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Alkhatib D, Isa S, Pour-Ghaz I, Butt A, Al-Taweel O, Ugonabo I, Yedlapati N, Jefferies JL. Novel Device Therapies for Heart Failure. J Cardiovasc Dev Dis 2023; 10:jcdd10040165. [PMID: 37103044 PMCID: PMC10143883 DOI: 10.3390/jcdd10040165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/22/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023] Open
Abstract
Heart failure (HF) therapeutics have advanced significantly over the past few years [...].
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Affiliation(s)
- Deya Alkhatib
- Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Sakiru Isa
- Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Issa Pour-Ghaz
- Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Asra Butt
- Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Omar Al-Taweel
- Division of Cardiology, University of Nevada Las Vegas School of Medicine, Las Vegas, NV 89154, USA
| | - Ifeoma Ugonabo
- Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Neeraja Yedlapati
- Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - John Lynn Jefferies
- Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN 38103, USA
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Alipour Symakani RS, Bartelds B, Merkus D, Bogers AJJC, Taverne YJHJ. Guiding Interventions for Secondary Tricuspid Regurgitation: Follow the Intricate Interplay Between Form and Function. Cardiol Rev 2023; 31:7-15. [PMID: 34495894 DOI: 10.1097/crd.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Secondary tricuspid regurgitation (TR) has long been considered a benign and well-tolerated valvular lesion that resolves after treatment of the underlying disease. This view has been challenged by data indicating that long-standing TR can be a progressive disorder, contributing to right ventricular failure and end-organ damage, despite adequate treatment of the underlying disease. Surgical correction is curative, but infrequently performed and historically associated with poor outcomes. This may be due to delayed diagnosis, lack of well-defined surgical indications, and, consequently, late intervention in patients in poor clinical condition with failing right ventricles. Because of limited evidence about timing and corresponding outcome of tricuspid valve surgery, current guideline recommendations are rather conservative and show several inconsistencies. Nevertheless, there has been a trend toward a more aggressive approach in the surgical treatment of TR with improved outcomes. Moreover, emerging transcatheter options claim to provide a lower-risk alternative for selected patients. This may facilitate earlier treatment and improve the attitude toward an early treatment strategy of secondary TR, yet is not reflected in the guidelines. Future research is needed for risk stratification to determine inclusion criteria and optimal timing for intervention.
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Affiliation(s)
- Rahi S Alipour Symakani
- From the Division of Experimental Cardiology, Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Beatrijs Bartelds
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Daphne Merkus
- From the Division of Experimental Cardiology, Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Iwasieczko A, Malinowski M, Solarewicz M, Bush J, MacDougall B, Rausch M, Timek TA. Impact of reductive tricuspid ring annuloplasty on right ventricular size, geometry and strain in an ovine model of functional tricuspid regurgitation. Interact Cardiovasc Thorac Surg 2022; 35:6628589. [PMID: 35781336 PMCID: PMC9270866 DOI: 10.1093/icvts/ivac187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/18/2022] [Accepted: 06/01/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
Reductive ring annuloplasty of the tricuspid annulus represents the contemporary surgical approach to functional tricuspid regurgitation (FTR). We set out to investigate the influence of moderate reductive tricuspid ring annuloplasty on tricuspid regurgitation and right ventricular (RV) size, geometry and strain in an ovine model of chronic FTR.
METHODS
Eight healthy Dorsett male sheep (62.8 + 2kg) underwent a left thoracotomy for placement and tightening of pulmonary artery band to at least double proximal pulmonary artery blood pressure. After 8 weeks of recovery, animals underwent sternotomy, epicardial echocardiography and sonomicrometry crystal implantation. Six crystals were placed around tricuspid annulus and 13 on RV free wall epicardium along 3 parallels defining 3 wall regions (basal, mid and lower) and 1 on the RV apex. All animals underwent beating heart implantation of 26 mm MC3 annuloplasty ring during a second cardiopulmonary bypass run after baseline data acquisition. Simultaneous haemodynamic, sonomicrometry and echocardiography data were acquired at Baseline and after reductive tricuspid ring annuloplasty.
RESULTS
Implantation of reductive ring annuloplasty resulted in 47 ± 7% annular area reduction (996 ± 152 mm vs 516 ± 52 mm2, P = 0.0002) and significantly decreased RV end-diastolic volume (185 ± 27 vs 165 ± 30 ml, P = 0.02). Tricuspid ring annuloplasty effectively reduced FTR grade (3.75 ± 0.6 vs 0.3 ± 0.5, P = 0.00004) and had little influence on RV function, cross-sectional area, radius of curvature or free wall regional strains.
CONCLUSIONS
In adult sheep with 8 weeks of pulmonary artery banding and FTR, tricuspid annulus reduction of 47% with prosthetic ring annuloplasty effectively abolished FTR while maintaining regional RV function and strain patterns.
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Affiliation(s)
- Artur Iwasieczko
- Division of Cardiothoracic Surgery, Spectrum Health , Michigan State College of Human Medicine, Grand Rapids, MI, USA
- Clinical Department of Cardiac Surgery, District Hospital No. 2, University of Rzeszow , Rzeszow, Poland
| | - Marcin Malinowski
- Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice , Katowice, Poland
| | - Monica Solarewicz
- Division of Cardiothoracic Surgery, Spectrum Health , Michigan State College of Human Medicine, Grand Rapids, MI, USA
| | - Jared Bush
- Division of Cardiothoracic Surgery, Spectrum Health , Michigan State College of Human Medicine, Grand Rapids, MI, USA
| | - Brian MacDougall
- Division of Cardiothoracic Surgery, Spectrum Health , Michigan State College of Human Medicine, Grand Rapids, MI, USA
| | - Manuel Rausch
- Department of Aerospace Engineering & Engineering Mechanics, Department of Biomedical Engineering, Institute of Computational Engineering and Science, University of Texas at Austin , Austin, TX, USA
| | - Tomasz A Timek
- Division of Cardiothoracic Surgery, Spectrum Health , Michigan State College of Human Medicine, Grand Rapids, MI, USA
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Orkild BA, Zenger B, Iyer K, Rupp LC, Ibrahim MM, Khashani AG, Perez MD, Foote MD, Bergquist JA, Morris AK, Kim JJ, Steinberg BA, Selzman C, Ratcliffe MB, MacLeod RS, Elhabian S, Morgan AE. All Roads Lead to Rome: Diverse Etiologies of Tricuspid Regurgitation Create a Predictable Constellation of Right Ventricular Shape Changes. Front Physiol 2022; 13:908552. [PMID: 35860653 PMCID: PMC9291517 DOI: 10.3389/fphys.2022.908552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Myriad disorders cause right ventricular (RV) dilation and lead to tricuspid regurgitation (TR). Because the thin-walled, flexible RV is mechanically coupled to the pulmonary circulation and the left ventricular septum, it distorts with any disturbance in the cardiopulmonary system. TR, therefore, can result from pulmonary hypertension, left heart failure, or intrinsic RV dysfunction; but once it occurs, TR initiates a cycle of worsening RV volume overload, potentially progressing to right heart failure. Characteristic three-dimensional RV shape-changes from this process, and changes particular to individual TR causes, have not been defined in detail. Methods: Cardiac MRI was obtained in 6 healthy volunteers, 41 patients with ≥ moderate TR, and 31 control patients with cardiac disease without TR. The mean shape of each group was constructed using a three-dimensional statistical shape model via the particle-based shape modeling approach. Changes in shape were examined across pulmonary hypertension and congestive heart failure subgroups using principal component analysis (PCA). A logistic regression approach based on these PCA modes identified patients with TR using RV shape alone. Results: Mean RV shape in patients with TR exhibited free wall bulging, narrowing of the base, and blunting of the RV apex compared to controls (p < 0.05). Using four primary PCA modes, a logistic regression algorithm identified patients with TR correctly with 82% recall and 87% precision. In patients with pulmonary hypertension without TR, RV shape was narrower and more streamlined than in healthy volunteers. However, in RVs with TR and pulmonary hypertension, overall RV shape continued to demonstrate the free wall bulging characteristic of TR. In the subgroup of patients with congestive heart failure without TR, this intermediate state of RV muscular hypertrophy was not present. Conclusion: The multiple causes of TR examined in this study changed RV shape in similar ways. Logistic regression classification based on these shape changes reliably identified patients with TR regardless of etiology. Furthermore, pulmonary hypertension without TR had unique shape features, described here as the "well compensated" RV. These results suggest shape modeling as a promising tool for defining severity of RV disease and risk of decompensation, particularly in patients with pulmonary hypertension.
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Affiliation(s)
- Benjamin A. Orkild
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Brian Zenger
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Krithika Iyer
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
- School of Computing, University of Utah, Salt Lake City, UT, United States
| | - Lindsay C. Rupp
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Majd M Ibrahim
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, United States
| | - Atefeh G. Khashani
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
| | - Maura D. Perez
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
| | - Markus D. Foote
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Jake A. Bergquist
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Alan K. Morris
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
| | - Jiwon J. Kim
- Weill-Cornell Medical College, Division of Cardiology, New York, NY, United States
| | - Benjamin A. Steinberg
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, United States
| | - Craig Selzman
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT, United States
| | - Mark B. Ratcliffe
- Department of Surgery, The San Francisco VA Medical Center, University of California, San Francisco, San Francisco, CA, United States
| | - Rob S. MacLeod
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Shireen Elhabian
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
- School of Computing, University of Utah, Salt Lake City, UT, United States
| | - Ashley E. Morgan
- St. Luke’s Medical Center Cardiothoracic and Vascular Surgery, Boise, ID, United States
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van Wijngaarden AL, Mantegazza V, Hiemstra YL, Volpato V, van der Bijl P, Pepi M, Palmen M, Delgado V, Ajmone Marsan N, Tamborini G, Bax JJ. Prognostic Impact of Extra-Mitral Valve Cardiac Involvement in Patients With Primary Mitral Regurgitation. JACC Cardiovasc Imaging 2022; 15:961-970. [PMID: 35033499 DOI: 10.1016/j.jcmg.2021.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/15/2021] [Accepted: 11/04/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND In patients with severe primary mitral regurgitation (MR), the indication for surgery is currently based on the presence of symptoms, left ventricular dilatation and dysfunction, atrial fibrillation, and pulmonary hypertension. OBJECTIVES The aim of this study was to evaluate the prognostic impact of the presence of extra-mitral valve cardiac involvement (including known risk factors but also severe left atrial [LA] dilatation and right ventricular [RV] dysfunction) in a large multicenter study of patients with primary MR. METHODS Patients with severe primary MR undergoing surgery were included and categorized according to the extent (highest) of cardiac involvement: group 0, no cardiac involvement; group 1, left ventricular involvement; group 2, LA involvement; group 3, pulmonary vasculature or tricuspid valve involvement; or group 4, RV involvement. The outcome was all-cause mortality. RESULTS A total of 1,106 patients were included (mean age 63 ± 12 years, 68% male). In total, 377 patients (34%) were classified in group 0, 239 (22%) in group 1, 213 (19%) in group 2, 180 (16%) in group 3, and 97 (9%) in group 4. Kaplan-Meier curve analysis revealed significantly worse survival (log-rank chi-square = 43.4; P < 0.001) with higher group. On multivariable analysis, age, male sex, chronic obstructive pulmonary disease, kidney function, and group of cardiac involvement were independently associated with all-cause mortality. For each increase in group, a 17% higher risk for all-cause mortality was observed (95% CI: 1.051-1.313; P = 0.005) during a median follow-up time of 88 months. CONCLUSIONS In patients with severe primary MR, a novel classification system based on extra-mitral valve cardiac involvement may help refine risk stratification and timing of surgery, particularly including severe LA dilatation and RV dysfunction in the assessment.
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Affiliation(s)
| | - Valentina Mantegazza
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Yasmine L Hiemstra
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Valentina Volpato
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Meindert Palmen
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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6
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Fudim M, Abraham WT, von Bardeleben RS, Lindenfeld J, Ponikowski PP, Salah HM, Khan MS, Sievert H, Stone GW, Anker SD, Butler J. Device Therapy in Chronic Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:931-956. [PMID: 34446165 PMCID: PMC9941752 DOI: 10.1016/j.jacc.2021.06.040] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022]
Abstract
The regulatory landscape for device-based heart failure (HF) therapies has seen a major shift in the last 7 years. In 2013, the U.S. Food and Drug Administration released guidance for early feasibility and first-in-human studies, thereby encouraging device innovation, and in 2016 the U.S. Congress authorized the Breakthrough Devices Program to expedite access for Americans to innovative devices indicated for diagnosis and treatment of serious illnesses, such as HF. Since December 2016, there has been an increase in the number of HF devices for which manufacturers are seeking approval through the breakthrough designation pathway. This has led to a rapid uptake in the development and evaluation of device-based HF therapies. This article reviews the current and future landscape of device therapies for chronic HF and associated comorbidities and the regulatory environment that is driving current and future innovation.
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Affiliation(s)
- Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
| | - William T. Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Ralph Stephan von Bardeleben
- Medizinische Klinik - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsmedizin Mainz, Mainz, Germany
| | - JoAnn Lindenfeld
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Piotr P. Ponikowski
- Centre for Heart Diseases, University Hospital, Wroclaw, Poland,Department of Heart Diseases, Medical University, Wroclaw, Poland
| | - Husam M. Salah
- Department of Medicine, University of Arkansas for Medical Sciences, AR, USA
| | - Muhammad Shahzeb Khan
- Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA
| | - Horst Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany,Anglia Ruskin University, Chelmsford, United Kingdom
| | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, and the Cardiovascular Research Foundation, New York, NY, USA
| | - Stefan D. Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson, Mississippi, USA.
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Tagliari AP, Perez-Camargo D, Taramasso M. Tricuspid regurgitation: when is it time for surgery? Expert Rev Cardiovasc Ther 2021; 19:47-59. [DOI: 10.1080/14779072.2021.1854734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Ana Paula Tagliari
- Cardiac Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Postgraduate Program in Health Science: Cardiology and Cardiovascular Science, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Daniel Perez-Camargo
- Cardiac Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Fundación Interhospitalaria para la Investigación Cardiovascular, Madrid, Spain
| | - Maurizio Taramasso
- Cardiac Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- HerzZentrum Hirlsanden Zurich, Zurich, Switzerland
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8
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Meijerink F, Koch KT, de Winter RJ, Robbers-Visser D, Boekholdt SM, Holierook M, Baan J, Bouma BJ. Tricuspid regurgitation after transcatheter mitral valve repair: Clinical course and impact on outcome. Catheter Cardiovasc Interv 2021; 98:E427-E435. [PMID: 33458911 PMCID: PMC8518077 DOI: 10.1002/ccd.29464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/11/2020] [Accepted: 12/30/2020] [Indexed: 11/24/2022]
Abstract
Objectives The aim of this study was to determine the course of tricuspid regurgitation (TR) after transcatheter mitral valve repair (TMVR), identify predictors for severe TR after TMVR and determine the association of severe TR after TMVR with outcome. Background TR is often present in patients with symptomatic mitral regurgitation (MR) and is associated with increased morbidity and mortality. The clinical course of TR after TMVR has not been clearly determined. Methods Patients that underwent TMVR between 2009 and 2017 were included. Clinical data were compared between patients with and without severe TR at 6 months after TMVR. Multivariate logistic regression analysis was performed to identify predictors for severe TR after TMVR. Survival analysis was done for both groups, using the Kaplan–Meier method. Results A total of 146 patients were included (mean age 76 years, 51% male, 79% New York Heart Association class ≥3 and 29% severe TR at baseline). Advanced age, atrial fibrillation (AF), right ventricular (RV) dysfunction, and limited procedural MR reduction were revealed as independent predictors for severe TR after TMVR. Survival of patients with severe TR after TMVR was 58% after 2 years compared to 82% for those with non, mild or moderate TR. Conclusions Severe TR after TMVR is common in patients at advanced age, those with AF, RV dysfunction and limited MR reduction during TMVR and is associated with impaired survival. As the associated parameters are indicators of longstanding MR, research investigating the benefits of earlier intervention in MR should be initiated.
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Affiliation(s)
- Frank Meijerink
- Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Karel T Koch
- Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Robbert J de Winter
- Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | | | - S Matthijs Boekholdt
- Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Marja Holierook
- Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Jan Baan
- Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Berto J Bouma
- Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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Chang WT, Wu NC, Shih JY, Hsu CH, Chen ZC, Cheng BC. Right ventricular reserve post mitral valve repair is associated with heart failure hospitalization. Pulm Circ 2020; 10:2045894020943858. [PMID: 33403099 DOI: 10.1177/2045894020943858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/30/2020] [Indexed: 01/29/2023] Open
Abstract
Right ventricular impairment is a predictor of cardiovascular outcomes in patients with degenerative mitral regurgitation. However, the time course of right ventricular functional changes post-surgical mitral valve repair remains largely unknown. Herein, using right ventricular-focused echocardiography, we aimed to investigate right ventricular reserve and its impact on hospitalization for heart failure after mitral valve repair. In this prospective study, we enrolled 108 patients scheduled to undergo surgical repair of degenerative mitral regurgitation. Echocardiography, including right ventricular strain analysis, was performed prior to, and one month and six months post mitral valve repair. Right ventricular strain that improved one month post-surgery was defined as reserved right ventricular. In addition, any cardiovascular outcomes comprising heart failure that required admission were recorded. The median follow-up duration is 31 months. Despite a significant improvement in mitral valve regurgitant volume post-operatively, left ventricular ejection fraction (LVEF) at six months was similar to LVEF at baseline. There was a transient decrease in LV longitudinal strain at one month that was recovered six months post mitral valve repair. Regarding the right ventricular, in contrast with conventional right ventricular parameters, including right ventricular tissue Doppler S', fractional area change and tricuspid annular plane systolic excursion (TAPSE), only resolution of right ventricular strain at one month predicted the subsequent myocardial recovery. Furthermore, patients with reserved right ventricular had a lower risk of hospitalization for heart failure compared to those with non-reserved right ventricular. Collectively, the early resolution of right ventricular strain is associated with the improvement in right ventricular function (measured by TAPSE) and in heart failure hospitalization in patients who had undergone surgical mitral valve repair for degenerative mitral regurgitation.
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Affiliation(s)
- Wei-Ting Chang
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan.,Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan
| | - Nan-Chun Wu
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, Tainan
| | - Jhih-Yuan Shih
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan
| | - Chih-Hsin Hsu
- Department of Internal Medicine, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
| | - Zhih-Cherng Chen
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan
| | - Bor-Chih Cheng
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan.,Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, Tainan
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10
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Algarni KD, Arafat A, Algarni AD, Alfonso JJ, Alhossan A, Elsayed A, Kheirallah HM, Albacker TB. Degree of right ventricular dysfunction dictates outcomes after tricuspid valve repair concomitant with left-side valve surgery. Gen Thorac Cardiovasc Surg 2020; 69:911-918. [PMID: 33159277 DOI: 10.1007/s11748-020-01536-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/16/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The effect of different degrees of right ventricular (RV) dysfunction on long-term outcomes after tricuspid valve repair is the subject of ongoing research. We sought to evaluate the effect of preoperative RV dysfunction on mortality and recurrence of tricuspid regurgitation (TR) after tricuspid valve repair for secondary TR concomitant with left-side valve surgery. METHODS This is a retrospective study, including 548 patients who underwent repair of secondary TR (2009-2017) at a single institution. Patients were grouped according to preoperative right ventricular (RV) systolic function into three groups; normal RV function (group 1, n = 451), mild RV dysfunction (group 2, n = 60) and moderate/severe RV dysfunction (group 3, n = 37). Study endpoints were mortality and recurrence of TR. RESULTS Group 3 was associated with the highest hospital mortality (10.2%, p = .06). Predictors of moderate or higher grade TR were NYHA class (HR 2.1, p = 0.03); preoperative TR grade (HR 1.9, p < 0.01), mild RV dysfunction (HR 2.4, p < 0.01), isolated RV dilatation (HR 2.0, p < 0.01), and flexible TV repair prostheses (HR 2.4, p = 0.01). Predictors of mortality were renal impairment (HR 3.0, p < 0.01), ejection fraction (HR 0.97, p = 0.02), pulmonary artery systolic pressure (HR 1.02, p = 0.02), preoperative TR grade (HR 1.7, p < 0.01), and moderate/severe RV dysfunction (HR 3.1, p = 0.01). CONCLUSION Compared to normal and mild degree of RV dysfunction, moderate and severe RV dysfunction were independent predictors of poor long-term survival. Isolated RV dilatation increased the recurrence of TR. RV dysfunction and dilatation could be indications of tricuspid valve repair.
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Affiliation(s)
- Khaled D Algarni
- Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia.
- Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
| | - Amr Arafat
- Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Abdulaziz D Algarni
- Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Juan J Alfonso
- Cardiac Research Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Abdulaziz Alhossan
- Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Abdelhameed Elsayed
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Hatim M Kheirallah
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Turki B Albacker
- Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia
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11
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Wang N, Fulcher J, Abeysuriya N, McGrady M, Wilcox I, Celermajer D, Lal S. Tricuspid regurgitation is associated with increased mortality independent of pulmonary pressures and right heart failure: a systematic review and meta-analysis. Eur Heart J 2020; 40:476-484. [PMID: 30351406 DOI: 10.1093/eurheartj/ehy641] [Citation(s) in RCA: 215] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/15/2018] [Indexed: 12/29/2022] Open
Abstract
Aims To undertake a systematic review and meta-analysis to determine the influence of tricuspid regurgitation (TR) severity on mortality. Methods and results We performed a systematic search for studies reporting clinical outcomes of patients with TR. The primary endpoint was all-cause mortality and secondary endpoints were cardiac mortality and hospitalization for heart failure (HF). Overall risk ratios (RR) and 95% confidence intervals (CIs) were derived for each endpoint according to the severity of TR by meta-analysing the effect estimates of eligible studies. Seventy studies totalling 32 601 patients were included in the analysis, with a mean (±SD) follow-up of 3.2 ± 2.1 years. Moderate/severe TR was associated with a two-fold increased mortality risk compared to no/mild TR (RR 1.95, 95% CI 1.75-2.17). Moderate/severe TR remained associated with higher all-cause mortality among 13 studies which adjusted for systolic pulmonary arterial pressures (RR 1.85, 95% CI 1.44-2.39), and 15 studies, which adjusted for right ventricular (RV) dysfunction (RR 1.78, 95% CI 1.49-2.13). Moderate/severe TR was also associated with increased cardiac mortality (RR 2.56, 95% CI 1.84-3.55) and HF hospitalization (RR 1.73, 95% CI 1.14-2.62). Compared to patients with no TR, patients with mild, moderate, and severe TR had a progressively increased risk of all-cause mortality (RR 1.25, 1.61, and 3.44, respectively; P < 0.001 for trend). Conclusions Moderate/severe TR is associated with an increased mortality risk, which appears to be independent of pulmonary pressures and RV dysfunction.
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Affiliation(s)
- Nelson Wang
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Jordan Fulcher
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Michele McGrady
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Ian Wilcox
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - David Celermajer
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Sean Lal
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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12
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Right Ventricle Mechanics and Function during Stress in Patients with Asymptomatic Primary Moderate to Severe Mitral Regurgitation and Preserved Left Ventricular Ejection Fraction. Medicina (B Aires) 2020; 56:medicina56060303. [PMID: 32575723 PMCID: PMC7353882 DOI: 10.3390/medicina56060303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 11/17/2022] Open
Abstract
Background and objectives. Mitral regurgitation (MR) is usually dynamic and increasing with exertion. Stress may provoke symptoms, cause the progression of pulmonary hypertension (PH) and unmask subclinical changes of the left and right ventricle function. The aim of this study was to evaluate changes of right ventricle (RV) functional parameters during stress and to find out determinants of RV function in patients with MR. Materials and methods. We performed a prospective study that included patients with asymptomatic primary moderate to severe MR and preserved left ventricular (LV) ejection fraction (EF) at rest (≥60%). Conventional 2D echocardiography at rest and during stress (bicycle ergometry) and offline speckle tracking analysis were performed. Results. 80 patients were included as MR (50) and control (30) groups. Conventional functional and myocardial deformation parameters of RV were similar in both groups at all stages of exercise (p > 0.05). The grade of MR (p = 0.004) and higher LV global longitudinal strain (p = 0.037) contributed significantly to the changes of tricuspid annular plane systolic excursion (TAPSE) from rest to peak stress. Changes of MR ERA from the rest to peak stress were related to RV free wall longitudinal strain (FWLS) and four chambers longitudinal stain (4CLS) at rest (p = 0.011; r = −0.459 and p = 0.001; r = −0.572, respectively). Significant correlations between LV EF, stroke volume, cardiac output and RV fractional area change, S′, TAPSE, FWLS, 4CLS were obtained. However, systolic pulmonary artery pressure and RV functional, deformation parameters were not related (p > 0.05). Conclusions. Functional parameters of LV during exercise and severity of MR were significant determinants of RV function while PH has no correlation with it in patients with primary asymptomatic moderate to severe MR.
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Sakata T, Mogi K, Sakurai M, Tani K, Hashimoto M, Shiko Y, Kawasaki Y, Matsumiya G, Takahara Y. Impact of tricuspid annuloplasty on postoperative changes in the right ventricular systolic and diastolic function: A retrospective cohort study. J Card Surg 2020; 35:1464-1470. [DOI: 10.1111/jocs.14611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Tomoki Sakata
- Division of Cardiovascular Surgery Funabashi Municipal Medical Center Heart and Vascular Institute Funabashi Japan
- Department of Cardiovascular Surgery Chiba University Hospital Chiba Japan
| | - Kenji Mogi
- Division of Cardiovascular Surgery Funabashi Municipal Medical Center Heart and Vascular Institute Funabashi Japan
| | - Manabu Sakurai
- Division of Cardiovascular Surgery Funabashi Municipal Medical Center Heart and Vascular Institute Funabashi Japan
| | - Kengo Tani
- Division of Cardiovascular Surgery Funabashi Municipal Medical Center Heart and Vascular Institute Funabashi Japan
| | - Masafumi Hashimoto
- Division of Cardiovascular Surgery Funabashi Municipal Medical Center Heart and Vascular Institute Funabashi Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center Chiba University Hospital Chiba Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center Chiba University Hospital Chiba Japan
| | - Goro Matsumiya
- Department of Cardiovascular Surgery Chiba University Hospital Chiba Japan
| | - Yoshiharu Takahara
- Division of Cardiovascular Surgery Funabashi Municipal Medical Center Heart and Vascular Institute Funabashi Japan
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Prognostic Value of Right Ventricular Dysfunction and Tricuspid Regurgitation in Patients with Severe Low-Flow Low-Gradient Aortic Stenosis. Sci Rep 2019; 9:14580. [PMID: 31601929 PMCID: PMC6787042 DOI: 10.1038/s41598-019-51166-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 09/25/2019] [Indexed: 12/21/2022] Open
Abstract
Long and mid-term data in Low-Flow Low-Gradient Aortic Stenosis (LFLG-AS) are scarce. The present study sought to identify predictors of outcome in a sizeable cohort of patients with LFLG-AS. 76 consecutive patients with LFLG-AS (defined by a mean gradient <40 mmHg, an aortic valve area ≤1 cm2 and an ejection fraction ≤50%) were prospectively enrolled and followed at regular intervals. Events defined as aortic valve replacement (AVR) and death were assessed and overall survival was determined. 44 patients underwent AVR (10 transcatheter and 34 surgical) whilst intervention was not performed in 32 patients, including 9 patients that died during a median waiting time of 4 months. Survival was significantly better after AVR with survival rates of 91.8% (CI 71.1–97.9%), 83.0% (CI 60.7–93.3%) and 56.3% (CI 32.1–74.8%) at 1,2 and 5 years as compared to 84.3% (CI 66.2–93.1%), 52.9% (CI 33.7–69.0%) and 30.3% (CI 14.6–47.5%), respectively, for patients managed conservatively (p = 0.017). The presence of right ventricular dysfunction (HR 3.47 [1.70–7.09]) and significant tricuspid regurgitation (TR) (HR 2.23 [1.13–4.39]) independently predicted overall mortality while the presence of significant TR (HR 3.40[1.38–8.35]) and higher aortic jet velocity (HR 0.91[0.82–1.00]) were independent predictors of mortality and survival after AVR. AVR is associated with improved long-term survival in patients with LFLG-AS. Treatment delays are associated with excessive mortality, warranting urgent treatment in eligible patients. Right ventricular involvement characterized by the presence of TR and/or right ventricular dysfunction, identifies patients at high risk of mortality under both conservative management and after AVR.
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15
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Evolution of Tricuspid Regurgitation After Repair of Degenerative Mitral Regurgitation. Ann Thorac Surg 2019; 109:1350-1355. [PMID: 31545970 DOI: 10.1016/j.athoracsur.2019.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/13/2019] [Accepted: 08/08/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The fate of unrepaired tricuspid regurgitation (TR) after mitral valve repair for degenerative mitral regurgitation remains highly debated. The objective of this study was to examine the progress of unrepaired TR after mitral valve repair for degenerative mitral regurgitation, with a particular focus on comparing patients with moderate preoperative TR with those having none or mild preoperative TR. METHODS Between 2008 and 2018, 183 consecutive patients (mean age, 61 years [SD, 14]) with severe degenerative mitral regurgitation and less-than-severe TR underwent mitral valve repair alone without concomitant TR repair. They were prospectively followed for a median duration of 3.1 years (interquartile range, 1.6-5.5; maximal duration of 9.4 years). RESULTS At baseline 146 patients (80%) had none or mild TR; 37 patients (20%) had moderate TR. At follow-up 51 patients (30%) had improved TR compared with 28 patients (17%) who had worse TR. At 3 years postoperatively echocardiographic data were available for 82 of 183 patients: 70 (85%) had none or mild TR, 11 (13%) had moderate TR, and 1 (1.2%) had moderate to severe TR. In an exploratory multivariable analysis with limited statistical power, patients with moderate preoperative TR (vs those with none or mild TR) had an association with higher mortality (hazard ratio, 2.8; 95% confidence interval, 0.81-9.4; P = .11). CONCLUSIONS After mitral valve repair but without concomitant tricuspid valve repair, a number of patients had progression in their TR. There was a signal of harm in patients having moderate preoperative TR in terms of mortality, but this finding is exploratory and requires investigation.
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16
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Pingpoh C, Nuss S, Kueri S, Kreibich M, Czerny M, Beyersdorf F, Siepe M. Adding tricuspid repair to standard open heart surgery does not increase risk but improves right ventricular function. Interact Cardiovasc Thorac Surg 2019; 29:416-421. [DOI: 10.1093/icvts/ivz106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/10/2019] [Accepted: 03/17/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
To evaluate outcome of concomitant tricuspid annuloplasty in mild or moderate regurgitation on perioperative outcome and on right ventricular function in patients undergoing major cardiac surgery.
METHODS
Among 14 500 patients who underwent cardiac surgery at our institution between January 2000 and April 2016, 1023 patients had a documented history of tricuspid regurgitation (TR). Of those patients, 324 patients were diagnosed with mild or moderate secondary TR with a dilated annulus (≥40 mm or >21 mm/m2) and composed the study population. The decision to perform concomitant annuloplasty was subjected to the individual decision of the treating surgeon. Our analysis focused on a comparison between patients with concomitant TR-repair (group 1, n = 184) and patients without concomitant TR-repair (group 2, n = 140) after propensity score matching.
RESULTS
Following a preliminary data preprocessing, we observed a mean age of 73.8 years, mean logistic EuroSCORE of 10.5%. Perioperative mortality was 4.4% in group 1 and 5.7% in group 2. There was no significant difference in mid-term mortality. TR after surgery was significantly higher in group 2. After propensity score matching regression analysis, patients who had a repaired tricuspid valve (group 1) had better right ventricle (RV) function than those without TR-repair (group 2) (P > 0.05 at 95% confidence interval following Kolmogorov–Smirnov Goodness of fit Test).
CONCLUSIONS
Adding tricuspid valve repair in patients with mild or moderate secondary TR with a dilated annulus (≥40 mm or >21 mm/m2) to standard open heart surgery does not increase perioperative risk but improves right ventricular function. Therefore, standard tricuspid repair in this subgroup might be considered on a routine basis.
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Affiliation(s)
- Clarence Pingpoh
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany
- Medical Faculty, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Sarah Nuss
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany
- Medical Faculty, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Sami Kueri
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany
- Medical Faculty, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Maximillian Kreibich
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany
- Medical Faculty, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany
- Medical Faculty, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany
- Medical Faculty, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany
- Medical Faculty, Albert-Ludwigs-University Freiburg, Freiburg, Germany
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Yuan F, Wu Z, Jiang L, Zhou J, Xu L, Liu H, Ma L, Zhai Z, Zhang J. Short-Term Effects of Tolvaptan in Tricuspid Insufficiency Combined with Left Heart Valve Replacement-Caused Volume-Overload Patients: Results of a Prospective Pilot Study. Am J Cardiovasc Drugs 2019; 19:211-218. [PMID: 30255476 DOI: 10.1007/s40256-018-0304-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Our objective was to explore the effects of tolvaptan as a new therapeutic approach in patients with right heart failure with tricuspid insufficiency (TI). METHODS This prospective, multicenter, non-randomized controlled pilot study enrolled patients (N = 40) with TI from the Shanghai Chest Hospital and Shanghai Tongren Hospital who fulfilled inclusion criteria between March 2015 and June 2016. Participants were assigned to receive either tolvaptan combined with torasemide (n = 20) or torasemide monotherapy (n = 20; control group). The primary endpoints were changes in patient weight and in tricuspid annular plane systolic excursion (TAPSE) after 10 days of treatment. The secondary endpoints included net fluid balance and cardiac functions before and after medication from the first to the tenth day of treatment. Safety was evaluated by monitoring adverse and serious adverse events. RESULTS TAPSE significantly increased in the tolvaptan group compared with the control group after 10 days of medication (P = 0.029). Daily weight losses in the tolvaptan group significantly increased as the time of treatment increased (time × group, P = 0.022). Recovery to New York Heart Association (NYHA) grade I occurred 4 days earlier in the tolvaptan group. In addition, the net fluid balance and median net fluid balance were significantly higher in the tolvaptan group. Eight adverse events and one serious adverse event were recorded in the tolvaptan group and 15 adverse events were recorded in the control group. CONCLUSIONS Our results indicate that tolvaptan might be a useful and safe drug to improve heart function in patients with right heart failure with TI after left heart valve replacement. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier no. NCT02644616.
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Affiliation(s)
- Fang Yuan
- Department of Cardiology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200336, China
| | - Zhangmin Wu
- Department of Cardiology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200336, China
| | - Li Jiang
- Department of Cardiology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200336, China.
| | - Jun Zhou
- Department of Cardiology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200336, China
| | - Lei Xu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
| | - Hua Liu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
| | - Lan Ma
- Department of Ultrasound, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
| | - Zhenzhou Zhai
- Department of Emergency, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200336, China
| | - Junjie Zhang
- Department of Emergency, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200336, China
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De la Espriella R, Santas E, Chorro FJ, Miñana G, Soler M, Bodí V, Valero E, Núñez E, Bayés-Genis A, Lupón J, Sanchis J, Núñez J. Functional tricuspid regurgitation and recurrent admissions in patients with acute heart failure. Int J Cardiol 2019; 291:83-88. [PMID: 30955879 DOI: 10.1016/j.ijcard.2019.03.051] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/06/2019] [Accepted: 03/24/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Functional tricuspid regurgitation (TR) is a common echocardiographic finding in patients with heart failure (HF), and its role in disease progression and prognosis stratification is becoming increasingly relevant in recent years. However, data regarding its association with the burden of HF-readmission is scarce. In this work, we sought to evaluate the association between TR severity and HF-related readmissions following a hospitalization for acute heart failure (AHF). METHODS We prospectively included a cohort of 2101 patients admitted with the diagnosis of AHF. TR severity was assessed using a multiparametric integrative approach, and classified as none, mild, moderate, and severe. We used negative binomial regression to identify the association between TR grade and HF-related recurrent admissions. The risk associated to severity of TR was expressed as incidence rate ratio (IRR). RESULTS At a median follow-up of 2.53 years (IQR: 1.03-4.36), 978 (46.5%) patients died, and 1657 HF-readmissions occurred in 842 patients (40.0%). The proportion of patients with two or more admissions was 18.4%. The proportion of patients with moderate to severe TR was 17.2%. There was a stepwise increase in the incidence of readmissions from none to severe TR. After multivariable adjustment, only patients with severe TR were independently associated with higher risk of recurrent HF admissions (IRR = 1.34, CI 95%: 1.05-1.71; p = .019). CONCLUSIONS In patients with AHF, severe functional TR is independently associated with an increased risk of long-term recurrent HF hospitalizations.
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Affiliation(s)
- Rafael De la Espriella
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Francisco J Chorro
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Meritxell Soler
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Ernesto Valero
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Antoni Bayés-Genis
- CIBER Cardiovascular, Spain; Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Josep Lupón
- CIBER Cardiovascular, Spain; Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain.
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Santoro C, Marco del Castillo A, González-Gómez A, Monteagudo JM, Hinojar R, Lorente A, Abellás M, Vieitez JM, Garcia Martìn A, Casas Rojo E, Ruíz S, Barrios V, Luis Moya J, Jimenez-Nacher JJ, Zamorano Gomez JL, Fernández-Golfín C. Mid-term outcome of severe tricuspid regurgitation: are there any differences according to mechanism and severity? Eur Heart J Cardiovasc Imaging 2019; 20:1035-1042. [DOI: 10.1093/ehjci/jez024] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/27/2018] [Accepted: 02/04/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
Patients with significant tricuspid regurgitation (TR) addressed according the new classification in torrential TR may have different prognosis compared with just severe TR patients. We sought to determine distribution and mechanism of consecutive severe TR patients, in accordance with aetiology and severity by applying the new proposed classification scheme and their long-term outcomes.
Methods and results
Between January and December 2013, 249 patients with significant TR referred to the cardiac imaging unit (mean age 79.9 ± 10.2 years; 29.8% female) were included. Patients were divided according to aetiology in six groups, and TR severity was reclassified into severe, massive, and torrential TR. The follow-up period was of 313 ± 103 days. When considering cardiovascular mortality, patients in the massive/torrential group showed the highest number of events (P < 0.007). Patients with TR due to pulmonary diseases had the worst prognosis according to different aetiology. Noteworthy, the best predictors for the combined endpoint [cardiovascular mortality and readmission admission for heart failure (HF)] were TR severity according to the new classification [hazard ratio (HR) 2.48, 95% confidence interval (CI) 1.25–4.93] and clinical scores such as New York Heart Association classification and congestive status (HR 1.78, 95% CI 1.28–2.49; HR 2.08, 95% CI 1.06–4.06, respectively).
Conclusion
Patients with massive/torrential TR and patients with comorbidities, especially pulmonary disease, were identified as populations at higher risk of death and readmission for HF. New classification scheme and clinical assessment may establish who may benefit the most of intensive therapeutic treatments and intervention on the tricuspid valve.
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Affiliation(s)
- Ciro Santoro
- Cardiac Imaging Unit, Cardiology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9, 100, Madrid 28034, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | - Alvaro Marco del Castillo
- Cardiac Imaging Unit, Cardiology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9, 100, Madrid 28034, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | - Ariana González-Gómez
- Cardiac Imaging Unit, Cardiology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9, 100, Madrid 28034, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | - Juan Manuel Monteagudo
- Cardiac Imaging Unit, Cardiology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9, 100, Madrid 28034, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | - Rocio Hinojar
- Cardiac Imaging Unit, Cardiology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9, 100, Madrid 28034, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | - Alvaro Lorente
- Cardiac Imaging Unit, Cardiology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9, 100, Madrid 28034, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | - María Abellás
- Cardiac Imaging Unit, Cardiology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9, 100, Madrid 28034, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | - Jose Maria Vieitez
- Cardiac Imaging Unit, Cardiology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9, 100, Madrid 28034, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | - Ana Garcia Martìn
- Cardiac Imaging Unit, Cardiology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9, 100, Madrid 28034, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | - Eduardo Casas Rojo
- Cardiac Imaging Unit, Cardiology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9, 100, Madrid 28034, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | - Soledad Ruíz
- Cardiac Imaging Unit, Cardiology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9, 100, Madrid 28034, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | - Vivencio Barrios
- Cardiac Imaging Unit, Cardiology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9, 100, Madrid 28034, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | - Jose Luis Moya
- Cardiac Imaging Unit, Cardiology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9, 100, Madrid 28034, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | - Jose Julio Jimenez-Nacher
- Cardiac Imaging Unit, Cardiology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9, 100, Madrid 28034, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | - Jose Luis Zamorano Gomez
- Cardiac Imaging Unit, Cardiology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9, 100, Madrid 28034, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | - Covadonga Fernández-Golfín
- Cardiac Imaging Unit, Cardiology Department, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9, 100, Madrid 28034, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
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Malinowski M, Jazwiec T, Goehler M, Bush J, Quay N, Ferguson H, Rausch MK, Timek TA. Impact of tricuspid annular size reduction on right ventricular function, geometry and strain. Eur J Cardiothorac Surg 2019; 56:5303950. [PMID: 30698674 DOI: 10.1093/ejcts/ezy484] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/21/2018] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVES Restrictive tricuspid annuloplasty is a clinically accepted approach to treat functional tricuspid regurgitation. We set out to investigate the effect of varying degrees of tricuspid annular reduction on the right ventricular (RV) function, geometry and strain. METHODS Eight, healthy sheep (45 ± 4 kg) had 6 sonomicrometry crystals implanted around the tricuspid annulus and 20 onto the epicardium of the right ventricle defining 3 free wall regions: basal, mid and lower. A polypropylene annuloplasty suture was placed around the tricuspid annulus and externalized to an epicardial tourniquet. Simultaneous echocardiographic, haemodynamic and sonomicrometry data were acquired at baseline and during 5 consecutive annular reduction steps (TAR 1-5) with successive (5-7 mm) suture cinching. RV free wall circumferential, longitudinal and areal cardiac and interventional strains, RV radius of curvature (ROC), cross-sectional area and tricuspid annular dimensions were calculated from 3-dimensional crystal coordinates. RESULTS TAR 1-5 resulted in 19 ± 15%, 35 ± 15%, 51 ± 15%, 60 ± 15% and 68 ± 13% tricuspid annular area reduction, respectively. TAR 1 and 2 had minimal influence on the RV function, RV-ROC and strains. TAR 4 and 5 decreased RV-ROC in basal and mid-regions, but reduced the RV cross-sectional area change (from 19 ± 4% at baseline to 14 ± 3% and 13 ± 2%, respectively, P < 0.001) and circumferential and areal strains. TAR 3 significantly decreased free wall RV-ROC from 44.0 ± 1.5 to 42.6 ± 2.4 mm P < 0.001 at the RV base but maintained the regional ventricular function and strains. CONCLUSIONS In healthy ovine hearts, a tricuspid annular area reduction of ∼50% provides optimal conditions for reducing RV-ROC while maintaining regional RV function and strain patterns.
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Affiliation(s)
- Marcin Malinowski
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
- Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Tomasz Jazwiec
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Disease, Zabrze, Poland
| | - Matthew Goehler
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
| | - Jared Bush
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
| | - Nathan Quay
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
| | - Haley Ferguson
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
| | - Manuel K Rausch
- Department of Aerospace Engineering and Engineering Mechanics, Institute for Computational Engineering and Science, University of Texas at Austin, Austin, TX, USA
- Department of Biomedical Engineering, Institute for Computational Engineering and Science, University of Texas at Austin, Austin, TX, USA
| | - Tomasz A Timek
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
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21
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Malinowski M, Proudfoot AG, Eberhart L, Schubert H, Wodarek J, Langholz D, Rausch MK, Timek TA. Large animal model of acute right ventricular failure with functional tricuspid regurgitation. Int J Cardiol 2019; 264:124-129. [PMID: 29776560 DOI: 10.1016/j.ijcard.2018.02.072] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/12/2018] [Accepted: 02/19/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Functional tricuspid regurgitation (FTR) commonly arises secondary to conditions affecting the left heart and is associated with right ventricular dysfunction and tricuspid annular dilatation. We set out to establish an animal model of acute RV failure (RVF) with FTR resembling the clinical features. METHODS Ten adult sheep had pressure sensors placed in the LV, RV, and right atrium while sonomicrometry crystals were implanted around tricuspid annulus and on the RV. Animals were studied open-chest to assess for RV function and FTR after: (1) volume infusion, (2) pulmonary artery constriction, (3) 5 min posterior descending artery occlusion, and (4) combination of all interventions. Hemodynamic, echocardiographic, and sonomicrometry data were collected at baseline and after every intervention. RV dimensions, RV strain, and annular area, perimeter, and size were calculated from crystal coordinates. The model was validated in six additional sheep studied only before and after combined interventions. RESULTS Neither volume infusion, pulmonary hypertension, nor ischemia were associated with RVF or clinically significant TR when applied separately but combined resulted in RVF and greater than moderate FTR. In the validation group, maximal RV volume increased (62 ± 14 vs 70 ± 16 ml, p = 0.006), contractility decreased (20 ± 6 vs 12 ± 2%, p = 0.02), and strain increased. FTR increased from 0.4 ± 0.5 to 2.5 ± 0.8 (p < 0.001) and annular area from 652 ± 87 mm2 to 739 ± 87 mm2 (p = 0.005). CONCLUSIONS The developed ovine model of acute RVF was associated with significant annular and RV enlargement and FTR. This novel and clinically pertinent research platform offers insight into the acute RVF pathophysiology and can be utilized to evaluate treatment interventions.
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Affiliation(s)
- Marcin Malinowski
- Meijer Heart and Vascular Institute at Spectrum Health, 100 Michigan Ave NE, Grand Rapids, MI 49503, USA; Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice, Ziołowa 47, 40635 Katowice, Poland
| | - Alistair G Proudfoot
- Meijer Heart and Vascular Institute at Spectrum Health, 100 Michigan Ave NE, Grand Rapids, MI 49503, USA
| | - Lenora Eberhart
- Meijer Heart and Vascular Institute at Spectrum Health, 100 Michigan Ave NE, Grand Rapids, MI 49503, USA
| | - Hans Schubert
- Meijer Heart and Vascular Institute at Spectrum Health, 100 Michigan Ave NE, Grand Rapids, MI 49503, USA
| | - Jeremy Wodarek
- Meijer Heart and Vascular Institute at Spectrum Health, 100 Michigan Ave NE, Grand Rapids, MI 49503, USA
| | - David Langholz
- Meijer Heart and Vascular Institute at Spectrum Health, 100 Michigan Ave NE, Grand Rapids, MI 49503, USA
| | - Manuel K Rausch
- Department of Aerospace Engineering & Engineering Mechanics, Department of Biomedical Engineering, Institute for Computational Engineering and Science, University of Texas at Austin, 210 E 24th Street, Austin, TX 78703, USA
| | - Tomasz A Timek
- Meijer Heart and Vascular Institute at Spectrum Health, 100 Michigan Ave NE, Grand Rapids, MI 49503, USA.
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22
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Megaly M, Khalil C, Abraham B, Saad M, Tawadros M, Stanberry L, Kalra A, Goldsmith SR, Bart B, Bae R, Brilakis ES, Gössl M, Sorajja P. Impact of Transcatheter Mitral Valve Repair on Left Ventricular Remodeling in Secondary Mitral Regurgitation: A Meta-Analysis. STRUCTURAL HEART 2018. [DOI: 10.1080/24748706.2018.1516912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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23
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Mantegazza V, Pasquini A, Agati L, Fusini L, Muratori M, Gripari P, Ghulam Ali S, Vignati C, Bartorelli AL, Ferrari C, Alamanni F, Pepi M, Tamborini G. Comprehensive Assessment of Mitral Valve Geometry and Cardiac Remodeling With 3-Dimensional Echocardiography After Percutaneous Mitral Valve Repair. Am J Cardiol 2018; 122:1195-1203. [PMID: 30082038 DOI: 10.1016/j.amjcard.2018.06.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/19/2018] [Accepted: 06/26/2018] [Indexed: 01/01/2023]
Abstract
MitraClip is a validated treatment for significant mitral regurgitation (MR) in high-risk patients. Aims of the study were to evaluate immediate changes in mitral valve (MV) geometry induced by MitraClip and correlations between baseline geometry and cardiac remodeling. Eighty patients who underwent MitraClip for primary (48%) or secondary (52%) MR were enrolled. Intraoperative transesophageal echocardiographic 3D images were acquired immediately before and after the procedure for MV annulus (MVA) morphology analysis. Transthoracic 3D echocardiography was performed preoperatively and at 6 months follow-up (6MFU). Patients were classified on the basis of MR reduction (ΔMR) at 6MFU as Optimal (ΔMR ≥ 2) or Suboptimal (ΔMR < 2). An optimal result was reached in 60 (75%) patients, whereas 20 subjects showed a ΔMR< 2 at 6MFU. The Optimal showed significantly smaller baseline MVA (antero-posterior diameter 4.05 ± 0.59 vs 4.43 ± 0.68 cm; anterolateral-posteromedial diameter 4.38 ± 0.56 vs 4.70 ± 0.73 cm; MVA circumference 14.1 ± 1.7 vs 15.1 ± 2.3 cm; and 3D area 14.8 ± 3.9 vs 17.4 ± 5.3 cm2), lower sphericity index and nonplanar angle compared with Suboptimal. A value of antero-posterior diameter ≥4.44cm was identified (receiver-operating characteristic curve) as a possible cut-off for preoperative identification of Suboptimal patients. Postoperatively, MitraClip induced reduction of MVA flattening (nonplanar angle), sphericity index, and size (as expressed by antero-posterior diameter, MVA circumference and area). At 6MFU, the Optimal showed significant decrease in left ventricular volumes and pulmonary artery systolic pressure. In conclusion, MitraClip induces remarkable changes in MVA geometry and favorable left ventricular remodeling is detected in patients with optimal mid-term outcome; a preprocedural antero-posterior diameter <4.44cm seems to be a potential predictor of mid-term optimal result.
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Del Rio JM, Grecu L, Nicoara A. Right Ventricular Function in Left Heart Disease. Semin Cardiothorac Vasc Anesth 2018; 23:88-107. [DOI: 10.1177/1089253218799345] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Right ventricular (RV) function is an independent prognostic factor for short- and long-term outcomes in cardiac surgical patients. Patients with mitral valve (MV) disease are at increased risk of RV dysfunction before and after MV operations. Yet RV function is not part of criteria for decision making or risk stratification in this setting. The role of MV disease in the development of pulmonary hypertension (PHTN) and the ultimate impact of PHTN on RV function have been well described. Nonetheless, there are other mechanisms by which MV disease and MV surgery affect RV performance. Research suggests that PHTN may not be the most important determinant of RV dysfunction. Both RV dysfunction and PHTN have independent prognostic significance. This review explores the unique anatomic and functional features of the RV and the pathophysiologic and prognostic implications of RV dysfunction in patients with MV disease in the perioperative period.
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Affiliation(s)
- J. Mauricio Del Rio
- Divisions of Cardiothoracic Anesthesiology & Critical Care Medicine, Department of Anesthesiology, Duke University School of Medicine / Duke University Medical Center, Durham, NC, USA
| | - Loreta Grecu
- Divisions of Cardiothoracic Anesthesiology & Critical Care Medicine, Department of Anesthesiology, Duke University School of Medicine / Duke University Medical Center, Durham, NC, USA
| | - Alina Nicoara
- Divisions of Cardiothoracic Anesthesiology & Critical Care Medicine, Department of Anesthesiology, Duke University School of Medicine / Duke University Medical Center, Durham, NC, USA
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25
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Effect of tricuspid annuloplasty concomitant with left heart surgery on right heart geometry and function. J Thorac Cardiovasc Surg 2018; 156:1050-1061. [DOI: 10.1016/j.jtcvs.2018.03.101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 01/11/2018] [Accepted: 03/02/2018] [Indexed: 01/30/2023]
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26
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Veen KM, Muslem R, Soliman OI, Caliskan K, Kolff MEA, Dousma D, Manintveld OC, Birim O, Bogers AJJC, Takkenberg JJM. Left ventricular assist device implantation with and without concomitant tricuspid valve surgery: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2018; 54:644-651. [DOI: 10.1093/ejcts/ezy150] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/18/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kevin M Veen
- Thoraxcenter, Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Rahatullah Muslem
- Thoraxcenter, Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
- Thoraxcenter, Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Osama I Soliman
- Thoraxcenter, Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Kadir Caliskan
- Thoraxcenter, Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Marit E A Kolff
- Thoraxcenter, Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Dagmar Dousma
- Thoraxcenter, Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Olivier C Manintveld
- Thoraxcenter, Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Ozcan Birim
- Thoraxcenter, Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Thoraxcenter, Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Johanna J M Takkenberg
- Thoraxcenter, Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
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Gripari P, Tamborini G, Bottari V, Maffessanti F, Carminati MC, Muratori M, Vignati C, Bartorelli AL, Alamanni F, Pepi M. Three-Dimensional Transthoracic Echocardiography in the Comprehensive Evaluation of Right and Left Heart Chamber Remodeling Following Percutaneous Mitral Valve Repair. J Am Soc Echocardiogr 2016; 29:946-954. [PMID: 27502042 DOI: 10.1016/j.echo.2016.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Percutaneous mitral valve repair (PMVR) is an alternative treatment in patients with significant mitral regurgitation (MR) who are denied surgery. Although in surgical patients, outcomes have been related both to acute hemodynamic favorable results and to positive cardiac remodeling in the midterm, in the case of PMVR the effect on cardiac chamber remodeling has never been extensively studied. The aims of this study were (1) to evaluate the short- and mid-term remodeling induced by PMVR on cardiac chamber volume using two- and three-dimensional (3D) transthoracic echocardiographic (TTE) imaging and (2) to assess changes in left ventricular (LV) shape on the basis of 3D TTE data. METHODS Patients undergoing PMVR were prospectively enrolled. Two-dimensional and 3D TTE data sets acquired at baseline, and at 30 days and 6 months after PMVR were analyzed to assess LV and right ventricular (RV) volumes and ejection fraction and left atrial and right atrial volumes. Moreover, 3D endocardial surfaces were extracted to compute 3D shape indexes of LV sphericity and conicity at end-diastole and end-systole. RESULTS Six of the 64 enrolled patients did not reach follow-up and were excluded. The analysis was feasible in all 58 patients considered (26 with functional MR and 32 [55%] with degenerative MR). PMVR resulted in significant reduction of MR and in favorable remodeling: (1) effective PMVR was mainly associated with decreased LV loading, (2) PMVR-related reverse remodeling was observed in patients with degenerative MR and those with functional MR at 30 days and continued at 6-month follow-up, (3) favorable remodeling in LV shape from abnormally spherical to more normal conical took place in both groups after PMVR, and (4) RV volumes and systolic function were preserved after PMVR. CONCLUSIONS A comprehensive two-dimensional and 3D TTE analysis allows investigation from a double perspective (volume and morphology) of the entity and modality of changes following PMVR. In high-risk patients undergoing PMVR, postprocedural heart remodeling involves all cardiac chambers, occurs in the short term, and further improves at midterm follow-up.
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Affiliation(s)
| | | | | | - Francesco Maffessanti
- Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois; Center for Computational Medicine in Cardiology, Institute of Computational Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | | | | | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Francesco Alamanni
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
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28
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Chikwe J, Itagaki S, Anyanwu A, Adams DH. Impact of Concomitant Tricuspid Annuloplasty on Tricuspid Regurgitation, Right Ventricular Function, and Pulmonary Artery Hypertension After Repair of Mitral Valve Prolapse. J Am Coll Cardiol 2015; 65:1931-8. [DOI: 10.1016/j.jacc.2015.01.059] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 12/21/2014] [Accepted: 01/07/2015] [Indexed: 10/23/2022]
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29
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De Meester P, De Cock D, Van De Bruaene A, Gabriels C, Buys R, Helsen F, Voigt JU, Herijgers P, Herregods MC, Budts W. Additional tricuspid annuloplasty in mitral valve surgery results in better clinical outcome. Heart 2015; 101:720-6. [DOI: 10.1136/heartjnl-2014-306801] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 01/29/2015] [Indexed: 01/08/2023] Open
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30
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Pettersson GB, Rodriguez LL, Blackstone EH. Severe Tricuspid Valve Regurgitation Is Not an Innocent Finding to Be Ignored! JACC Cardiovasc Imaging 2014; 7:1195-7. [DOI: 10.1016/j.jcmg.2014.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 08/14/2014] [Indexed: 10/24/2022]
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31
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Zhu TY, Min XP, Zhang HB, Meng X. Preoperative Risk Factors for Residual Tricuspid Regurgitation after Isolated Left-Sided Valve Surgery: A Systematic Review and Meta-Analysis. Cardiology 2014; 129:242-9. [DOI: 10.1159/000367589] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 08/12/2014] [Indexed: 11/19/2022]
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32
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Ye Y, Desai R, Vargas Abello LM, Rajeswaran J, Klein AL, Blackstone EH, Pettersson GB. Effects of right ventricular morphology and function on outcomes of patients with degenerative mitral valve disease. J Thorac Cardiovasc Surg 2014; 148:2012-2020.e8. [DOI: 10.1016/j.jtcvs.2014.02.082] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 02/20/2014] [Accepted: 02/26/2014] [Indexed: 11/26/2022]
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33
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van Riel AC, Boerlage-van Dijk K, de Bruin-Bon RH, Araki M, Koch KT, Vis MM, Meregalli PG, van den Brink RB, Piek JJ, Mulder BJ, Baan J, Bouma BJ. Percutaneous Mitral Valve Repair Preserves Right Ventricular Function. J Am Soc Echocardiogr 2014; 27:1098-106. [DOI: 10.1016/j.echo.2014.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Indexed: 10/25/2022]
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34
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Owais K, Taylor CE, Jiang L, Khabbaz KR, Montealegre-Gallegos M, Matyal R, Gorman JH, Gorman RC, Mahmood F. Tricuspid annulus: a three-dimensional deconstruction and reconstruction. Ann Thorac Surg 2014; 98:1536-42. [PMID: 25249160 DOI: 10.1016/j.athoracsur.2014.07.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Before clinical manifestation of regurgitation, the tricuspid annulus dilates and flattens when right ventricular dysfunction is potentially reversible. That makes the case for a prophylactic tricuspid annuloplasty even in the absence of significant tricuspid regurgitation. Owing to the appreciation of the favorable prognostic value of tricuspid annuloplasty, the geometry of the normal tricuspid annulus merits critical analysis. METHODS Three-dimensional transesophageal echocardiographic data from 26 patients were analyzed using Image Arena (TomTec, Munich, Germany) software. Cartesian coordinate data from tricuspid annuli were exported to MATLAB (Mathworks, Natick, MA) for further processing. Annular metrics related to size, shape, and motion were computed. RESULTS The tricuspid annulus demonstrated significant changes in area (p<0.01) and perimeter (p<0.03) during the cardiac cycle, with maximum values attained at end diastole. There was significant correlation between two- and three-dimensional area changes, indicating true expansion in the annulus. The anterolateral region of the annulus demonstrated the greatest dynamism (p<0.01), and the anteroseptal region showed the least. The anteroseptal region also displayed the most nonplanarity in the annulus. In addition, vertical translational motion was observed, with a mean distance of 11.3±3.7 mm between end systolic and end diastolic annular centroids. CONCLUSIONS The tricuspid annulus is a dynamic, multiplanar structure with heterogeneous regional behavior. These characteristics should be taken into account for optimal annuloplasty device design and efficacy.
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Affiliation(s)
- Khurram Owais
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Charles E Taylor
- Department of Mechanical Engineering, University of Louisiana at Lafayette, Lafayette, Louisiana
| | - Luyang Jiang
- Department of Anesthesia, Peking University People's Hospital, Beijing, China
| | - Kamal R Khabbaz
- Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Mario Montealegre-Gallegos
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Joseph H Gorman
- Gorman Cardiovascular Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert C Gorman
- Gorman Cardiovascular Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Wang J, Han J, Li Y, Xu C, Jiao Y, Yang B, Meng X, Bolling SF. Preoperative risk factors of medium-term mitral valve repair outcome. Interact Cardiovasc Thorac Surg 2014; 19:946-54. [PMID: 25217622 DOI: 10.1093/icvts/ivu294] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate risk factors that affect mitral valve (MV) repair outcomes. METHODS From 2002 to 2012, 580 consecutive patients with mitral regurgitation (MR) underwent MV repair. Of the total number of patients, 48.9% were found to be in New York Heart Association (NYHA) Class III or IV. Anterior, posterior and bileaflet prolapse was present in 34.8, 47.6 and 17.6% of patients, respectively. Atrial fibrillation (AF) was found in 29.7% of patients. The mean follow-up was 5.3 ± 2.6 years. RESULTS There were eight early and 14 late deaths. NYHA Class III/IV, left ventricular ejection fraction ≤50%, systolic pulmonary artery pressure ≥50 mmHg, AF and low cardiac output syndrome with extracorporeal membrane oxygen were independent predictors of early mortality. AF, NYHA Class III/IV, left ventricular end-systolic diameter ≥40 mm and systolic pulmonary artery pressure ≥50 mmHg remained predictors of late mortality. At 5 years, the rate of survival, freedom from reoperation and recurrent moderate to severe MR was 99.0 ± 0.6 97.2 ± 0.8 and 93.3 ± 1.2%, respectively. Anterior leaflet involvement was predictive of reoperation and recurrent moderate to severe MR. In patients with a moderate tricuspid regurgitation (TR) and annulus <40 mm, the degree of TR during follow-up was worse with right ventricular dilatation. CONCLUSIONS MV repair should be performed before the deterioration of ventricular function, development of pulmonary hypertension and AF occurrence. The pathophysiology of MR affects MV repair durability, while concomitant tricuspid annuloplasty should be considered in patients with moderate TR despite annular dilatation.
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Affiliation(s)
- Jiangang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Han
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yan Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chunlei Xu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuqing Jiao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Bo Yang
- University of Michigan Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Xu Meng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Steven F Bolling
- University of Michigan Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
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Yiu KH, Wong A, Pu L, Chiang MF, Sit KY, Chan D, Lee HY, Lam YM, Chen Y, Siu CW, Lau CP, Au WK, Tse HF. Prognostic Value of Preoperative Right Ventricular Geometry and Tricuspid Valve Tethering Area in Patients Undergoing Tricuspid Annuloplasty. Circulation 2014; 129:87-92. [DOI: 10.1161/circulationaha.113.003811] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Patients who undergo tricuspid annuloplasty during left-side heart valve surgery have a poor postoperative clinical outcome. However, preoperative right ventricular (RV) echocardiography parameters that predict adverse events in these patients are poorly understood.
Methods and Results—
We studied 74 patients (age, 58±10 years; men, 27%) with significant tricuspid regurgitation who consequently underwent tricuspid annuloplasty during left-side heart valve surgery. A total of 26 adverse events (22 heart failures and 4 cardiovascular deaths) occurred during a median follow-up of 26 months. RV midcavity diameter (hazard ratio=2.44; 95% confidence interval=1.48–4.02;
P
<0.01), RV longitudinal dimension (hazard ratio=1.64; 95% confidence interval=1.10–2.45;
P
=0.02), and tricuspid valve tethering area (hazard ratio=3.25; 95% confidence interval=1.71–6.19;
P
<0.01) were independently associated with adverse events after adjustment for age and New York Heart Association class III/IV. Receiver-operator characteristic curve analysis demonstrated that RV midcavity diameter (area under the curve=0.74;
P
<0.01) and tricuspid valve tethering area (area under the curve=0.70;
P
=0.04) were most associated with adverse events at the 1-year follow-up. The presence of either a large RV midcavity diameter or tricuspid valve tethering area was predictive of adverse outcome at 1 year after tricuspid annuloplasty.
Conclusions—
The present study demonstrates that RV geometry dimensions, namely RV midcavity diameter and tricuspid valve tethering area, are important preoperative measures associated with adverse events in patients undergoing tricuspid annuloplasty.
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Affiliation(s)
- Kai-Hang Yiu
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Arthur Wong
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Lijun Pu
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Man-Fung Chiang
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Ko-Yung Sit
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Daniel Chan
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Hou-Yee Lee
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Yui-Ming Lam
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Yan Chen
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Chung-Wah Siu
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Chu-Pak Lau
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Wing-Kok Au
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Hung-Fat Tse
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
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Desai RR, Vargas Abello LM, Klein AL, Marwick TH, Krasuski RA, Ye Y, Nowicki ER, Rajeswaran J, Blackstone EH, Pettersson GB. Tricuspid regurgitation and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure. J Thorac Cardiovasc Surg 2012; 146:1126-1132.e10. [PMID: 23010580 DOI: 10.1016/j.jtcvs.2012.08.061] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 07/30/2012] [Accepted: 08/23/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To study the effect of mitral valve repair with or without concomitant tricuspid valve repair on functional tricuspid regurgitation and right ventricular function. METHODS From 2001 to 2007, 1833 patients with degenerative mitral valve disease, a structurally normal tricuspid valve, and no coronary artery disease underwent mitral valve repair, and 67 underwent concomitant tricuspid valve repair. Right ventricular function (myocardial performance index and tricuspid annular plane systolic excursion) was measured before and after surgery using transthoracic echocardiography for randomly selected patients with tricuspid regurgitation grade 0, 1+, and 2+ (100 patients for each grade) and 93 with grade 3+/4+, 393 patients in total. RESULTS In patients with mild (<3+) preoperative tricuspid regurgitation, mitral valve repair alone was associated with reduced tricuspid regurgitation and mild worsening of right ventricular function. Tricuspid regurgitation of 2+ or greater developed in fewer than 20%, and right ventricular function had improved, but not to preoperative levels, at 3 years. In patients with severe (3+/4+) preoperative tricuspid regurgitation, mitral valve repair alone reduced tricuspid regurgitation and improved right ventricular function; however, tricuspid regurgitation of 2+ or greater returned and right ventricular function worsened toward preoperative levels within 3 years. Concomitant tricuspid valve repair effectively eliminated severe tricuspid regurgitation and improved right ventricular function. Also, over time, tricuspid regurgitation did not return and right ventricular function continued to improve to levels comparable to that of patients with lower grades of preoperative tricuspid regurgitation. CONCLUSIONS In patients with mitral valve disease and severe tricuspid regurgitation, mitral valve repair alone was associated with improved tricuspid regurgitation and right ventricular function. However, the improvements were incomplete and temporary. In contrast, concomitant tricuspid valve repair effectively and durably eliminated severe tricuspid regurgitation and improved right ventricular function toward normal, supporting an aggressive approach to important functional tricuspid regurgitation.
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Affiliation(s)
- Ravi R Desai
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
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38
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Itagaki S, Hosseinian L, Varghese R. Right Ventricular Failure After Cardiac Surgery: Management Strategies. Semin Thorac Cardiovasc Surg 2012. [DOI: 10.1053/j.semtcvs.2012.08.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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