important background, anatomic considerations, therapeutic options, and future directions with regard to treatment of tricuspid valve disease.
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5
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Rudziński PN, Henzel J, Witkowski A, Dąbrowski M, Huczek Z, Wojakowski W, Targoński R, Jagielak D, Kralisz P, Demkow M. Transcatheter Intervention for Inoperable Tricuspid Surgical Prosthesis Dysfunction: Minimally Invasive Approach to Mitigate Heart Failure. Am J Cardiol 2024; 217:25-28. [PMID: 38432337 DOI: 10.1016/j.amjcard.2024.02.037] [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: 11/17/2023] [Revised: 01/21/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
What is the efficacy and safety of transcatheter tricuspid valve-in-valve implantation for patients with inoperable tricuspid surgical prosthesis dysfunction? Thirty-day mortality after greatly effective transcatheter treatment is 2 times less than the estimated surgical risk.
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Affiliation(s)
| | - Jan Henzel
- National Institute of Cardiology, Warsaw, Poland
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Maisano F, Hahn R, Sorajja P, Praz F, Lurz P. Transcatheter treatment of the tricuspid valve: current status and perspectives. Eur Heart J 2024; 45:876-894. [PMID: 38426859 DOI: 10.1093/eurheartj/ehae082] [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: 08/02/2023] [Revised: 01/13/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Transcatheter tricuspid valve interventions (TTVI) are emerging as alternatives to surgery in high-risk patients with isolated or concomitant tricuspid regurgitation. The development of new minimally invasive solutions potentially more adapted to this largely undertreated population of patients, has fuelled the interest for the tricuspid valve. Growing evidence and new concepts have contributed to revise obsolete and misleading perceptions around the right side of the heart. New definitions, classifications, and a better understanding of the disease pathophysiology and phenotypes, as well as their associated patient journeys have profoundly and durably changed the landscape of tricuspid disease. A number of registries and a recent randomized controlled pivotal trial provide preliminary guidance for decision-making. TTVI seem to be very safe and effective in selected patients, although clinical benefits beyond improved quality of life remain to be demonstrated. Even if more efforts are needed, increased disease awareness is gaining momentum in the community and supports the establishment of dedicated expert valve centres. This review is summarizing the achievements in the field and provides perspectives for a less invasive management of a no-more-forgotten disease.
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Affiliation(s)
- Francesco Maisano
- Division of Cardiac Surgery and Valve Center, IRCCS Ospedale San Raffaele, Università Vita Salute, Via Olgettina 60, 20132 Milano, Italy
| | - Rebecca Hahn
- Department of Medicine, Columbia University Irving Medical Center, New York, 161 Fort Washington Avenue, 10032 New York, NY, USA
| | - Paul Sorajja
- Minneapolis Heart Institute at Abbott Northwestern Hospital, 920 East 28th Street, Suite 100, 55407 Minneapolis, MN, USA
| | - Fabien Praz
- Bern University Hospital, University of Bern, Anna-Seiler-Haus Freiburgstrasse 20, 3010 Bern, Switzerland
| | - Philipp Lurz
- Department of Cardiology, Universitätsmedizin Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
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Wang Y, Liu Y, Yang J. Transjugular tricuspid valve-in-ring replacement using the novel system under three-dimensional printing guidance. ESC Heart Fail 2024; 11:581-586. [PMID: 37985215 PMCID: PMC10804192 DOI: 10.1002/ehf2.14589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/31/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023] Open
Abstract
Recurrent tricuspid regurgitation after failed ring annuloplasty is associated with high mortality rates and unfavourable clinical outcomes. Transcatheter tricuspid valve-in-ring (TVIR) replacement offers an alternative to high-risk surgical reoperation, but challenges remain. We present a case of a 67-year-old male who underwent tricuspid annuloplasty 3 years ago and developed severe recurrent tricuspid regurgitation (regurgitation volume = 36 mL) 6 months ago. To avoid a high-risk thoracotomy, we finally performed TVIR replacement using the novel device, LuX-Valve Plus system, via the transjugular approach. Cardiovascular three-dimensional printing technology was utilized to investigate the distinct advantages offered by the new device in this specific intervention, as well as to simulate the procedure. Successful TVIR replacement resulted in significant symptomatic improvement. TVIR replacement with the LuX-Valve Plus system is feasible for failed annuloplasty ring cases. Patient-specific three-dimensional printed models enable personalized procedural planning, enhancing safety and precision.
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Affiliation(s)
- Yiwei Wang
- Department of Cardiovascular SurgeryXijing Hospital, Air Force Medical University127 Changle West RoadXi'an710032ShaanxiChina
| | - Yang Liu
- Department of Cardiovascular SurgeryXijing Hospital, Air Force Medical University127 Changle West RoadXi'an710032ShaanxiChina
| | - Jian Yang
- Department of Cardiovascular SurgeryXijing Hospital, Air Force Medical University127 Changle West RoadXi'an710032ShaanxiChina
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Khokhar AA, Curio J, Sticchi A, Hartley A, Demir OM, Ruparelia N. Transcatheter Aortic Valve Implantation to Treat Degenerated Aortic, Mitral and Tricuspid Bioprosthesis. J Clin Med 2024; 13:592. [PMID: 38276098 PMCID: PMC10816283 DOI: 10.3390/jcm13020592] [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: 12/22/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is now well established as the treatment of choice for patients with native aortic valve stenosis who are high or intermediate risk for surgical aortic valve replacement. Recent data has also supported the use of TAVI in patients at low surgical risk and also in anatomical subsets that were previously felt to be contra-indicated including bicuspid aortic valves and aortic regurgitation. With advancements and refinements in procedural techniques, the application of this technology has now been further expanded to include the management of degenerated bioprosthesis. After the demonstration of feasibility and safety in the management of degenerated aortic bioprosthetic valves, mitral and tricuspid bioprosthetic valve treatment is now also well-established and provides an attractive alternative to performing redo surgery. In this review, we appraise the latest clinical evidence and highlight procedural considerations when utilising TAVI technology in the management of degenerated aortic, mitral or tricuspid prosthesis.
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Affiliation(s)
- Arif A. Khokhar
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (A.A.K.); (A.H.)
| | - Jonathan Curio
- Department of Cardiology, Heart Center Cologne, Faculty of Medicine, University Hospital, University of Cologne, 50937 Cologne, Germany;
| | - Alessandro Sticchi
- Cardiac Catheterisation Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy;
- Università di Pisa, Lungarno Pacinotti 43, 56126 Pisa, Italy
| | - Adam Hartley
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (A.A.K.); (A.H.)
| | - Ozan M. Demir
- Department of Cardiology, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon SS16 5NL, UK
| | - Neil Ruparelia
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (A.A.K.); (A.H.)
- Cardiology, Royal Berkshire Hospital, Reading RG1 5AN, UK
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9
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Salama AA, Abozied OA, Anderson JH, Miranda WR, Connolly HM, Jain C, Cabalka A, Egbe AC. Cardiac Reverse Remodeling and Changes in Heart Failure Indices After Transcatheter Tricuspid Valve Replacement in Adults With Congenital Heart Disease. Circ Cardiovasc Interv 2024; 17:e013334. [PMID: 37942627 PMCID: PMC10841471 DOI: 10.1161/circinterventions.123.013334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/11/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND There are limited data about changes in cardiac function (cardiac reverse remodeling) and heart failure indices after transcatheter tricuspid valve-in-valve replacement (TT-VIVR). The purpose of this study was to evaluate cardiac reverse remodeling and temporal changes in heart failure indices after TT-VIVR in adults with congenital heart disease. METHODS Retrospective cohort study of adults with congenital heart disease that underwent TT-VIVR and had >6 months of follow-up (January 1, 2011, to April 30, 2023). Echocardiographic indices of cardiac remodeling and heart failure indices (New York Heart Association class, NT-proBNP (N-terminal pro-brain natriuretic peptide), glomerular filtration rate, and model for end-stage liver disease excluding international normalized ratio score) were assessed preintervention and at 1-, 3-, and 5-year postintervention. RESULTS Of 39 patients (age 39 [32-46] years), 14 (36%) and 25 (64%) received Melody valve and Sapien valve prosthesis, respectively. At 1-year post-TT-VIVR, there was a temporal improvement in right atrial reservoir strain (17±8% versus 22±8%, P<0.001), right atrial volume (81 [59-108] versus 63 [48-82] mL/m2, P<0.001), right atrial pressure (12±4% versus 6±4%, P<0.001), and right ventricular global longitudinal strain (-15±7% versus -20±7%, P<0.001). Similarly, there was a temporal improvement in NT-proBNP, glomerular filtration rate, model for end-stage liver disease excluding international normalized ratio score, and New York Heart Association class. The temporal improvements in heart failure indices and valve function were maintained at 3- and 5-year post-TT-VIVR. CONCLUSIONS Considering the significant mortality risk associated with reoperations for tricuspid valve replacement, these data suggest favorable outcomes after TT-VIVR, and support TT-VIVR as a viable alternative to surgical tricuspid valve replacement, especially in high-risk patients.
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Affiliation(s)
- Abdalla A Salama
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN (A.A.S., O.A.A., J.H.A., W.R.M., H.M.C., C.J., A.C., A.C.E.)
- Department of Cardiovascular Diseases, Suez Canal University, Ismailia, Egypt (A.A.S.)
| | - Omar A Abozied
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN (A.A.S., O.A.A., J.H.A., W.R.M., H.M.C., C.J., A.C., A.C.E.)
| | - Jason H Anderson
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN (A.A.S., O.A.A., J.H.A., W.R.M., H.M.C., C.J., A.C., A.C.E.)
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN (A.A.S., O.A.A., J.H.A., W.R.M., H.M.C., C.J., A.C., A.C.E.)
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN (A.A.S., O.A.A., J.H.A., W.R.M., H.M.C., C.J., A.C., A.C.E.)
| | - Charles Jain
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN (A.A.S., O.A.A., J.H.A., W.R.M., H.M.C., C.J., A.C., A.C.E.)
| | - Allison Cabalka
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN (A.A.S., O.A.A., J.H.A., W.R.M., H.M.C., C.J., A.C., A.C.E.)
| | - Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN (A.A.S., O.A.A., J.H.A., W.R.M., H.M.C., C.J., A.C., A.C.E.)
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10
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Zoghbi WA, Jone PN, Chamsi-Pasha MA, Chen T, Collins KA, Desai MY, Grayburn P, Groves DW, Hahn RT, Little SH, Kruse E, Sanborn D, Shah SB, Sugeng L, Swaminathan M, Thaden J, Thavendiranathan P, Tsang W, Weir-McCall JR, Gill E. Guidelines for the Evaluation of Prosthetic Valve Function With Cardiovascular Imaging: A Report From the American Society of Echocardiography Developed in Collaboration With the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2024; 37:2-63. [PMID: 38182282 DOI: 10.1016/j.echo.2023.10.004] [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] [Indexed: 01/07/2024]
Abstract
In patients with significant cardiac valvular disease, intervention with either valve repair or valve replacement may be inevitable. Although valve repair is frequently performed, especially for mitral and tricuspid regurgitation, valve replacement remains common, particularly in adults. Diagnostic methods are often needed to assess the function of the prosthesis. Echocardiography is the first-line method for noninvasive evaluation of prosthetic valve function. The transthoracic approach is complemented with two-dimensional and three-dimensional transesophageal echocardiography for further refinement of valve morphology and function when needed. More recently, advances in computed tomography and cardiac magnetic resonance have enhanced their roles in evaluating valvular heart disease. This document offers a review of the echocardiographic techniques used and provides recommendations and general guidelines for evaluation of prosthetic valve function on the basis of the scientific literature and consensus of a panel of experts. This guideline discusses the role of advanced imaging with transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance in evaluating prosthetic valve structure, function, and regurgitation. It replaces the 2009 American Society of Echocardiography guideline on prosthetic valves and complements the 2019 guideline on the evaluation of valvular regurgitation after percutaneous valve repair or replacement.
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Affiliation(s)
- William A Zoghbi
- Houston Methodist Hospital, DeBakey Heart & Vascular Center, Houston, Texas.
| | - Pei-Ni Jone
- Lurie Children's Hospital, Northwestern University, Chicago, Illinois
| | | | - Tiffany Chen
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul Grayburn
- Baylor Scott & White Health, University of Texas Southwestern, Dallas, Texas
| | - Daniel W Groves
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York
| | - Stephen H Little
- Houston Methodist Hospital, DeBakey Heart & Vascular Center, Houston, Texas
| | - Eric Kruse
- University of Chicago Medical Center, Chicago, Illinois
| | | | - Sangeeta B Shah
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Lissa Sugeng
- North Shore University Hospital, Manhasset, New York
| | - Madhav Swaminathan
- Cardiothoracic Anesthesiology and Critical Care Medicine, Duke University, Durham, North Carolina
| | | | | | - Wendy Tsang
- University of Toronto, Toronto, Ontario, Canada
| | | | - Edward Gill
- University of Colorado School of Medicine, Aurora, Colorado
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11
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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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12
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Meier D, Akodad M, Tzimas G, Muller O, Cheung A, Wood DA, Blanke P, Sathananthan J, Praz F, Boone RH, Webb JG. Update on Transcatheter Treatment of Mitral and Tricuspid Valve Regurgitation. Curr Cardiol Rep 2023; 25:1361-1371. [PMID: 37698820 DOI: 10.1007/s11886-023-01954-y] [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] [Accepted: 08/28/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE OF REVIEW Mitral and tricuspid regurgitation represents a clinical challenge. They are associated with a poor prognosis, and many patients are not eligible for conventional surgery. Transcatheter therapies have been the focus of numerous studies and devices over the past decade. Here, we provide a summary of current options for transcatheter treatment of these 2 entities. RECENT FINDINGS Recent studies have demonstrated the benefits of edge-to-edge repair for increasing numbers of patients. Encouraging early results with transcatheter valve replacement are also becoming available. To date, transcatheter edge-to-edge repair is currently the first-line transcatheter treatment for both mitral and tricuspid regurgitation for many patients who are not candidates for surgery. A number of transcatheter replacement devices are under development and clinical investigation but, for the most part, their current use is limited to compassionate cases or clinical trials.
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Affiliation(s)
- David Meier
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mariama Akodad
- Ramsay Santé, Institut Cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Massy, France
| | - Georgios Tzimas
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anson Cheung
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Philipp Blanke
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, Canada
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Robert H Boone
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada.
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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13
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Haramati A, Latib A, Lazarus MS. Post-procedural structural heart CT imaging: TAVR, TMVR, and other interventions. Clin Imaging 2023; 101:86-95. [PMID: 37311399 DOI: 10.1016/j.clinimag.2023.05.012] [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: 03/20/2023] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 06/15/2023]
Abstract
Transcatheter valve replacement has experienced substantial growth in the past decade and this technique can now be used for any of the four heart valves. Transcatheter aortic valve replacement (TAVR) has overtaken surgical aortic valve replacement. Transcatheter mitral valve replacement (TMVR) is often performed in pre-existing valves or after prior valve repair, although numerous devices are undergoing trials for replacement of native valves. Transcatheter tricuspid valve replacement (TTVR) is similarly under active development. Lastly, transcatheter pulmonic valve replacement (TPVR) is most often used for revision treatment of congenital heart disease. Given the growth of these techniques, radiologists are increasingly called upon to interpret post-procedural imaging for these patients, particularly with CT. These cases will often arise unexpectedly and require detailed knowledge of potential post-procedural appearances. We review both normal and abnormal post-procedural findings on CT. Certain complications-device migration or embolization, paravalvular leak, or leaflet thrombosis-can occur after replacement of any valve. Other complications are specific to each type of valve, including coronary artery occlusion after TAVR, coronary artery compression after TPVR, or left ventricular outflow tract obstruction after TMVR. Finally, we review access-related complications, which are of particular concern due to the requirement of large-bore catheters for these procedures.
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Affiliation(s)
- Adina Haramati
- Department of Radiology, New York-Presbyterian/Weill Cornell Medicine, 525 East 68(th) Street, New York, NY 10065, United States of America
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210(th) Street, Bronx, NY 10467, United States of America
| | - Matthew S Lazarus
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210(th) Street, Bronx, NY 10467, United States of America.
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14
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Herron C, Lehenbauer D, Shahanavaz S. Transcatheter Melody Valve Placement in a Native Right Atrioventricular Valve in a Pediatric Patient. Pediatr Cardiol 2023; 44:1183-1186. [PMID: 36867232 DOI: 10.1007/s00246-023-03132-x] [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: 02/04/2023] [Accepted: 02/17/2023] [Indexed: 03/04/2023]
Abstract
Transcatheter tricuspid valve placement in congenital heart disease is becoming increasingly used when a previously placed surgical ringed valve becomes dysfunctional. Surgically repaired and/or native tricuspid inflows are generally not amenable to transcatheter valve placement without a prior ring being placed. We present the second pediatric case to our knowledge of transcatheter tricuspid valve placement in a surgically repaired tricuspid valve in the absence of a ring.
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Affiliation(s)
- Christopher Herron
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.,Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - David Lehenbauer
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.,Division of Cardiothoracic Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Shabana Shahanavaz
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA. .,Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA. .,Division of Pediatric Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
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15
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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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16
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Chen J, Yang Y, Song W, Feng D, Yan Y, Wang C, Wei L. Transcatheter tricuspid valve-in-valve implantation for degenerated surgical bioprosthesis. Catheter Cardiovasc Interv 2023; 101:442-448. [PMID: 36617381 DOI: 10.1002/ccd.30554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/23/2022] [Accepted: 12/25/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Isolated redo surgery for degenerated tricuspid bioprosthesis is of very high risk. We aimed to evaluate the safety and efficacy of transcatheter valve-in-valve (TVIV) implantation using a novel balloon expandable Renato valve. METHODS A prospective multicenter study was conducted to enroll patients with degenerated tricuspid bioprostheses. A total of 12 patients underwent TVIV implantation using the Renato valve system via transfemoral, transjugular, or transatrial approaches at three institutions from May 2021 to October 2021. All-cause mortality and hemodynamic performance were evaluated up to 6 months after procedure. RESULTS The median age was 68.2 years, and 75.0% were female. Six patients had a history of rheumatic left-sided valve surgery and late tricuspid valve replacement. The median preoperative Society of Thoracic Surgeons score was 9.9%. The procedures were successful in all cases. Tricuspid regurgitation and paravalvular leak were none or mild in all patients. The median transvalvular gradient decreased from 7.8 mmHg preoperatively to 4.5 mmHg at 6 months after TVIV, respectively. No death occurred and all patients recovered to New York Heart Association functional class I or II during a 6-month follow-up. CONCLUSIONS TVIV implantation with the Renato valve was a safe and effective treatment for degenerated bioprostheses in high-risk patients.
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Affiliation(s)
- Jinmiao Chen
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ye Yang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenyu Song
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Deguang Feng
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yang Yan
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China
| | - Chunsheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lai Wei
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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17
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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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18
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Babur Guler G, Memic Sancar K, Corekcioglu B, Topel C, Erturk M. Early Valve Thrombosis Management After Successful Transcatheter Tricuspid Valve-in-Valve Implantation. JACC Case Rep 2022; 5:101584. [PMID: 36636503 PMCID: PMC9830461 DOI: 10.1016/j.jaccas.2022.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/06/2022]
Abstract
Transcatheter tricuspid valve-in-valve implantation is a critical option in high risk bioprosthetic tricuspid valve dysfunction. In this case report, balloon-expandable transcatheter heart valve was implanted successfully into the tricuspid valve and early thrombosis was managed successfully. (Level of Difficulty: Intermediate.).
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Key Words
- ACC/AHA, American College of Cardiology/American Heart Association
- ASA, acetylsalicylic acid
- ESC, European Society of Cardiology
- IVC, inferior vena cava
- PHT, pressure half time
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
- TTVIV, transcatheter tricuspid valve-in-valve
- TV, tricuspid valve
- VIV, valve-in-valve
- VKA, vitamin K antagonist
- percutaneous valve
- thrombus
- transcatheter valve implantation
- tricuspid valve
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Affiliation(s)
- Gamze Babur Guler
- Department of Cardiology, University of Health Sciences Istanbul, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Kadriye Memic Sancar
- Department of Cardiology, University of Health Sciences Istanbul, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey,Address for correspondence: Dr Kadriye Memic Sancar, University of Health Sciences Istanbul, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istasyon, Turgut Ozal Bulvari No: 11, 34303 Kuçukcekmece/Istanbul, Turkey.
| | - Busra Corekcioglu
- Department of Cardiology, University of Health Sciences Istanbul, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cagdas Topel
- Department of Cardiovascular Radiology, University of Health Sciences Istanbul, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Erturk
- Department of Cardiology, University of Health Sciences Istanbul, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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19
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Prosthesis choice for tricuspid valve replacement in the era of transcatheter valve-in-valve technique. J Thorac Cardiovasc Surg 2022. [DOI: 10.1016/j.jtcvs.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Transcatheter Tricuspid Valve-in-Valve Replacement Using a J-Valve System for a Failed Tricuspid Bioprosthesis. Case Rep Cardiol 2022; 2022:7353522. [PMID: 35813080 PMCID: PMC9259371 DOI: 10.1155/2022/7353522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Redo operation for failed tricuspid bioprosthetic valves is associated with high morbidity and mortality. Transcatheter tricuspid valve-in-valve implantation has become an acceptable option for high-risk patients with a failed tricuspid bioprosthesis. We present a case of successful tricuspid valve-in-valve implantation using a J-valve in a failed tricuspid bioprosthesis position. Case Summary. A 48-year-old male, who had a failed tricuspid bioprosthesis, presented with right-side heart failure, right-to-left shunting at the atrial level, severe dyspnea, cyanosis, peripheral edema, hepatauxe, and ascites. After the interdisciplinary assessment, we successfully performed transcatheter tricuspid valve-in-valve implantation with the J-valve system. At 34-month postoperative follow-up, the patient had no symptoms of heart failure and the echocardiogram showed good valve position and well hemodynamic status. Conclusions This case demonstrated that the J-valve system may be a new option for high-risk patients with a failed tricuspid bioprosthetic valve.
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21
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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: 2] [Impact Index Per Article: 1.0] [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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22
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Romeo JD, Bashline MJ, Fowler JA, Kliner DE, Toma C, Smith AJC, Sultan I, Sanon S. Current Status of Transcatheter Tricuspid Valve Therapies. Heart Int 2022; 16:49-58. [PMID: 36275351 PMCID: PMC9524678 DOI: 10.17925/hi.2022.16.1.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/10/2022] [Indexed: 01/04/2024] Open
Abstract
Tricuspid regurgitation is a complex disease that carries a poor prognosis, and surgical repair is associated with high mortality. In light of the success of other transcatheter-based valve interventions, transcatheter tricuspid therapy has recently seen exponential use both clinically and in innovation. Given the rapid development of many tricuspid systems and multiple on-going clinical trials, the aim of this review is to highlight the current state of transcatheter tricuspid therapeutics and to provide an up-to-date view of their clinical use, outcomes and future directions.
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Affiliation(s)
- Jared D Romeo
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael J Bashline
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jeffrey A Fowler
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Dustin E Kliner
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Catalin Toma
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - AJ Conrad Smith
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ibrahim Sultan
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Saurabh Sanon
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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23
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Barry OM, Bouhout I, Kodali SK, George I, Rosenbaum MS, Petit CJ, Kalfa D. Interventions for Congenital Atrioventricular Valve Dysfunction: JACC Focus Seminar. J Am Coll Cardiol 2022; 79:2259-2269. [PMID: 35654497 DOI: 10.1016/j.jacc.2021.08.083] [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: 04/30/2021] [Revised: 07/27/2021] [Accepted: 08/24/2021] [Indexed: 11/27/2022]
Abstract
Innovation and creativity have led to tremendous advancements in the care and management of patients with congenital heart disease (CHD) that have resulted in considerably increased survival. Catheter-based interventions have contributed significantly to these advancements. However, catheter-based interventions for congenital lesions of the atrioventricular (AV) valves have been limited in scope and effectiveness mainly because of patient size and anatomical challenges. Thus, surgical repair and replacement for congenital AV valve lesions have remained the preferred therapy. However, the ongoing transcatheter heart valve revolution has led to techniques and technologies that are changing the landscape, particularly for adult CHD patients. Many devices for AV valve repair and replacement are being studied in adult patients without CHD, and translation of select practices to CHD patients has begun, with many more to come. Transcatheter AV valve interventions represent exciting opportunities for the growing numbers of adult CHD patients.
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Affiliation(s)
- Oliver M Barry
- Division of Pediatric Cardiology, New York-Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA
| | - Ismail Bouhout
- Section of Pediatric and Congenital Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, New York-Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA
| | - Susheel K Kodali
- Division of Cardiology, New York-Presbyterian-Columbia University Medical Center, New York, New York, USA
| | - Isaac George
- Division of Cardiac, Thoracic, and Vascular Surgery, New York-Presbyterian-Columbia University Medical Center, New York, New York, USA
| | - Marlon S Rosenbaum
- Division of Cardiology, New York-Presbyterian-Columbia University Medical Center, New York, New York, USA
| | - Christopher J Petit
- Division of Pediatric Cardiology, New York-Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA.
| | - David Kalfa
- Section of Pediatric and Congenital Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, New York-Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA.
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24
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Kresoja K, Rahgozar K, Kitamura M, Goldberg Y, Latib A, Lurz P. Transcatheter Tricuspid Valve Repair and Replacement. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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25
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Tricuspid Structural Valve Deterioration Treated with a Transcatheter Valve-in-Valve Implantation: A Single-Center Prospective Registry. J Clin Med 2022; 11:jcm11092667. [PMID: 35566791 PMCID: PMC9104146 DOI: 10.3390/jcm11092667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 02/01/2023] Open
Abstract
The valve-in-valve (ViV) technique is an emerging alternative for the treatment of bioprosthetic structural valve deterioration (SVD) in the tricuspid position. We report on the outcomes of patients treated by a transcatheter tricuspid valve-in-valve (TT-ViV) implantation for symptomatic SVD in the tricuspid position during the years 2010-2019 at our center. Three main outcomes were examined during the follow-up period: TT-ViV hemodynamic data per echocardiography, mortality and NYHA functional class. Our cohort consisted of 12 patients with a mean age 65.4 ± 11.9 years, 83.3% male. The mean time from initial valve intervention to TT-ViV was 17.4 ± 8.7 years. The indications for TT-ViV were varied (41.7% for predominant regurgitation, 33.3% for predominant stenosis and 25.0% with a mixed pathology). All patients were treated with a balloon-expandable device. The mean follow-up was 3.4 ± 1.3 years. Tricuspid regurgitation was ≥ moderate in 57.2% of patients prior to the procedure and this decreased to 0% following the procedure. The mean transtricuspid valve gradients mildly decreased from the mean pre-procedural values of 9.0 mmHg to 7.0 mmHg at one month following the procedure (p = 0.36). Mortality at one year was 8.0% (95% CI 0-23). At the baseline, 4 patients (33.3%) were in NYHA functional class III/IV; this was reduced to 2 patients (18.2%) at the one year follow-up and both were in NYHA III. The TT-ViV procedure offered a safe, feasible and less invasive treatment option for patients with SVD in our detailed cohort.
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26
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Shojaeifard M, Rahnamoun Z, Firouzi A, Sadeghipour P. A case of early thrombosis following a percutaneous tricuspid valve in valve implantation managed by thrombolysis. Echocardiography 2022; 39:844-848. [PMID: 35524711 DOI: 10.1111/echo.15362] [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: 01/07/2022] [Revised: 03/29/2022] [Accepted: 04/23/2022] [Indexed: 01/09/2023] Open
Abstract
Bioprosthetic valve thrombosis (BPVT) is a growing recognized entity, especially with the increasing use of the valve in vale procedures and the advent of new detection technologies (e.g., 4D CT and 4D echocardiography). The incidence of BPVT is higher in transcatheter valves than surgically implanted bioprosthetic valves. However, the best thromboprophylaxis regimen and optimal management strategy in the acute context remain unknown. This paper presents a case of early thrombosis following the percutaneous tricuspid valve in vale procedure that was successfully managed with thrombolysis.
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Affiliation(s)
- Maryam Shojaeifard
- Echocardiography Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Rahnamoun
- Tehran Heart Center, Tehran University of Medical Science, Tehran, Iran
| | - Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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27
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Kanjanahattakij N, Tuluca A, Pressman GS, Singer R, Witzke C. Simultaneous transcatheter tricuspid and mitral valve-in-valve replacement for the treatment of degenerated bioprosthetic valves. J Card Surg 2022; 37:2182-2186. [PMID: 35393681 DOI: 10.1111/jocs.16489] [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: 02/14/2022] [Accepted: 03/25/2022] [Indexed: 11/28/2022]
Abstract
Transcatheter valve-in-valve replacement has become a viable option for patients with degenerated bioprosthetic valves at high risk for redo surgery. We report a case of a patient who had degenerated mitral and tricuspid bioprosthesis causing severe tricuspid and mitral regurgitation. We performed simultaneous mitral and tricuspid valve-in-valve replacement via a transfemoral approach. Although the data on performing both valve-in-valve procedures are limited, this case demonstrated that these procedures can be safely done as a single procedure.
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Affiliation(s)
- Napatt Kanjanahattakij
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Alexandra Tuluca
- Department of Surgery, Division of Cardiothoracic Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Gregg S Pressman
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Raymond Singer
- Department of Surgery, Division of Cardiothoracic Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Christian Witzke
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, Pennsylvania, USA
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28
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Poschner T, Mach M, Andreas M, Russo M. Editorial commentary: Cutting the Gordian knot of right-sided prosthetic valve thrombosis. J Card Surg 2022; 37:865-867. [PMID: 34996127 DOI: 10.1111/jocs.16210] [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: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022]
Abstract
With limited data available for the tricuspid valve, there are no stringent recommendations in the current guidelines (ESC 2021). Valve replacement for the right-sided heart is inherently problematic and bears the potential for complications - including prosthetic valve thrombosis (PVT). The purpose of this editorial is to review the key features of this clinical scenario and to outline the essential aspects for optimized patient management and improved outcome. Depending on the clinical presentation of PVT, either immediate surgery, thrombolysis, or anticoagulation may be considered - with the sole intensification of anticoagulation likely being the most inferior. Given the high risk of re-thrombosis, a dedicated follow-up program is essential to identify complications early and offer adequate treatment.
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Affiliation(s)
- Thomas Poschner
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Markus Mach
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Marco Russo
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria.,Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital of Rome, Rome, Italy
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29
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Melody valve insertion for relief of "Tricuspid" stenosis in an unbalanced atrioventricular septal defect. Cardiol Young 2022; 32:135-137. [PMID: 34183082 DOI: 10.1017/s1047951121002419] [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] [Indexed: 11/06/2022]
Abstract
A Melody valve was successfully placed across a very stenotic right-sided component of a common atrioventricular valve because of ongoing troublesome arrhythmias in a young woman with an unbalanced atrioventricular septal defect, a very dilated right atrium and a hypoplastic right ventricle. Four years later, she remains well.
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30
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Duarte D, Prieto L, Suntharos P. Melody valve-in-valve implantation in the tricuspid position through a Fontan conduit fenestration. Ann Pediatr Cardiol 2022; 15:180-182. [PMID: 36246762 PMCID: PMC9564403 DOI: 10.4103/apc.apc_71_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/09/2021] [Indexed: 11/12/2022] Open
Abstract
Patients with single right ventricle and tricuspid regurgitation have increased morbidity and mortality rates. The outcomes of surgical tricuspid valve repair and replacement are dismal. Although some centers prefer valve replacement with a bioprosthetic valve in the tricuspid position for the pediatric population, these valves have limited longevity and will eventually need to be replaced. Unfortunately, single ventricle patients are fragile and unlikely to tolerate a second replacement. Percutaneous valve-in-valve (ViV) implantation is an acceptable alternative with low morbidity and mortality. Studies have also shown acceptable short- and mid-term outcomes. We report a case of Melody ViV placement in the tricuspid position in a patient with hypoplastic left heart syndrome through the fenestration of a Fontan conduit.
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31
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Firouzi A, Khalilipur E, Abdi S, Alemzadeh-Ansari MJ, Alizadehasl A, Khajali Z, Hosseini Z. The Transcatheter Tricuspid Valve-in-Valve Technique in Degenerated Bioprostheses Without Fluoroscopic Radiopaque Landmarks. Curr Probl Cardiol 2021; 47:101081. [PMID: 34902393 DOI: 10.1016/j.cpcardiol.2021.101081] [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: 11/26/2021] [Accepted: 12/05/2021] [Indexed: 11/16/2022]
Abstract
Nonetheless, in principle, bioprosthetic heart valves are often preferred to mechanical valves in that not only do they obviate the need for high-level systemic anticoagulation and the attendant bleeding risks, but also higher rates of prosthetic valve thrombosis have been reported observed in the tricuspid position. The transcatheter tricuspid valve-in-valve (TVIV) procedure has expanded the horizons of cardiac surgery by allowing the implantation of stent-valves within degenerated bioprostheses in older adults and even young patients as the reported rate of the mortality of redo surgery in antecedent studies is at least 37%. Fluoroscopic guidance can assist the operator in implanting a bioprosthetic valve by radiopaque findings in the ideal position and depth; nonetheless, the complete radiolucency of some bioprosthetic valves represents a significant hurdle. In this state-of-the-art manuscript, we decided to deeply explain the appropriate heart-team approach in this scenario.
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Affiliation(s)
- Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ehsan Khalilipur
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seifollah Abdi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Alemzadeh-Ansari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Alizadehasl
- Rajaie Cardiovascular Medical and Research Center, Cardio-Oncology Department and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Khajali
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Hosseini
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
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32
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Russo G, Taramasso M, Pedicino D, Gennari M, Gavazzoni M, Pozzoli A, Muraru D, Badano LP, Metra M, Maisano F. Challenges and future perspectives of transcatheter tricuspid valve interventions: adopt old strategies or adapt to new opportunities? Eur J Heart Fail 2021; 24:442-454. [PMID: 34894039 DOI: 10.1002/ejhf.2398] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 01/08/2023] Open
Abstract
Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease and is associated with an increased risk of cardiovascular events and death at long-term follow-up. Functional TR accounts for over 90% of TR and is mainly due to annular or right ventricular dilatation. Most often, TR is observed in patients with left-sided valvular heart disease (with or without previous surgical correction) and pulmonary hypertension. Isolated TR is less frequent, though burdened by high surgical mortality. This, together with an incomplete understanding of the disease, has brought to a significant undertreatment in spite of the growing evidence of the impact of severe TR on mortality. Moreover, uncertainties about the appropriate timing for intervention and the predictors of procedural success have contributed to limit TR treatment. Transcatheter tricuspid valve replacement or repair interventions represent novel and less invasive alternatives to surgery and have shown early promising results. The purpose of this review is to provide a complete and updated overview of TR pathology with a special focus on current percutaneous treatment options, future challenges and directions.
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Affiliation(s)
- Giulio Russo
- Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Daniela Pedicino
- Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Mara Gavazzoni
- IRCCS, Instituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, Milan, Italy
| | - Alberto Pozzoli
- Heart Surgery Unit, Cardiocentro Ticino, Lugano, Switzerland
| | - Denisa Muraru
- IRCCS, Instituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, Milan, Italy
| | - Luigi P Badano
- IRCCS, Instituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, Milan, Italy
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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33
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Eng MH, Yadav P, Thourani V, Fang K. Transcatheter Tricuspid Valve Replacement for Surgical Failures. Interv Cardiol Clin 2021; 11:81-86. [PMID: 34838299 DOI: 10.1016/j.iccl.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Tricuspid valve surgery has high mortality for first-time operations and repeat surgery is fraught with even higher rates. When failed tricuspid surgical prostheses and repairs are present, physicians look toward transcatheter tricuspid valve replacement (TTVR) as a tangible solution. Using balloon-expandable bioprosthetic valves in an off-label fashion, tricuspid valve-in-valve (TViV) procedures can be performed reliably; however, valve-in-ring cases are more nuanced and have higher risks of paravalvular leak and valve malpositioning. TTVR specific issues include THV anchoring, management of preexisting pacing leads, postprocedure thromboembolic prophylaxis, and possible tricuspid reintervention.
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Affiliation(s)
- Marvin H Eng
- Division of Cardiology, Structural Heart Program, University of Arizona, Banner University Medical Center, 1111 East McDowell Road, Phoenix, AZ 85006, USA.
| | - Pradeep Yadav
- Division of Cardiology, Piedmont Heart Institute, 275 Collier Road Northwest #500, Atlanta, GA 30309, USA
| | - Vinod Thourani
- Division of Cardiothoracic Surgery, Piedmont Heart Institute, 275 Collier Road Northwest #500, Atlanta, GA 30309, USA
| | - Kenith Fang
- Division of Cardiothoracic Surgery, Banner University Medical Center, 1111 East McDowell Road, Phoenix, AZ 85006, USA
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34
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Greenbaum AB, Babaliaros VC, Eng MH. Orthotopic Transcatheter Tricuspid Valve Replacement. Interv Cardiol Clin 2021; 11:87-94. [PMID: 34838300 DOI: 10.1016/j.iccl.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Severe tricuspid regurgitation renders patients frail, and surgical treatment is associated with high mortality. Because most of the tricuspid regurgitation patients are functional and have significant annular dilation, large coaptation gaps are seen. This anatomy is best addressed with transcatheter tricuspid valve replacement (TTVR), and promising therapies are under clinical investigation. Most TTVR devices are in early clinical development with one transcatheter heart valve in pivotal trial; TTVR is expected to significantly affect tricuspid regurgitation and survival.
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Affiliation(s)
- Adam B Greenbaum
- Structural Heart and Valve Center, Department of Internal Medicine-Cardiology, Emory University, 550 Peachtree St Ne Medical, Office Tower, Fl 6, Atlanta, GA 30308, USA
| | - Vasilis C Babaliaros
- Structural Heart and Valve Center, Department of Internal Medicine-Cardiology, Emory University, 550 Peachtree St Ne Medical, Office Tower, Fl 6, Atlanta, GA 30308, USA
| | - Marvin H Eng
- Division of Cardiology, Structural Heart Program, Banner University Medical Center- Phoenix, University of Arizona, 1111 East McDowell Road, Phoenix, AZ 85006, USA.
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35
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Chen S, Dershowitz L, George I. Transcatheter valve implantation for degenerated tricuspid bioprosthesis and failed tricuspid ring. Ann Cardiothorac Surg 2021; 10:651-657. [PMID: 34733692 DOI: 10.21037/acs-2021-tviv-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/29/2021] [Indexed: 11/06/2022]
Abstract
Background Transcatheter tricuspid valve-in-valve (TViV) and valve in-ring (TViR) implantation have become a viable therapy for a failed tricuspid bioprosthesis. Here we report short (thirty days) and long (one-year) term clinical outcomes of ten patients who underwent TViV at our institution. Methods The electronic databases of New York Presbyterian Columbia Medical Center were retrospectively reviewed for cases of transcatheter tricuspid valve replacement (TViV or TViR). Between 2012 and 2019, data from ten patients who underwent TViV were collected. The primary safety outcome was procedure-related adverse events, including clinically evident cardiac perforation, new pericardial effusion and sustained ventricular arrhythmia. The primary efficacy endpoint was defined as successful valve deployment with total (paravalvular or intravalvular) tricuspid regurgitation (TR) estimated as mild or less. Results are descriptive in nature. Results A total of ten patients who underwent TViV were included in the study. Of them, 40% presented with isolated tricuspid bioprosthetic stenosis (TS), 20% with isolated TR and 40% with mixed TS and TR. All patients were treated with the SAPIEN valve (first generation, XT, or Sapien 3). The TViV procedure was successful in all patients, and no immediate post-replacement paravalvular leak (PVL) or intra-procedural complications were reported. The primary safety and efficacy endpoints were met in all patients. At thirty-days, all patients were alive and reported significant improvements in symptoms and functional status. Conclusions Transcatheter tricuspid valve implantation is a safe and effective therapy for degenerative tricuspid bioprosthesis.
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Affiliation(s)
- Shmuel Chen
- Division of Cardiac, Thoracic & Vascular Surgery, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Lyle Dershowitz
- Division of Cardiac, Thoracic & Vascular Surgery, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Isaac George
- Division of Cardiac, Thoracic & Vascular Surgery, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
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36
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Chandavimol M, Ngernsritrakul T, Meemook K, Apinyasawat S, Tangcharoen T, Pienvichit P, Samankatiwat P, Boonbaichaiyapruck S. Transcatheter tricuspid valve-in-valve implantation for degenerative surgical bio-prosthesis using SAPIEN 3: A case series. Clin Case Rep 2021; 9:e05029. [PMID: 34824847 PMCID: PMC8603360 DOI: 10.1002/ccr3.5029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/01/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022] Open
Abstract
We evaluated early outcomes of transcatheter valve-in-valve (ViV) implantation in patients with degenerated bio-prosthesis in tricuspid position. Total of 5 patients were included in our case series. Baseline native tricuspid valve etiology were highly varied ranging from chest wall trauma, Ebstein anomaly, rheumatic heart disease, infective endocarditis and complex congenital heart disease. These differences also made patient comorbidities highly varied. Procedure details were also varied due to different clinical and technical challenges. All cases underwent successful Tricuspid VIV implantation with satisfactory hemodynamics results. All patients experienced improved clinical symptoms at follow up.
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Affiliation(s)
- Mann Chandavimol
- Faculty of MedicineRamathibodi HospitalMahidiol UniversityBangkokThailand
| | | | - Krissada Meemook
- Faculty of MedicineRamathibodi HospitalMahidiol UniversityBangkokThailand
| | - Sirin Apinyasawat
- Faculty of MedicineRamathibodi HospitalMahidiol UniversityBangkokThailand
| | | | - Pavit Pienvichit
- Faculty of MedicineRamathibodi HospitalMahidiol UniversityBangkokThailand
| | - Piya Samankatiwat
- Faculty of MedicineRamathibodi HospitalMahidiol UniversityBangkokThailand
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37
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Kosmidis D, Ninios I, Arvanitaki A, Koutsakis A, Thanopoulos V, Karvounis H, Giannakoulas G, Ninios V. Transcatheter valve-in-valve implantation in failing tricuspid bioprosthesis of a young adult with tetralogy of Fallot. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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38
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Reversal of Femoral Vein Pulsatility Due to Severe Tricuspid Regurgitation After Transcatheter Tricuspid Valve-in-Valve Implantation: A "Wave Dissipation" Effect. Heart Lung Circ 2021; 30:e129-e130. [PMID: 34244064 DOI: 10.1016/j.hlc.2021.05.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/21/2021] [Indexed: 11/20/2022]
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39
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Park B, Jeong DS, Kim WS, Sung K, Park PW. Reappraisal of mechanical tricuspid valve replacement in the current era: a single center retrospective study. J Thorac Dis 2021; 13:3359-3368. [PMID: 34277032 PMCID: PMC8264679 DOI: 10.21037/jtd-20-3027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/08/2021] [Indexed: 11/17/2022]
Abstract
Background This study aimed to investigate the early and late outcomes of mechanical tricuspid valve replacement (mTVR). Methods We evaluated 113 patients (82 women; median age, 53 years) who underwent mTVR between 1995 and 2017. Based on a history of cardiac surgery, patients were divided into primary (n=42) and reoperative mTVR (n=71) groups. The median follow-up duration was 12.7 years in primary and 9.3 years in reoperative mTVR, respectively (P=0.045). Results Patients in the reoperative group were older (54 vs. 46 years; P=0.007) and showed higher central venous pressure (16±6 vs. 13±6 mmHg; P=0.002) than the primary group. Early mortality occurred in 2 patients in the reoperative group (2 vs. 0; P=0.529). There was no significant difference in overall survival between the primary and reoperation groups (15-year survival rate: 86% vs. 78%; P=0.215). The independent risk factors of overall survival were age [P<0.001; hazard ratio (HR), 1.11; 95% confidential interval (CI), 1.05–1.18], left ventricular ejection fraction of less than 40% (P=0.001; HR, 5.1; 95% CI, 2.21–28.2), and central venous pressure over 20 mmHg (P=0.016; HR, 3.7; 95% CI, 1.28–10.7). Overall survival did not differ between the age groups (<60 vs. 60–70 years) in the reoperative group (P=0.772). Tricuspid valve thrombosis occurred in 8 patients (7 primary, 1 reoperative; P=0.004). Conclusions The incidence of tricuspid valve thrombosis was significantly higher in the primary mTVR group compared with the reoperative mTVR group. The patients who underwent mTVR at a relatively young age showed good early and late outcomes in both groups.
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Affiliation(s)
- Byungjoon Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Korea
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Thoracic and Cardiovascular Surgery, Mediplex Sejong Hospital, Incheon, Korea
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40
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Lake P, Kuhn EW, Mauri V, Macherey S, Kaliba J, Baldus S, Frerker C, Schmidt T. Transcatheter valve-in-valve-in-valve replacement in tricuspid position in a patient with pre-existing permanent dual-chamber pacemaker. Clin Res Cardiol 2021; 110:2010-2014. [PMID: 33909128 PMCID: PMC8639564 DOI: 10.1007/s00392-021-01842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
Graphic abstract
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Affiliation(s)
- Philipp Lake
- Department of Internal Medicine III, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Elmar W Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Victor Mauri
- Department of Internal Medicine III, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Sascha Macherey
- Department of Internal Medicine III, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | | | - Stephan Baldus
- Department of Internal Medicine III, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Christian Frerker
- Department of Internal Medicine II, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany
| | - Tobias Schmidt
- Department of Internal Medicine II, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany
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41
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Bastos Filho JBB, Sampaio RO, Cividanes FR, Rosa VEE, da Costa LPN, Vieira MLC, Jatene FB, Tarasoutchi F, Palma JH, Ribeiro HB. Double transcatheter balloon-expandable valve implantation for severe valve dysfunction in high-risk patients: initial experience. Interact Cardiovasc Thorac Surg 2021; 31:461-466. [PMID: 32901288 DOI: 10.1093/icvts/ivaa142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/15/2020] [Accepted: 07/06/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Concomitant valvular heart valve disease is a frequent finding, with higher morbidity and mortality among patients undergoing redo surgical procedures. Our goal was to report our initial experience with combined transcatheter Inovare bioprosthesis implants for severe valve dysfunction. METHODS Among 300 transcatheter procedures, a total of 6 patients had concurrent simultaneous transcatheter bioprosthesis implants for severe mitral bioprosthesis failure (valve-in-valve), with a second valve procedure that included native aortic (n = 2) or degenerated bioprostheses in the aortic position (n = 4). During the procedures, all patients were treated with a balloon-expandable Inovare transcatheter valve, using the transapical approach. RESULTS Patients were highly symptomatic [New York Heart Association (NYHA) functional class IV: 100%], with a mean age of 62 ± 5 years, yielding a mean European System for Cardiac Operative Risk II (EuroSCORE II) of 24.0 ± 10.1%. There was a mean of 1.6 ± 0.4 prior valve operations/patient, with a median time from prior mitral bioprosthesis surgery of 13.0 (9.2-20.0) years. Device success was 100% according to the Mitral Valve Academic Research Consortium and the Valve Academic Research Consortium-2 criteria. During the hospital stay, only 1 patient required dialysis, and the median intensive care unit and hospital lengths of stay were 5.0 (3.2-6.7) days and 16.0 (12.2-21.2) days, respectively. No deaths occurred at 30 days; at a median follow-up of 287 (194-437) days, 1 patient died of a non-cardiac cause and the rest of patients were in NYHA functional class I or II, with normofunctioning bioprostheses. CONCLUSIONS Transcatheter double valve interventions using the Inovare bioprosthesis in this initial series were shown to be a reasonable alternative to redo surgical operations. The short- and mid-term clinical and echocardiographic outcomes demonstrate promising results, although future studies with a larger number of patients and longer follow-up are warranted.
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Affiliation(s)
| | | | | | | | | | | | | | - Flavio Tarasoutchi
- Heart Institute of São Paulo (InCor), University of São Paulo, São Paulo, Brazil
| | - José Honório Palma
- Heart Institute of São Paulo (InCor), University of São Paulo, São Paulo, Brazil
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42
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Maoz-Metzl D, McCarthy FH, Berson DG, Kunz GA. Transcatheter tricuspid valve replacement in dehisced flexible ring. Catheter Cardiovasc Interv 2021; 97:E739-E742. [PMID: 32761862 DOI: 10.1002/ccd.29162] [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: 03/30/2020] [Revised: 06/17/2020] [Accepted: 07/09/2020] [Indexed: 11/10/2022]
Abstract
Transcatheter tricuspid valve-in-surgical annuloplasty ring is an appealing concept in light of the high mortality associated with reoperation on the tricuspid valve. The clinical necessity of this procedure is derived from a considerable failure rate of tricuspid repairs over time. The presented case demonstrates that transcatheter valve-in-ring is a feasible option for patients with flexible tricuspid ring even in the context of significant ring dehiscence. Meticulous procedural planning, preemptively addressing a potential paravalvular leak, and clear understanding of the intricate three-dimensional anatomy are imperative for procedural success.
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Affiliation(s)
- Daniel Maoz-Metzl
- Cardiothoracic Surgery, New-Mexico Heart Institute, Albuquerque, New Mexico, USA
| | - Fenton H McCarthy
- Cardiothoracic Surgery, New-Mexico Heart Institute, Albuquerque, New Mexico, USA
| | - Daniel G Berson
- Cardiac Anesthesia, Main Street Anesthesia of New Mexico, Albuquerque, New Mexico, USA
| | - Geoffrey A Kunz
- Invasive Cardiology, New-Mexico Heart Institute, Albuquerque, New Mexico, USA
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43
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Dannenberg V, Donà C, Koschutnik M, Winter MP, Nitsche C, Kammerlander AA, Bartko PE, Hengstenberg C, Mascherbauer J, Goliasch G. Transcatheter treatment by valve-in-valve and valve-in-ring implantation for prosthetic tricuspid valve dysfunction. Wien Klin Wochenschr 2021; 133:780-785. [PMID: 33791869 PMCID: PMC8373758 DOI: 10.1007/s00508-021-01842-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/27/2021] [Indexed: 11/27/2022]
Abstract
Valve degeneration after surgical tricuspid valve replacement or repair is frequent and may require repeat replacement/repair. For high-risk patients, transcatheter valve-in-valve and valve-in-ring procedures have emerged as valuable treatment alternatives. Preprocedural transthoracic echocardiography is the method of choice to detect malfunction of the prosthesis including degenerative stenosis and/or regurgitation requiring reintervention. Subsequently, computed tomography is helpful for detailed anatomical analysis and periprocedural planning. Device selection and sizing depend on the size and structural details of the implanted ring or prosthesis. The procedure is mainly guided by fluoroscopy; however, transesophageal echocardiography provides complementary guidance during device implantation. Preferred access route is the right femoral vein but in cases of more horizontal implants a jugular approach might be feasible. Suitable transcatheter valves are the Edwards Sapien 3 and the Medtronic Melody valves. Differences in surgical prostheses or annuloplasty implants are important for device selection, height consideration and additional ballooning prior to or after implantation. Transesophageal echocardiography postimplantation is convenient for the assessment of transvalvular gradients or paravalvular leaks.
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Affiliation(s)
- Varius Dannenberg
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Carolina Donà
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Matthias Koschutnik
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Max-Paul Winter
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christian Nitsche
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Andreas A Kammerlander
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Philipp E Bartko
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christian Hengstenberg
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Julia Mascherbauer
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Georg Goliasch
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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44
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Duran Karaduman B, Ayhan H, Keleş T, Bozkurt E. Transcatheter Tricuspid Valve-in-Valve Implantation With a Novel Balloon Expandable Myval THV. Ann Thorac Surg 2021; 112:e435-e437. [PMID: 33737045 DOI: 10.1016/j.athoracsur.2021.03.014] [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: 02/18/2021] [Revised: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 11/26/2022]
Abstract
The transcatheter tricuspid valve-in-valve implantation has not yet been clarified, and several case series have documented results in patients with tricuspid bioprosthetic valve degeneration who underwent transcatheter implantation of Edwards SAPIEN XT and SAPIEN 3 (Edwards Lifesciences, Irvine, CA) and Medtronic (Minneapolis, MN) valves. Here, we present the case of a patient with severe bioprosthetic tricuspid valve stenosis who was successfully treated with the transfemoral route through the 29-mm novel balloon expandable Myval transcatheter heart valve (Meril Life Sciences Pvt Ltd, Vapi, Gujarat, India) system.
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Affiliation(s)
- Bilge Duran Karaduman
- Department of Cardiology, Faculty of Medicine, Atılım University, Medicana International Ankara Hospital, Ankara, Turkey.
| | - Hüseyin Ayhan
- Department of Cardiology, Faculty of Medicine, Atılım University, Medicana International Ankara Hospital, Ankara, Turkey
| | - Telat Keleş
- Department of Cardiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara City Hospital, Ankara, Turkey
| | - Engin Bozkurt
- Department of Cardiology, Medicana International Ankara Hospital, Ankara, Turkey
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45
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Luciani GB, de Manna ND, Segreto A, Lanzoni L, Faggian G. Scalloped Freehand Pulmonary Homograft for Prosthetic Tricuspid Valve Replacement. Ann Thorac Surg 2021; 112:e61-e64. [PMID: 33662315 DOI: 10.1016/j.athoracsur.2020.12.089] [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: 11/27/2020] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
Tricuspid valve replacement is commonly performed using biologic or mechanical prostheses. Partial or complete valve replacement using mitral homograft tissue has also been described. Anecdotal reports exist of valve replacement using a pulmonary homograft within a cylinder. This report describes a technique for native or prosthetic valve replacement using a freehand scalloped pulmonary homograft. Late follow-up confirmed the efficacy of this surgical strategy.
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Affiliation(s)
- Giovanni Battista Luciani
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy.
| | - Nunzio Davide de Manna
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
| | - Antonio Segreto
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
| | - Laura Lanzoni
- IRCCS Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | - Giuseppe Faggian
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
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46
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Kronberg K, Horn M, Mellert F, Elsässer A. Transcatheter tricuspid valve-in-valve replacement in two patients with Ebstein anomaly: technical considerations. Clin Res Cardiol 2021; 110:472-477. [PMID: 33169225 PMCID: PMC7907046 DOI: 10.1007/s00392-020-01756-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Kay Kronberg
- Klinikum Oldenburg - Universitätsklinik für Innere Medizin - Kardiologie, Oldenburg, Germany.
| | - Malena Horn
- Klinikum Oldenburg - Universitätsklinik für Innere Medizin - Kardiologie, Oldenburg, Germany
| | - Fritz Mellert
- Klinikum Oldenburg - Universitätsklinik für Herzchirurgie, Oldenburg, Germany
| | - Albrecht Elsässer
- Klinikum Oldenburg - Universitätsklinik für Innere Medizin - Kardiologie, Oldenburg, Germany
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47
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Tagliari AP, Perez-Camargo D, Taramasso M. Tricuspid regurgitation: when is it time for surgery? Expert Rev Cardiovasc Ther 2021; 19:47-59. [DOI: 10.1080/14779072.2021.1854734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Ana Paula Tagliari
- Cardiac Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Postgraduate Program in Health Science: Cardiology and Cardiovascular Science, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Daniel Perez-Camargo
- Cardiac Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Fundación Interhospitalaria para la Investigación Cardiovascular, Madrid, Spain
| | - Maurizio Taramasso
- Cardiac Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- HerzZentrum Hirlsanden Zurich, Zurich, Switzerland
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48
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Chiam PT, Lim YT, Lim CP, Wong PS, Chua YL. Transfemoral transcatheter tricuspid valve replacement of a degenerated tricuspid bioprosthesis: Initial experience in Southeast Asia with three-year follow-up. Singapore Med J 2020; 61:614-616. [PMID: 33283245 DOI: 10.11622/smedj.2020154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Paul Tl Chiam
- The Heart and Vascular Centre, Mount Elizabeth Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yean Teng Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cardiology Associates, Mount Elizabeth Hospital, Singapore
| | - Choon Pin Lim
- The Heart and Vascular Centre, Mount Elizabeth Hospital, Singapore
| | - Poo Sing Wong
- Wong Poo Sing Heart and Lung Surgery, Mount Elizabeth Hospital, Singapore
| | - Yeow Leng Chua
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
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49
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Wang R, Gao C, Kawashima H, Modolo R, Rosseel L, Onuma Y, Soliman O, Serruys PW, Mylotte D. Valvular heart interventions: advances from 2019 to 2020. EUROINTERVENTION 2020; 16:808-823. [PMID: 32958460 DOI: 10.4244/eij-d-20-00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Rutao Wang
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
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50
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Jensen JK, Frederiksen CA, Andersen MJ, Poulsen SH. A case report of isolated severe valve stenosis in a previous tricuspid valve repair: an integrated multimodality imaging and invasive haemodynamic evaluation. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 32974440 DOI: 10.1093/ehjcr/ytaa147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/30/2019] [Accepted: 05/05/2020] [Indexed: 11/14/2022]
Abstract
Background Tricuspid valve (TV) stenosis is a very rare condition and the aetiology is primarily due to rheumatic disease, carcinoid disease, congenital heart disease, endocarditis, and following degeneration of biological valve prosthesis. Case summary We present a 45-year-old man with a rare case of symptomatic TV stenosis (TS) in a previously isolated TV repair. A meticulous multimodality diagnostic approach is presented in order to determine the severity of the TS and to evaluate the right ventricular function. Discussion This case report presents an integrated multimodality imaging and haemodynamic approach to evaluate and document the suspicion of development of a symptomatic significant stenosis in a previous TV repair. The initial TV repair was done without ring annuloplasty, because only the anterior leaflet was affected and bicuspidalization of the valve made it patent. In addition, minimizing the amount of implanted material was intended to minimize the risk of reinfection. The final treatment was performed as a TV replacement with insertion of a bioprosthesis.
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Affiliation(s)
- Jesper Khedri Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | | | - Mads Jønsson Andersen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Steen Hvitfeldt Poulsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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