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Ning X, Xu H, Cao J, Li N, Wang W, Qiao F, Han L, Lu F, Xu Z. Transcatheter tricuspid valve interventions: Current devices and clinical evidence. J Cardiol 2024; 84:73-79. [PMID: 38583664 DOI: 10.1016/j.jjcc.2024.04.001] [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: 12/03/2023] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
The tricuspid valve is known as "the forgotten valve". Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease. TR is often late in the course of the disease when it becomes symptomatic, often being a marker of late-stage chronic heart failure with a poor prognosis and high mortality rate at long-term follow-up. Despite the clear correlation between TR and mortality, most TR patients are under-treated. Neither pharmacologic nor surgical treatment demonstrates a significant survival benefit. Isolated tricuspid valve surgery has the highest mortality rate of all valve surgeries. Therefore, there is an urgent clinical need for minimally invasive therapies to meet the needs of patients with TR. In recent years, a variety of transcatheter tricuspid valve interventions representing less invasive alternatives to surgery have shown promising results, which bring hope to patients with severe TR. The purpose of this review is to provide a complete and updated overview on current transcatheter tricuspid valve interventions and clinical evidence.
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Affiliation(s)
- Xiaoping Ning
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Hongjie Xu
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Jingyi Cao
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Ning Li
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Wei Wang
- Department of Cardiovascular Surgery, The First People's Hospital of Shanghai Transportation University, Shanghai, China
| | - Fan Qiao
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Lin Han
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Fanglin Lu
- Department of Cardiovascular Surgery, The First People's Hospital of Shanghai Transportation University, Shanghai, China.
| | - Zhiyun Xu
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China.
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2
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Sharedalal A, Zois A, Sharedalal P, Frishman WH, Aronow WS. Transcatheter Intervention for Management of Tricuspid Regurgitation Using TriClip. Cardiol Rev 2024:00045415-990000000-00290. [PMID: 38934619 DOI: 10.1097/crd.0000000000000740] [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] [Indexed: 06/28/2024]
Abstract
Severe tricuspid regurgitation (TR) is an underrated, common pathology that affects over 70 million individuals worldwide. Traditionally, TR has been managed with diuretic therapies without any significant mortality benefit. The underlying cause of TR can be primary, coming from structural issues with tricuspid valve and more commonly secondary, arising from conditions affecting the right ventricle or the pulmonary circulation. Management of TR has seen few improvements until recently. Traditionally, valve replacement and surgical repair were the therapeutic options available. Tricuspid valve is a complex cardiac structure with many technical challenges for surgical intervention. Transcatheter valve interventions have proven to be safe and effective novel therapeutic options for severe TR, which reduce the severity of TR with associated improvement in quality of life. In this review, we will provide an overview of the management of severe TR utilizing transcatheter edge-to-edge repair with the TriClip device (Abbott, Santa Clara, CA).
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Affiliation(s)
- Anmol Sharedalal
- From the Department of Medicine, St. Georges University, Grenada, West Indies
| | - Alexandra Zois
- From the Department of Medicine, St. Georges University, Grenada, West Indies
| | - Parija Sharedalal
- Department of Medicine, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | | | - Wilbert S Aronow
- Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
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3
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Rajiah PS, Reddy P, Baliyan V, Hedgire SS, Foley TA, Williamson EE, Eleid MF. Utility of CT and MRI in Tricuspid Valve Interventions. Radiographics 2023; 43:e220153. [PMID: 37384544 DOI: 10.1148/rg.220153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Transcatheter tricuspid valve interventions (TTVIs) comprise a variety of catheter-based interventional techniques for treatment of tricuspid regurgitation (TR) in patients at high surgical risk and those with failed previous surgeries. Several TTVI devices with different mechanisms of action are either currently used or in preclinical evaluation. Echocardiography is the first-line modality for evaluation of tricuspid valve disease that provides information on tricuspid valve morphology, mechanism of TR, and hemodynamics. Cardiac CT and MRI have several advantages for a comprehensive preprocedure evaluation. CT and MRI provide complementary information to that of echocardiography on the mechanism and cause of TR. MRI can quantify the severity of TR using indirect or direct techniques that involve two-dimensional or four-dimensional flow sequences. MRI and CT can also accurately quantify right ventricular volumes and function, which is crucial for timing of intervention. CT provides comprehensive three-dimensional information on the morphology of the valve, annulus, subvalvular apparatus, and adjacent structures. CT is the procedure of choice for evaluation of several device-specific measurements, including tricuspid annulus dimensions, annulus-to-right coronary artery distance, leaflet morphology, coaptation gaps, caval dimensions, and cavoatrial-to-hepatic vein distance. CT allows evaluation of the vascular access as well as optimal procedure fluoroscopic angles and catheter trajectory. Postprocedure CT and MRI are useful in detection of complications such as paravalvular leak, pseudoaneurysm, thrombus, pannus, infective endocarditis, and device migration. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Prabhakar Shantha Rajiah
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Prajwal Reddy
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Vinit Baliyan
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Sandeep S Hedgire
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Thomas A Foley
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Eric E Williamson
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Mackram F Eleid
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
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4
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Blusztein DI, Hahn RT. New therapeutic approach for tricuspid regurgitation: Transcatheter tricuspid valve replacement or repair. Front Cardiovasc Med 2023; 10:1080101. [PMID: 36910541 PMCID: PMC9995444 DOI: 10.3389/fcvm.2023.1080101] [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: 10/25/2022] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
The tricuspid valve is a complex structure with normal function dependent on the leaflet morphology, right atrial and annular dynamics, and right ventricular and chordal support. Thus, the pathophysiology of tricuspid regurgitation (TR) is equally complex and current medical and surgical management options are limited. Transcatheter devices are currently being investigated as possible treatment options with lower morbidity and mortality than open surgical procedures. These devices can be divided by their implant location/mechanism of action: leaflet approximation devices, annuloplasty devices, orthotopic valve implants, and heterotopic valve implants. The current review will discuss each class of transcatheter device therapy, and further delve into the current understanding of who and when to treat. Finally, we will include a brief discussion of the future of device and surgical therapy trials for TR and the remaining questions to answer about this complex disease process.
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Affiliation(s)
- David I Blusztein
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY, United States
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY, United States
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5
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Alperi A, Almendárez M, Álvarez R, Moris C, Leon V, Silva I, Hernández-Vaquero D, Pascual I, Avanzas P. Transcatheter tricuspid valve interventions: Current status and future perspectives. Front Cardiovasc Med 2022; 9:994502. [PMID: 36187002 PMCID: PMC9518720 DOI: 10.3389/fcvm.2022.994502] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
The development of transcatheter therapies to treat valvular heart diseases has changed the rules of the game, particularly in the case of aortic stenosis and mitral regurgitation. In the last years, the tricuspid valve has also been the focus of these percutaneous techniques for several reasons: (1) tricuspid regurgitation is a frequent disease associated with poor clinical outcomes in spite of medical treatment, leading to end-stage right ventricular heart failure, (2) surgical tricuspid valve repair or replacement has been the treatment of choice for patients with tricuspid valve disease, but high mortality rates for isolated surgical tricuspid valve intervention have been reported in the literature, and (3) most patients with tricuspid pathology are ultimately denied cardiac surgery because of their comorbidity burden. Thus, in this context the development of less invasive catheter-based therapies would be of high clinical relevance. The present review provides an overview regarding the framework of chronic tricuspid regurgitation transcatheter therapeutic options, summarizes the transcatheter systems under clinical use or clinical evaluation with their technical features, and describes the updated current evidence in this challenging and evolving field.
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Affiliation(s)
- Alberto Alperi
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Marcel Almendárez
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Rut Álvarez
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Cesar Moris
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Victor Leon
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Iria Silva
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Daniel Hernández-Vaquero
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
- Isaac Pascual
| | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
- *Correspondence: Pablo Avanzas ;
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6
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Zahr F, Chadderdon S, Song H, Sako E, Fuss C, Bailey SR, Cigarroa J. Contemporary diagnosis and management of severe tricuspid regurgitation. Catheter Cardiovasc Interv 2022; 100:646-661. [DOI: 10.1002/ccd.30364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 04/23/2022] [Accepted: 07/09/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Firas Zahr
- Division of Cardiology, Knight Cardiovascular Institute Oregon Health & Science University Portland Oregon USA
| | - Scott Chadderdon
- Division of Cardiology, Knight Cardiovascular Institute Oregon Health & Science University Portland Oregon USA
| | - Howard Song
- Division of Cardiac Surgery, Knight Cardiovascular Institute Oregon Health & Science University Portland Orego USA
| | - Edward Sako
- Department of Cardiothoracic Surgery UT Health San Antonio San Antonio Texas USA
| | - Cristina Fuss
- Department of Radiology Oregon Health & Science University Portland Oregon USA
| | - Steven R. Bailey
- Department of Internal Medicine LSU Health Shreveport School of Medicine Shreveport Louisiana USA
| | - Joaquin Cigarroa
- Division of Cardiology, Knight Cardiovascular Institute Oregon Health & Science University Portland Oregon USA
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7
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Transcatheter interventions for severe tricuspid regurgitation: a literature review. J Geriatr Cardiol 2022; 19:539-550. [PMID: 35975018 PMCID: PMC9361160 DOI: 10.11909/j.issn.1671-5411.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The prevalence of tricuspid regurgitation (TR) increases with age, affecting 65%-85% of adults. Primary TR is caused by a congenital or acquired abnormality of the tricuspid valve apparatus (leaflets, chordae, papillary muscles, or annulus). Secondary TR is due to insufficient coaptation from dilation of tricuspid valve annulus due to the right ventricle (RV) or right atrium (RA) remodeling and increased RV pressures. Isolated TR is without increased RV pressures and is associated with atrial fibrillation. Mild TR is a benign disease. Moderate to severe tricuspid regurgitation has independently been associated with increased mortality. Most of these patients are treated medically due to poor outcomes with surgical repair of isolated TR. The in-hospital mortality rate is 8.8%, and the median length of stay in hospital is 11 days resulting in higher healthcare costs. Even if the patients undergo surgical repair or replacement, available data do not show improvement in survival. With a more detailed understanding of the complex anatomy and physiology of the tricuspid valve and significant complications from untreated tricuspid valve disease, the approach to the management of TR has shifted from a conservative approach to a process of prevention and intervention. In the past decade, transcatheter tricuspid valve interventions and tricuspid annuloplasty rings have been developed, contributing to decreased mortality from surgical repair. Transcatheter tricuspid valve intervention techniques have improved survival, quality of life, and reduced heart failure rehospitalization. This review summarizes normal anatomy, types of TR, etiology and different mechanisms of TR, echocardiographic assessment of the severe TR, and highlights various percutaneous transcatheter techniques for tricuspid valve repair.
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8
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Bhardwaj B, Cigarroa JE, Zahr F. Tricuspid Valve Percutaneous Therapies. Curr Cardiol Rep 2022; 24:1209-1226. [PMID: 35767178 DOI: 10.1007/s11886-022-01739-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW In this review, we have focused on the currently available transcatheter tricuspid valve therapies, device selection, as well as role and management of tricuspid regurgitation (TR) in the setting of other transcatheter valvular procedures. RECENT FINDINGS In this review, we have enlisted the recently finished as well as ongoing trials in the percutaneous tricuspid valve therapies. TR is highly prevalent yet remains underrecognized and is often untreated. TR has traditionally been managed conservatively with medical therapies including diuretics for volume management, whereas surgical therapies are reserved for those undergoing left-sided valvular surgery. Although the transcatheter devices for tricuspid repair and replacement are in clinical trials, the experience to date for their effectiveness and safety has been reassuring.
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Affiliation(s)
- Bhaskar Bhardwaj
- Division of Cardiology, Knight Cardiovascular Institute, OHSU, Portland, OR, United States
| | - Joaquin E Cigarroa
- Division of Cardiology, Knight Cardiovascular Institute, OHSU, Portland, OR, United States
| | - Firas Zahr
- Division of Cardiology, Knight Cardiovascular Institute, OHSU, Portland, OR, United States.
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9
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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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10
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Fazzari F, Cannata F, Maurina M, Bragato RM, Francone M. Multi-Modality Imaging of the Tricuspid Valve: From Tricuspid Valve Disease to Catheter-Based Interventions. Rev Cardiovasc Med 2022; 23:199. [PMID: 39077186 PMCID: PMC11273762 DOI: 10.31083/j.rcm2306199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 07/31/2024] Open
Abstract
Tricuspid valve disease represents a major health problem that affects a wide proportion of heart failure patients with a significant prognostic impact. In recent years an increasing number of minimally invasive and transcatheter treatments have been developed. The choice of the optimal transcatheter device therapy needs a careful patient selection and a dedicated anatomic assessment, mainly based on echocardiographic and computed tomography evaluation. Moreover, cardiac magnetic resonance has an established role in the functional assessment of right heart chambers with relevant prognostic implications. In this review we describe the role of multimodality imaging in the tricuspid valve disease assessment with an intervention-oriented perspective, from the pre-operative planning for different devices to the intraprocedural guide during transcatheter edge-to-edge repair.
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Affiliation(s)
- Fabio Fazzari
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy
| | - Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy
| | - Matteo Maurina
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy
| | - Renato Maria Bragato
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy
- Department of Radiology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan Italy
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11
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Bruoha S, Mangieri A, Ho EC, Goldberg Y, Chau M, Latib A. Transcatheter Annular Approaches for Tricuspid Regurgitation (Cardioband and Others). Interv Cardiol Clin 2021; 11:67-80. [PMID: 34838298 DOI: 10.1016/j.iccl.2021.09.002] [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
The tricuspid valve often is referred to as "the forgotten valve" because it frequently is managed conservatively due to poor prognostic outcomes with conventional surgical intervention, in particular, in high-risk patients. Nevertheless, a paradigm shift has occurred in recent years, due to a growing evidence base supporting the independent prognostic influence of severe tricuspid regurgitation (TR) on patient outcomes. Both transcatheter valve replacement and valve repair have emerged as feasible and efficacious interventions for TR correction. Novel transcatheter repair techniques that replicate surgical annuloplasty are evolving as potentially lower-risk alternatives.
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Affiliation(s)
- Sharon Bruoha
- Department of Cardiology, Montefiore Medical Center, 1825 Eastchester Road, Bronx, NY 10461, USA
| | - Antonio Mangieri
- Department of Invasive Cardiology, Humanitas Clinical and Reasearch Center, IRCCS, Via Manzoni, 56, Rozzano, Milan 20089, Italy
| | - Edwin C Ho
- Department of Cardiology, Montefiore Medical Center, 1825 Eastchester Road, Bronx, NY 10461, USA
| | - Ythan Goldberg
- Department of Cardiology, Montefiore Medical Center, 1825 Eastchester Road, Bronx, NY 10461, USA
| | - Mei Chau
- Department of Cardiology, Montefiore Medical Center, 1825 Eastchester Road, Bronx, NY 10461, USA
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, 1825 Eastchester Road, Bronx, NY 10461, USA.
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12
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Mesnier J, Alperi A, Panagides V, Bédard E, Salaun E, Philippon F, Rodés-Cabau J. Transcatheter tricuspid valve interventions: Current devices and associated evidence. Prog Cardiovasc Dis 2021; 69:89-100. [PMID: 34801577 DOI: 10.1016/j.pcad.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 11/14/2021] [Indexed: 11/15/2022]
Abstract
Tricuspid regurgitation (TR) is a common finding in patients with chronic cardiopathy, and often a marker of an advanced disease. Being silent or with symptoms intertwined with the primitive left heart disease, TR has often been neglected, leading to the late referral of patients with advanced right-heart failure. Hence, isolated tricuspid surgery has been associated with high morbidity and mortality rates, the worse of all valve interventions, and medical management has been limited to symptomatic treatment. In this context, percutaneous therapies for severe TR have gained traction, addressing the unmet therapeutic gap for a less invasive disease-modifying management. The aim of this review is to provide an updated overview on transcatheter tricuspid valve interventions, focusing on devices' characteristics, associated evidence, and future perspectives.
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Affiliation(s)
- Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Alberto Alperi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Vassili Panagides
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Elisabeth Bédard
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Erwan Salaun
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - François Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clínic Barcelona, Barcelona, Spain.
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13
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Parody-Cuerda G, Rodríguez-Caulo E, Barquero-Aroca JM. Tratamiento endovascular de la válvula tricúspide: estado actual. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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Rosch S, Lurz P. [Current technologies in interventional treatment of tricuspid valve regurgitation]. Herz 2021; 46:437-444. [PMID: 34374789 DOI: 10.1007/s00059-021-05056-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
For a long time, severe tricuspid valve regurgitation (TR) was an underestimated disease, especially in the older population and was associated with high morbidity and mortality. Due to the high perioperative mortality of tricuspid valve surgery, historically only pharmaceutical treatment was a practical treatment option. In the first studies interventional approaches could achieve promising results with an effective reduction of TR with simultaneous proof of a convincing safety profile. Conceptually, the currently available interventional treatment options can be divided into three concepts: coaptation systems (edge-to-edge repair), annuloplasty and interventional valve replacement. The largest clinical experience and best scientific body of evidence could so far be generated in the field of coaptation systems. Very promising preliminary results with effective reduction of TR and improvement of the clinical symptoms are, however, also available for interventional valve replacement. Meticulous preprocedural diagnostics with selection of the most suitable treatment option for each individual patient is paramount for successful treatment in this critically ill patient cohort. Future prospective randomized studies will investigate the net benefit of an interventional treatment of TR in comparison to a purely conservative treatment concept.
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Affiliation(s)
- Sebastian Rosch
- Klinik für Innere Medizin/Kardiologie, Universität Leipzig - Herzzentrum, Strümpellstraße 39, 04289, Leipzig, Deutschland
| | - Philipp Lurz
- Klinik für Innere Medizin/Kardiologie, Universität Leipzig - Herzzentrum, Strümpellstraße 39, 04289, Leipzig, Deutschland.
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Tricuspid Regurgitation: When and How to Treat. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00938-x] [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: 10/20/2022]
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16
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Rahgozar K, Ho E, Goldberg Y, Chau M, Latib A. Transcatheter tricuspid valve repair and replacement: a landscape review of current techniques and devices for the treatment of tricuspid valve regurgitation. Expert Rev Cardiovasc Ther 2021; 19:399-411. [PMID: 33834941 DOI: 10.1080/14779072.2021.1915133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background and ObjectiveTricuspid regurgitation is a prevalent and undertreated cardiac pathology impacting millions across the globe. While historically surgical interventions for isolated tricuspid regurgitation were largely avoided due to data citing poor surgical outcomes, advances in transcatheter techniques and imaging modalities have reframed the approach to tricuspid valve disease in promising new ways.MethodsHere we sought to provide a landscape review of the current state of the field for transcatheter tricuspid valve interventions. We first start with a descriptive overview of the tricuspid valve, reviewing the anatomy, imaging characteristics, and the current guidelines for tricuspid interventions. We then review both transcatheter valve repair and valve replacement modalities, highlighting the devices, techniques, and valves currently under investigation, summarizing available outcomes data for each modality when possible.Results and ConclusionOur aim in writing this landscape review is the create an all-encompassing, up-to-date resource for clinicians to refer to when seeking to learn about the current state of transcatheter tricuspid valve interventions. We also hope to highlight the exciting promise of transcatheter tricuspid valve replacement in appropriate patients, and review the valves currently under development for use in the tricuspid position.
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Affiliation(s)
- Kusha Rahgozar
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Edwin Ho
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ythan Goldberg
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mei Chau
- Department of Cardiothoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Transcatheter Interventions for Tricuspid Valve Disease: What to Do and Who to Do It On. Can J Cardiol 2021; 37:953-967. [PMID: 33493660 DOI: 10.1016/j.cjca.2020.12.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/01/2020] [Accepted: 12/14/2020] [Indexed: 11/21/2022] Open
Abstract
Tricuspid valve disease, and particularly the management of severe tricuspid regurgitation (TR), has gained momentum in recent years. Although it is well known that this frequent condition is associated with poor clinical outcomes, these patients have been classically managed medically, leading to end-stage right ventricular heart failure. Moreover, late referral to surgery has contributed to a high rate of periprocedural complications and in-hospital surgical mortality. Thus, the development of a less invasive catheter-based therapy would be of high clinical relevance in this context. Several transcatheter tricuspid valve intervention (TTVI) devices have been developed in recent years. The particular characteristics of the tricuspid valve (large noncalcific annulus, presence of chief surrounding structures such as the conduction system or the right coronary artery) make multimodality imaging (eg, transesophageal echocardiography, computed tomography) key in the preprocedural assessment of TTVI. According to their mechanism of action and therapeutic target, TTVI includes transcatheter repair either with coaptation or annuloplasty systems, caval valve devices, and transcatheter tricuspid valve replacement. The initial TTVI experience showed that most procedures were well tolerated, with high procedural success and low in-hospital and early mortality. Also, most TTVI recipients improved their functional status and recent data suggest improved outcomes compared with medical management. However, the rate of significant residual TR after transcatheter tricuspid valve repair remains high and very scarce data exist on longer term (beyond 6-12 months) outcomes. The present review provides an overview regarding the framework of chronic TR and TTVI therapeutic options, and describes the updated current evidence in this challenging field.
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Zhao F, Chen Q, Guo Z, Jiang N. Thoracoscopic assistance in tricuspid valvuloplasty in an unarrested state: a case report and literature review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1607. [PMID: 33437806 PMCID: PMC7791200 DOI: 10.21037/atm-20-6995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Tricuspid regurgitation, a common tricuspid lesion, consists of organic and functional tricuspid insufficiency (FTI). FTI is usually secondary to the valvular heart disease in left atrium. Pulmonary hypertension may result in right ventricular and tricuspid annular enlargement. This report documents our findings of tricuspid valve surgery under cardiac arrest with telescopic assistance. A 65-year-old female patient referred to our department received thoracoscope-associated tricuspid valvuloplasty. The patient exhibited a history of intermittent dyspnea and shortness of breath for 20 years, together with edema in the lower limbs for 3 months. A small incision was made, prior to an additional incision of about 3 cm in length before localization was performed at the lateral side of the 4th midclavicular line. The satellite hole was localized at the 5th midaxillary line. The operation was completed under cardiopulmonary bypass with a beating heart. Echocardiogram (ECG) analysis 10 days post-surgery indicated no clinically significant findings. Finally, the patient was discharged with slight tricuspid regurgitation .Thoracoscopy-associated heart surgery reduces postoperative pain and shortens postoperative recovery time. It is in line with the concept of rapid recovery and beauty needs. Our data confirmed that thoracoscope-assisted tricuspid valvuloplasty in an unarrested state was effective for the treatment of patients with tricuspid insufficiency, secondary to post-cardiac surgery.
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Affiliation(s)
- Feng Zhao
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin University, Tianjin, China
| | - Qingliang Chen
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin University, Tianjin, China
| | - Zhigang Guo
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin University, Tianjin, China
| | - Nan Jiang
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin University, Tianjin, China
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19
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Functional tricuspid regurgitation: indications, techniques, and outcomes. Indian J Thorac Cardiovasc Surg 2020; 36:131-139. [PMID: 33061194 DOI: 10.1007/s12055-019-00915-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022] Open
Abstract
Functional tricuspid regurgitation (TR) results from asymmetric dilation of the tricuspid valve annulus. This often occurs due to right ventricular enlargement and dysfunction as a consequence of myocardial or valvular abnormalities of the left heart. Even mild TR at the time of left-sided valvular surgery may worsen postoperatively, which carries poor prognostic implications. In spite of data revealing poor outcomes associated with residual TR, surgery for functional TR remains underutilized. Surgical repair techniques for TR include placement of a rigid or semi-rigid tricuspid annular ring, which has been shown to provide superior longevity compared with suture and flexible band repair techniques. Additionally, emerging percutaneous annuloplasty techniques to correct functional TR can expand interventional treatment options to patients who would otherwise carry prohibitive operative risk.
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20
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Abstract
Tricuspid regurgitation (TR) is a highly prevalent echocardiographic finding in general population being present in almost 80% to 90% of them. However, TR is mild or functional rather than organic in majority of people. Significant TR was seen in 14.8% of adult men and 18.4% of adult women, respectively. Of all the significant TRs, approximately 8% to 10% are primary. Mild TR is benign but moderate-to-severe TR tends to progress and carries significant morbidity and mortality. Tricuspid valve disease is either primary or secondary (functional) in nature. Valve leaflets are predominantly diseased in primary TR, whereas annular dilatation is the main culprit in secondary TR. Of all the heart valves, tricuspid valve was the most neglected valve till a decade ago, though there was enough evidence to show that moderate to severe TR was not as benign as was assumed. With the availability of 2-dimensional echocardiography (2D echo) and transesophageal echocardiography, we are able to diagnose and determine the severity as well as etiology of TR. Although surgical therapy remains the gold standard for severe primary tricuspid valve disease, it continues to suffer from one of the highest morbidity and mortality rates among all cardiac valve-related surgeries even in the hands of experienced surgeons. For the same reason, majority of patients are not referred or subjected to surgical therapy. Therefore, there is an unmet need for less invasive and safer form of therapy to overcome this hurdle. So, several less-invasive and innovative technologies for treating patients with severe tricuspid valve disease at high surgical risk are being developed. Some of them have already been used for treatment of severe mitral regurgitation. They are being adopted for the treatment of severe TR. This review provides a comprehensive picture of newer guidelines and latest technologies and their impact on diagnosis and outcome of high-risk TV disease.
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21
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Goyal A, Krishnaswamy A. Percutaneous Valve Interventions in Heart Failure. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00841-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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22
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Santaló-Corcoy M, Asmarats L, Li CH, Arzamendi D. Catheter-based treatment of tricuspid regurgitation: state of the art. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:964. [PMID: 32953764 PMCID: PMC7475403 DOI: 10.21037/atm.2020.03.219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Tricuspid regurgitation is a highly prevalent condition, with detrimental effects on long-term survival. However, it has been historically neglected, and only surgically addressed when symptomatic diuretic agents proved insufficient to alleviate congestion. Besides, mortality rates of isolated tricuspid regurgitation surgery have been persistently high, even in contemporary series. This has led to the advent of a myriad of transcatheter tricuspid valve interventions mimicking current surgical technologies, for which a comprehensive imaging work-up holds the key for proper patient selection and intraprocedural monitoring. Although initially designed for compassionate use patients, growing experience and encouraging results of these less-invasive technologies are broadening the spectrum of beneficiaries. In this review, we will focus on the current picture of transcatheter tricuspid valve interventions, with special interest on the current understanding of pathoanatomic tricuspid regurgitation progression, preprocedural multimodality imaging and the latest experience on the different transcatheter devices.
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Affiliation(s)
- Marcel Santaló-Corcoy
- Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lluís Asmarats
- Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Chi-Hion Li
- Division of Cardiac Imaging, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Dabit Arzamendi
- Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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23
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Alushi B, Vathie K, Thiele H, Lauten A. Transcatheter therapies for severe tricuspid regurgitation. Quo vadis? Herz 2020; 46:234-241. [PMID: 32468139 DOI: 10.1007/s00059-020-04941-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/13/2020] [Accepted: 05/04/2020] [Indexed: 11/25/2022]
Abstract
Moderate-to-severe tricuspid regurgitation (TR) is common and is associated with a poor prognosis. To date, most patients are undertreated; therefore, transcatheter options could be clinically impactful in those who are denied surgery. Several transcatheter solutions have been developed that address the problem via leaflet enhancement, annuloplasty, or heterotopic implantation of self-expandable or balloon-expandable valves in the caval veins. A comprehensive patient evaluation, based on multimodality imaging techniques for a better understanding of the valvular pathology and TR mechanism, remains paramount for an appropriate device selection. To date, several trials have shown the feasibility and safety of a multitude of devices in this setting, but data from randomized clinical trials regarding clinical benefit based on hard endpoints are still lacking. Although the optimal patient profile and timing of intervention remain under investigation, data from available studies indicate that an earlier treatment referral, before onset of irreversible right ventricular remodeling, could be beneficial. This review discusses the present landscape and future implications of transcatheter therapies for severe TR.
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Affiliation(s)
- Brunilda Alushi
- Department of General and Interventional Cardiology, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089, Erfurt, Germany.
- Department of Cardiology, Campus Benjamin Franklin, Charité Medical University Berlin, Berlin, Germany.
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany.
| | - Kourosh Vathie
- Department of General and Interventional Cardiology, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089, Erfurt, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Alexander Lauten
- Department of General and Interventional Cardiology, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089, Erfurt, Germany
- Department of Cardiology, Campus Benjamin Franklin, Charité Medical University Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
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Abstract
Heart valve diseases are common disorders with five million annual diagnoses being made in the United States alone. All heart valve disorders alter cardiac hemodynamic performance; therefore, treatments aim to restore normal flow. This paper reviews the state-of-the-art clinical and engineering advancements in heart valve treatments with a focus on hemodynamics. We review engineering studies and clinical literature on the experience with devices for aortic valve treatment, as well as the latest advancements in mitral valve treatments and the pulmonic and tricuspid valves on the right side of the heart. Upcoming innovations will potentially revolutionize treatment of heart valve disorders. These advancements, and more gradual enhancements in the procedural techniques and imaging modalities, could improve the quality of life of patients suffering from valvular disease who currently cannot be treated.
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Affiliation(s)
- Gil Marom
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv Israel
- To whom correspondence should be addressed. E-mail:
| | - Shmuel Einav
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
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25
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Kolte D, Elmariah S. Current state of transcatheter tricuspid valve repair. Cardiovasc Diagn Ther 2020; 10:89-97. [PMID: 32175231 PMCID: PMC7044094 DOI: 10.21037/cdt.2019.09.11] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/09/2019] [Indexed: 11/06/2022]
Abstract
Tricuspid regurgitation (TR) is a common valvular heart disease affecting >1.6 million people in the United States (US) and >70 million people worldwide. The age- and sex-adjusted prevalence of more than or equal to moderate TR in the US is estimated to be 0.55%. One-year mortality increases with increasing severity of TR. Yet, the majority of patients with severe TR are managed medically in the absence of another indication for cardiac surgery, and isolated tricuspid valve (TV) surgery remains infrequent. To address this unmet clinical need, various transcatheter TV therapies are now being developed as an alternative to surgery in extreme- and high-risk patients with severe functional TR. Transcatheter TV repair devices are aimed at improving leaflet coaptation either directly by bringing the leaflets together (leaflet/coaptation devices) or indirectly by repairing the dilated annulus (annuloplasty devices). In this review, we describe the current state of transcatheter TV repair therapies and summarize the available data on the efficacy and safety of various devices. Procedural and clinical outcomes of transcatheter TV repair therapies are expected to improve in the coming years with technological advancement, newer device iterations, and increased experience in this field. Appropriate patient selection, optimal timing of intervention, and evaluation of long-term outcomes and device durability will be key in ongoing and future studies.
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Affiliation(s)
- Dhaval Kolte
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sammy Elmariah
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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26
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Voci D, Pozzoli A, Miura M, Gavazzoni M, Gülmez G, Scianna S, Zuber M, Maisano F, Taramasso M. Developments in transcatheter tricuspid valve therapies. Expert Rev Cardiovasc Ther 2019; 17:841-856. [PMID: 31795771 DOI: 10.1080/14779072.2019.1699056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: Transcatheter tricuspid valve (TV) procedures emerged as an alternative to surgery for symptomatic high-risk patients with severe tricuspid regurgitation.Areas covered: A literature search was performed using PubMed. Authors review clinical evidence in this field, the imaging features and the developments in TV transcatheter technologies. Currently, transcatheter devices for TV procedures can be allocated into four main groups: 1) those ones targeting leaflet malcoaptation, 2) those addressing annular dilatation, 3) those performing heterotopic valve implantation and 4) those onesaccomplishing a complete transcatheter replacement of the valve.Expert opinion: Actually, encouraging results are provided by initial experience in the field of transcatheter TV procedures. However, this field remains full of challenges that faced could lead to better results and prognosis for the patients. The next steps in this emerging field will need to focus on accurate patient selection, an early patient referral and on studies comparable and providing long-term data.
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Affiliation(s)
- Davide Voci
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Alberto Pozzoli
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Mizuki Miura
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Mara Gavazzoni
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Gökhan Gülmez
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Salvatore Scianna
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Michel Zuber
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Francesco Maisano
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Maurizio Taramasso
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
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27
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Imaging Needs in Novel Transcatheter Tricuspid Valve Interventions. JACC Cardiovasc Imaging 2019; 11:736-754. [PMID: 29747849 DOI: 10.1016/j.jcmg.2017.10.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 09/26/2017] [Accepted: 10/05/2017] [Indexed: 02/01/2023]
Abstract
The advent of novel transcatheter therapies for severe tricuspid regurgitation (TR) has attracted much attention. Novel 3-dimensional imaging techniques have permitted analysis of the tricuspid valve (TV) anatomy from unparalleled views and better understanding of the underlying pathophysiology of TR. Grading TR and assessment of right ventricular function remain challenging, and although 2-dimensional echocardiography is the mainstay imaging technique to evaluate patients with severe TR the use of 3-dimensional echocardiography and cardiovascular magnetic resonance is increasing. The number of transcatheter interventions for TR is growing, and procedural success relies significantly on the pre-procedural evaluation of the anatomy of the TV, etiology and severity of TR, right ventricular size and function, and importantly, the anatomic relationships of the TV. The role of multimodality imaging in patient selection and procedural planning for transcatheter TV repair is reviewed.
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28
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Gallet R, Ternacle J, Teiger E. [Transcatheter treatment of tricuspid regurgitation]. Ann Cardiol Angeiol (Paris) 2019; 68:480-485. [PMID: 31668340 DOI: 10.1016/j.ancard.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Tricuspid regurgitation is serious disease for which surgical correction is underperformed because of a prohibitive risk. It is responsible for a 50% mortality at 3 years which is decreased by surgical treatment. However, only a negligible proportion of patients undergoes surgery. In this context, there is currently an unmet need for percutaneous treatment technique. Several technologies are undergoing preclinical or early clinical development. These techniques aim to mimic the different surgical strategies used for the treatment of tricuspid regurgitation. Thus, some target the leaflets, the tricuspid annulus or offer a complete tricuspid valve replacement. Before planning a transcatheter tricuspid intervention, a comprehensive evaluation is mandatory, addressing the patient clinical status and comorbidities, the tricuspid regurgitation ad its consequences on right heart and, the anatomy of the tricuspid annulus and the right heart to determine if the patient is eligible for the chosen technique. This article will review the indications, contraindications and exams to perform before transcatheter tricuspid intervention and will then detail the different strategies available or undergoing development.
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Affiliation(s)
- R Gallet
- Service de Cardiologie, CHU Henri-Mondor, 51, avenue du Maréchal de Lattre de-Tassigny, 94010 Créteil, France.
| | - J Ternacle
- Service de Cardiologie, CHU Henri-Mondor, 51, avenue du Maréchal de Lattre de-Tassigny, 94010 Créteil, France
| | - E Teiger
- Service de Cardiologie, CHU Henri-Mondor, 51, avenue du Maréchal de Lattre de-Tassigny, 94010 Créteil, France
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29
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Oliveira DC, Oliveira CGC. The Forgotten, Not Studied or Not Valorized Tricuspid Valve: The Transcatheter Revolution Is Coming. Cardiol Res 2019; 10:199-206. [PMID: 31413775 PMCID: PMC6681841 DOI: 10.14740/cr874] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/03/2019] [Indexed: 12/30/2022] Open
Abstract
The tricuspid valve (TV) has been known as the forgotten valve. However, considering recent information from scientific studies, this nomenclature may need to be adjusted for the valve, which also needs to be better studied and understood. For decades, tricuspid regurgitation (TR) was not fully appreciated and was never the priority. However, studies have revealed that such pathology is related to a possible negative impact on prognosis of patients. Severe TR is a predictor of higher mortality. For the treatment of TR, repair or valve replacement can be performed. Repair techniques can be performed on the annulus (suture annuloplasty or ring implant), on the leaflets (e.g. triangular resection), on the cords (transfers or new cords) and on the papillary muscles (e.g. sliding technique). The anatomical characteristics of the TV determine the repair technique to be used. In some cases, valve repair is not possible and/or not indicated and valve replacement is selected based on the strategy. Nowadays transcatheter therapies have been used and studied. The main transcatheter strategies for the treatment of TR are based on reduction of the annulus (Cardioband, Trialign, TriCinch, Millipede and TRAIPTA), improvement of the leaflet coaptation (Mitraclip, FORMA device, PASCAL system, and TV occluder), reduction of the reflux for the vena cava system (Tric valve and Sapien valve implant), and valve implants (Navigate, Trisol, Sapien, Melody). In this context, there are still other devices (such as Tricentro, Pasta, etc.) being developed and tested throughout several phases of research. In the future, improved knowledge of the TV and the evolution of transcatheter treatments will alter the history of the TV. The transcatheter revolution is coming!
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Affiliation(s)
- Dinaldo C Oliveira
- Federal University of Pernambuco, Recife, Pernambuco, Brazil.,Hospital Ilha do Leite, Recife, Pernambuco, Brazil
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30
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Abstract
PURPOSE OF REVIEW This review discusses the normal anatomy and pathology of the tricuspid valve (TV) and right side of the heart. Emphasis is on those anatomic and pathologic features relevant to interventions intended to restore normal function to the TV in disease states. RECENT FINDINGS TV pathology is less common than aortic and mitral valve pathology, and treatment and outcomes for interventions face considerable hurdles. New innovations and early data showing safety and efficacy in transcatheter interventions have transformed TV interventions into the next frontier in cardiac valve disease treatment. Certain features of the TV and right heart have presented themselves as potential targets, as well as impediments, for TV intervention. The causes of TV pathology and the anatomy of the TV and right heart bring unique challenges to intervention. Approaches to intervention will continue to progress and change the way we view and treat TV pathology.
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Affiliation(s)
- Ryan P Lau
- David Geffen School of Medicine at University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Gregory A Fishbein
- David Geffen School of Medicine at University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Michael C Fishbein
- David Geffen School of Medicine at University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
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Curio J, Demir OM, Pagnesi M, Mangieri A, Giannini F, Weisz G, Latib A. Update on the Current Landscape of Transcatheter Options for Tricuspid Regurgitation Treatment. ACTA ACUST UNITED AC 2019; 14:54-61. [PMID: 31178930 PMCID: PMC6545971 DOI: 10.15420/icr.2019.5.1] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/21/2019] [Indexed: 11/04/2022]
Abstract
Most patients with severe tricuspid regurgitation lack treatment options because of prohibitive surgical risk. New transcatheter treatments under development and investigation might be able to address this unmet clinical need. This article gives an update on the landscape of devices for transcatheter tricuspid regurgitation treatment including different approaches (i.e. repair with leaflet approximation or annuloplasty and replacement using orthotopic or heterotopic valves) at different stages of development, from experimental to clinical trial. Repair devices such as the Cardioband or the MitraClip are leading the field with promising preliminary data and further trials are ongoing. However, with implantations of the Gate bioprosthesis, replacement devices are catching up. Potential advantages of different approaches and most recent data are discussed.
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Affiliation(s)
- Jonathan Curio
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute Milan, Italy.,Charité University Medical Care Berlin, Germany
| | - Ozan M Demir
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust London, UK
| | - Matteo Pagnesi
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital Cotignola, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital Cotignola, Italy
| | - Giora Weisz
- Department of Cardiology, Montefiore Medical Center New York, NY, US
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center New York, NY, US
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Abstract
PURPOSE OF REVIEW This review aims to provide an updated overview and a clinical perspective on novel transcatheter tricuspid valve interventions (TTVI), highlighting potential challenges and future directions. RECENT FINDINGS Severe tricuspid regurgitation (TR) is a predictor of mortality. However, a sizeable number of patients remain untreated until the end-stage when cardiac surgery presents a prohibitive risk. The emergent need in finding a treatment for patients with TR, deemed for surgery options, has encouraged the development of TTVI. These procedures mimic classical surgery techniques and are mainly divided in four categories: annuloplasty and coaptation devices, edge-to-edge techniques and transcatheter tricuspid valve replacement. Early studies showed promising results, but long-term follow-up data are not available. For patients with severe TR and high surgical risk, several percutaneous options are available. However, these therapies are in a growing phase and bigger studies and long term follow-up are needed to prove their efficacy.
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Khan JM, Rogers T, Schenke WH, Greenbaum AB, Babaliaros VC, Paone G, Ramasawmy R, Chen MY, Herzka DA, Lederman RJ. Transcatheter pledget-assisted suture tricuspid annuloplasty (PASTA) to create a double-orifice valve. Catheter Cardiovasc Interv 2018; 92:E175-E184. [PMID: 29405564 PMCID: PMC6078835 DOI: 10.1002/ccd.27531] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 01/15/2018] [Accepted: 01/15/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Pledget-assisted suture tricuspid valve annuloplasty (PASTA) is a novel technique using marketed equipment to deliver percutaneous trans-annular sutures to create a double-orifice tricuspid valve. BACKGROUND Tricuspid regurgitation is a malignant disease with high surgical mortality and no commercially available transcatheter solution in the US. METHODS Two iterations of PASTA were tested using trans-apical or trans-jugular access in swine. Catheters directed paired coronary guidewires to septal and lateral targets on the tricuspid annulus under fluoroscopic and echocardiographic guidance. Guidewires were electrified to traverse the annular targets and exchanged for pledgeted sutures. The sutures were drawn together and knotted, apposing septal and lateral targets, creating a double orifice tricuspid valve. RESULTS Twenty-two pigs underwent PASTA. Annular and chamber dimensions were reduced (annular area, 10.1 ± 0.8 cm2 to 3.8 ± 1.5 cm2 (naïve) and 13.1 ± 1.5 cm2 to 6.2 ± 1.0 cm2 (diseased); septal-lateral diameter, 3.9 ± 0.3 mm to 1.4 ± 0.6 mm (naïve) and 4.4 ± 0.4 mm to 1.7 ± 1.0 mm (diseased); and right ventricular end-diastolic volume, 94 ± 13 ml to 85 ± 14 ml (naïve) and 157 ± 25 ml to 143 ± 20 ml (diseased)). MRI derived tricuspid regurgitation fraction fell from 32 ± 12% to 4 ± 5%. Results were sustained at 30 days. Pledget pull-through force was five-fold higher (40.6 ± 11.7N vs 8.0 ± 2.6N, P < .01) using this strategy compared to single puncture techniques used to anchor current investigational devices. Serious complications were related to apical access. CONCLUSIONS PASTA reduces annular dimensions and tricuspid regurgitation in pigs. It may be cautiously applied to selected patients with severe tricuspid regurgitation and no options. This is the first transcatheter procedure, to our knowledge, to deliver standard pledgeted sutures to repair cardiac pathology.
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Affiliation(s)
- Jaffar M. Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - William H. Schenke
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Adam B. Greenbaum
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Vasilis C Babaliaros
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Gaetano Paone
- Division of Cardiac Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marcus Y. Chen
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Daniel A. Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Multi-Modality Imaging in the Evaluation and Treatment of Tricuspid Regurgitation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:77. [PMID: 30094651 DOI: 10.1007/s11936-018-0672-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW The goal of this review is to cover the epidemiology of tricuspid regurgitation (TR), anatomy of the tricuspid valve (TV), and the mechanisms and modern treatment of TR. The focus will be on the role of echocardiography, cardiac CT, and MRI to determine the mechanism, severity, and management strategies of TR. RECENT FINDINGS The evaluation and management of TR is a rapidly growing field with significant advances in both imaging and interventions. Important advances have been made to understand TV anatomy and physiology in 3D echo, CT, and MRI. Additional understanding of the abnormal outcomes in both primary TR and secondary TR have been appreciated. Multiple transcatheter devices have reached the stage of early trials in high surgical risk cohorts with favorable initial findings. TR is a significant cardiovascular problem and vastly undertreated in the present era. There has been tremendous growth in knowledge of mechanisms of TR, its prognostic implications, timing of intervention, and development of novel treatment strategies. Multimodality imaging plays a key role in evaluation and treatment of this condition.
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Grasso C, Popolo Rubbio A, Braun D, Hausleiter J, Nickenig G. Transcatheter treatment of tricuspid regurgitation (focusing on current technologies). EUROINTERVENTION 2018; 14:AB112-AB120. [DOI: 10.4244/eij-d-18-00520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Asmarats L, Puri R, Latib A, Navia JL, Rodés-Cabau J. Transcatheter Tricuspid Valve Interventions. J Am Coll Cardiol 2018; 71:2935-2956. [DOI: 10.1016/j.jacc.2018.04.031] [Citation(s) in RCA: 183] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/29/2018] [Accepted: 04/15/2018] [Indexed: 01/11/2023]
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Taramasso M, Pozzoli A, Guidotti A, Nietlispach F, Inderbitzin DT, Benussi S, Alfieri O, Maisano F. Percutaneous tricuspid valve therapies: the new frontier. Eur Heart J 2018; 38:639-647. [PMID: 26802134 DOI: 10.1093/eurheartj/ehv766] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 12/28/2015] [Indexed: 11/13/2022] Open
Abstract
Moderate-to-severe tricuspid regurgitation (TR) affects ∼1.6 million patients in the USA, of whom only 8000 undergo tricuspid surgery annually; this results in an extremely large number of untreated patients with significant TR. Therefore, there is a large unmet clinical need for patients with severe TR who are not referred for conventional surgery, mainly due to expected high surgical risk. Percutaneous procedures are an attractive alternative to surgery for patients deemed to be high-risk surgical candidates. Whereas over the past few years, the development and clinical use of percutaneous approaches to the aortic valve and mitral valve have been widespread, few data are available about the feasibility and the efficacy of the percutaneous tricuspid valve treatment. This review will explore the available technologies, which are today under evaluation and the preliminary clinical results.
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Affiliation(s)
- Maurizio Taramasso
- Herz-Gefäss Chirurgie, UniversitätsSpital Zürich, University of Zürich, Rämistrasse 100, Zurich 8091, Switzerland
| | - Alberto Pozzoli
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Andrea Guidotti
- Herz-Gefäss Chirurgie, UniversitätsSpital Zürich, University of Zürich, Rämistrasse 100, Zurich 8091, Switzerland
| | - Fabian Nietlispach
- Klinik für Kardiologie, UniversitätsSpital Zürich, University of Zürich, Zurich, Switzerland
| | - Devdas T Inderbitzin
- Herz-Gefäss Chirurgie, UniversitätsSpital Zürich, University of Zürich, Rämistrasse 100, Zurich 8091, Switzerland
| | - Stefano Benussi
- Herz-Gefäss Chirurgie, UniversitätsSpital Zürich, University of Zürich, Rämistrasse 100, Zurich 8091, Switzerland
| | - Ottavio Alfieri
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Francesco Maisano
- Herz-Gefäss Chirurgie, UniversitätsSpital Zürich, University of Zürich, Rämistrasse 100, Zurich 8091, Switzerland
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Van Praet KM, Stamm C, Starck CT, Sündermann S, Meyer A, Montagner M, Nazari Shafti TZ, Unbehaun A, Jacobs S, Falk V, Kempfert J. An overview of surgical treatment modalities and emerging transcatheter interventions in the management of tricuspid valve regurgitation. Expert Rev Cardiovasc Ther 2018; 16:75-89. [DOI: 10.1080/14779072.2018.1421068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Karel M. Van Praet
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Christof Stamm
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- Department of Cardiothoracic Surgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph T. Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Simon Sündermann
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Alexander Meyer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Matteo Montagner
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Timo Z. Nazari Shafti
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Axel Unbehaun
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Stephan Jacobs
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic Surgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
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Tratamientos percutáneos de la valvulopatía tricuspídea: una nueva esperanza para la válvula «olvidada». Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2017.04.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Abstract
PURPOSE OF REVIEW Tricuspid regurgitation is common; however, recognition and diagnosis, clinical outcomes, and management strategies are poorly defined. Here, we will describe the etiology and natural history of tricuspid regurgitation (TR), evaluate existing surgical outcomes data, and review the evolving field of percutaneous interventions to treat TR. RECENT FINDINGS Previously, the only definitive corrective therapy for TR was surgical valve repair or replacement which is associated with significant operative mortality. Advances in percutaneous valve repair techniques are now being translated to the tricuspid valve. These novel interventions may offer a lower-risk alternative treatment in patients at increased surgical risk. Significant TR adversely impacts survival. Surgery remains the only proven therapy for treatment of TR and may be underutilized due to mixed outcomes data. Early experience with percutaneous interventions is promising, but large clinical experience is lacking. Further study will be required before these therapies are introduced into broader clinical practice.
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Mangieri A, Montalto C, Pagnesi M, Jabbour RJ, Rodés-Cabau J, Moat N, Colombo A, Latib A. Mechanism and Implications of the Tricuspid Regurgitation. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005043. [DOI: 10.1161/circinterventions.117.005043] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/15/2017] [Indexed: 01/28/2023]
Abstract
The tricuspid valve was virtually ignored for a long time in the past. However, significant tricuspid regurgitation (TR) often accompanies left-side heart valve pathology and does not always reverse with its correction. If left untreated, TR can progress and result in progressive right ventricular failure. Current guideline recommendations still hold minor differences. Nevertheless, there is a consensus to operate on patients with severe TR undergoing left-sided valve surgery (class I) or those with mild to moderate TR with a dilated annulus (≥40 or ≥21 mm
2
, Class IIa). However, in case of the primary TR, surgical options is limited by a relatively high risk of mortality and morbidity. For these patients, new percutaneous approaches are becoming available but no long-term data are still available. In this review, we provide a comprehensive overview of the epidemiological and pathophysiological aspects of TR, and the current and future directions of therapy.
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Affiliation(s)
- Antonio Mangieri
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Claudio Montalto
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Matteo Pagnesi
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Richard J. Jabbour
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Josep Rodés-Cabau
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Neil Moat
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Antonio Colombo
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Azeem Latib
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
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Campelo-Parada F, Lairez O, Carrié D. Percutaneous Treatment of the Tricuspid Valve Disease: New Hope for the "Forgotten" Valve. ACTA ACUST UNITED AC 2017. [PMID: 28645836 DOI: 10.1016/j.rec.2017.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tricuspid valve disease is a frequent condition but is currently undertreated. A limited number of patients undergo an isolated surgical tricuspid repair, and this intervention is associated with poor outcomes, especially in patients with previous cardiac surgery. Most patients are only medically treated, despite the impact of severe tricuspid regurgitation on functional status and long-term survival. Transcatheter therapies represent a promising alternative for patients with severe tricuspid regurgitation and high surgical risk. In the last few years, several percutaneous alternatives have been developed for the treatment of functional tricuspid regurgitation. Imaging techniques play an indispensable role in patient selection, procedural guidance and follow-up. The current available transcatheter options for native tricuspid valve disease can be divided into 3 main groups: heterotopic caval valve implantation, annuloplasty devices, and coaptation devices. In patients with previous tricuspid valve surgery, transcatheter valve-in-valve and valve-in-ring procedures have been reported. This review provides a detailed analysis of the novel transcatheter alternatives for the treatment of tricuspid valve disease that have already been successfully implanted in humans, as well as the most important aspects of tricuspid valve anatomy and imaging assessment.
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Affiliation(s)
| | - Olivier Lairez
- Department of Cardiology, Rangueil University Hospital, CHU Toulouse, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, Rangueil University Hospital, CHU Toulouse, Toulouse, France
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Aleman J, Adkins A, Boies L, Al-Quiati F, Sako E, Bhattacharya S. Effects of Cinching Force on the Tricuspid Annulus: A Species Comparison. JOURNAL OF CARDIOVASCULAR DISEASES & DIAGNOSIS 2017; 5:283. [PMID: 29911126 PMCID: PMC6002154 DOI: 10.4172/2329-9517.1000283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
PURPOSE Tricuspid annuloplasty rings are commonly used to cinch an enlarged tricuspid annulus back to its original shape and size in patients with severe functional tricuspid regurgitation. However, the invasive operation is contraindicated for patients at risk for reoperation. Fortunately, transcatheter repair procedures, currently in the development process, are minimally invasive alternatives to current repair techniques. This study aims to determine the species-dependence of cinching force with the potential of informing transcatheter repair design by quantifying the minimum required cinching force necessary to reduce tricuspid regurgitation. METHODS The cinching force necessary to reduce the septal-lateral diameter of a dilated annuls was quantified and compared in ten ovine hearts and nine porcine hearts. Additionally, a deparaffinization protocol and Verhoeff-Van Gieson stain were used to compare the microscopic structure of tissue samples at different stages of the experimental procedure in the two species. RESULTS The maximum annulus dilation observed for the porcine was 11.2%, and the maximum cinching force was 0.40 ± 0.12 N. As previously demonstrated, ovine hearts yielded a maximum annulus dilation and cinching force of 8.82% and 0.38 ± 0.09 N respectively. Histological stains revealed no gross tissue differences between ovine and porcine septal or free wall tissues. CONCLUSION The cinching force was not species dependent between ovine and porcine models. This study is an essential first step for determining which animal model should be utilized for the development of transcatheter devices.
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Affiliation(s)
- Jesus Aleman
- School of Science, Engineering, and Technology, St. Mary’s University, 1 Camino Santa Maria, San Antonio, Texas, USA
| | - Amy Adkins
- School of Science, Engineering, and Technology, St. Mary’s University, 1 Camino Santa Maria, San Antonio, Texas, USA
| | - Lori Boies
- School of Science, Engineering, and Technology, St. Mary’s University, 1 Camino Santa Maria, San Antonio, Texas, USA
| | - Fatima Al-Quiati
- School of Science, Engineering, and Technology, St. Mary’s University, 1 Camino Santa Maria, San Antonio, Texas, USA
| | - Edward Sako
- Department of Cardiothoracic Surgery, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Shamik Bhattacharya
- School of Science, Engineering, and Technology, St. Mary’s University, 1 Camino Santa Maria, San Antonio, Texas, USA
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Jabbour RJ, Giannini F, Tanaka A, Mangieri A, Mikhail GW, Latib A, Colombo A. Advances in percutaneous interventional therapies: the tricuspid valve. Future Cardiol 2017; 13:239-245. [PMID: 28560929 DOI: 10.2217/fca-2016-0072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Tricuspid regurgitation (TR) is a prevalent valve condition, with an estimated 1.6 million people in the USA living with moderate or greater severity. Functional TR, which predominantly develops due to left-sided heart disease, is the predominant condition affecting the tricuspid valve in the Western world and severe TR is associated with substantial morbidity and mortality. In part, due to a prolonged latency period with insidious symptoms, patients are often referred for surgery at advanced stages, with associated increased or prohibitive surgical risk. In addition, surgical treatment can result in high rates of recurrence. Therefore, there is an unmet need for percutaneous therapies that may provide a relatively low-risk treatment option. There are several devices with early human feasibility data available that will be reviewed in this article.
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Affiliation(s)
- Richard J Jabbour
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Department of Cardiology, Imperial College, London, UK
| | - Francesco Giannini
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Akihito Tanaka
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | | | - Azeem Latib
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
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Hahn RT. Current transcatheter devices to treat functional tricuspid regurgitation with discussion of issues relevant to clinical trial design. Ann Cardiothorac Surg 2017; 6:240-247. [PMID: 28706866 DOI: 10.21037/acs.2017.03.10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Functional or secondary tricuspid regurgitation (TR) has seen increased attention in recent times as relationships with clinically-relevant outcomes have come to light. Despite the association of increased mortality with significant TR, the disease remains under-recognized and thus relatively untreated. In addition, the disease itself has not been extensively studied and the interactions between annular dilatation, right heart disease and pulmonary hypertension are poorly understood. However, the high mortality and recurrence rate with current surgical replacement or repair techniques is well recognised, opening the door to transcatheter therapies for functional TR. The current perspective reviews the rationale for transcatheter solutions, describes some of the current approaches and discusses the ongoing questions of a poorly-studied condition which may limit the design of clinical trials for this disease.
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Affiliation(s)
- Rebecca T Hahn
- Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
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Fender EA, Nishimura RA, Holmes DR. Percutaneous therapies for tricuspid regurgitation. Expert Rev Med Devices 2016; 14:37-48. [DOI: 10.1080/17434440.2017.1268912] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Erin A. Fender
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Rick A. Nishimura
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - David R. Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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Hahn RT. State-of-the-Art Review of Echocardiographic Imaging in the Evaluation and Treatment of Functional Tricuspid Regurgitation. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.005332. [DOI: 10.1161/circimaging.116.005332] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Functional or secondary tricuspid regurgitation (TR) is the most common cause of severe TR in the Western world. The presence of functional TR, either isolated or in combination with left heart disease, is associated with unfavorable natural history. Surgical mortality for isolated tricuspid valve interventions remains higher than for any other single valve surgery, and surgical options for repair do not have consistent long-term durability. In addition, as more patients undergo transcatheter left valve interventions, developing transcatheter solutions for functional TR has gained greater momentum. Numerous transcatheter devices are currently in early clinical trials. All patients require an assessment of valve morphology and function, and transcatheter devices typically require intraprocedural guidance by echocardiography. The following review will describe tricuspid anatomy, define echocardiographic views for evaluating tricuspid valve morphology and function, and discuss imaging requirements for the current transcatheter devices under development for the treatment of functional TR.
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Affiliation(s)
- Rebecca T. Hahn
- From the Columbia University Medical Center, Department of Medicine, New York Presbyterian Hospital, NY
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