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Arafat AA, Alfonso J, Hassan E, Pragliola C, Adam AI, Algarni KD. The influence of mitral valve pathology on the concomitant tricuspid valve repair. J Card Surg 2022; 37:739-746. [DOI: 10.1111/jocs.16250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/14/2021] [Accepted: 10/23/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Amr A. Arafat
- Department of Adult Cardiac Surgery Prince Sultan Cardiac Center Riyadh Saudi Arabia
- Cardiothoracic Surgery Department Tanta University Tanta Egypt
| | - Juan Alfonso
- Clinical Research Department Prince Sultan Cardiac Center Riyadh Saudi Arabia
| | - Essam Hassan
- Department of Adult Cardiac Surgery Prince Sultan Cardiac Center Riyadh Saudi Arabia
- Cardiothoracic Surgery Department Tanta University Tanta Egypt
| | - Claudio Pragliola
- Department of Adult Cardiac Surgery Prince Sultan Cardiac Center Riyadh Saudi Arabia
| | - Adam I. Adam
- Department of Adult Cardiac Surgery Prince Sultan Cardiac Center Riyadh Saudi Arabia
| | - Khaled D. Algarni
- Department of Adult Cardiac Surgery Prince Sultan Cardiac Center Riyadh Saudi Arabia
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2
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Omori T, Maeda M, Kagawa S, Uno G, Rader F, Siegel RJ, Shiota T. Impact of Diastolic Interventricular Septal Flattening on Clinical Outcome in Patients With Severe Tricuspid Regurgitation. J Am Heart Assoc 2021; 10:e021363. [PMID: 34622664 PMCID: PMC8751866 DOI: 10.1161/jaha.121.021363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Little is known about the impact of diastolic interventricular septal flattening on the clinical outcome in patients with severe tricuspid regurgitation. This study sought to evaluate the association of diastolic interventricular septal flattening with clinical outcome in patients with severe tricuspid regurgitation. Methods and Results We retrospectively studied 407 patients who underwent 2‐dimensional transthoracic echocardiography and were diagnosed with severe tricuspid regurgitation between January 2014 and December 2015. Cardiovascular events were defined as cardiovascular death or admission for heart failure. The magnitude of interventricular septal flattening was calculated by the eccentricity index (EI) of the left ventricle, and hemodynamic parameters were obtained from transthoracic echocardiography. During follow‐up (median, 200 days; interquartile range, 35–1059), 117 of the patients experienced cardiovascular events. By multivariate analysis including potential covariates, EI at end‐diastole and left ventricular ejection fraction were independent predictors of cardiovascular events (hazard ratio, 5.33 [1.63–17.41]; hazard ratio, 0.98 [0.97–0.99], respectively). An EI of 1.2 at end‐diastole was the optimal cutoff value for identifying poor hemodynamic status defined as cardiac index ≤2.2 L/min per m2 and right atrial pressure 15 mm Hg, both on transthoracic echocardiography. Patients with D‐shaped left ventricle defined as EI ≥1.2 at end‐diastole showed worse outcomes than those without (adjusted hazard ratio, 1.80 [1.18–2.74]). Conclusions Increasing EI at end‐diastole was strongly associated with worse outcomes in patients with severe tricuspid regurgitation. Furthermore, the presence of D‐shaped left ventricle defined as EI ≥1.2 at end‐diastole provides prognostic value for cardiovascular events.
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Affiliation(s)
- Taku Omori
- Smidt Heart InstituteCedars-Sinai Medical Center Los Angeles CA
| | - Mika Maeda
- Smidt Heart InstituteCedars-Sinai Medical Center Los Angeles CA
| | - Shunsuke Kagawa
- Smidt Heart InstituteCedars-Sinai Medical Center Los Angeles CA
| | - Goki Uno
- Smidt Heart InstituteCedars-Sinai Medical Center Los Angeles CA
| | - Florian Rader
- Smidt Heart InstituteCedars-Sinai Medical Center Los Angeles CA.,Department of Medicine University of California Los Angeles CA
| | - Robert J Siegel
- Smidt Heart InstituteCedars-Sinai Medical Center Los Angeles CA.,Department of Medicine University of California Los Angeles CA
| | - Takahiro Shiota
- Smidt Heart InstituteCedars-Sinai Medical Center Los Angeles CA.,Department of Medicine University of California Los Angeles CA
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3
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Alkady H, Saber A, Abouramadan S, Elnaggar A, Nasr S, Mahmoud E. Mitral valve replacement in mitral stenosis; the problem of small left ventricle. J Cardiothorac Surg 2020; 15:67. [PMID: 32321541 PMCID: PMC7178577 DOI: 10.1186/s13019-020-01108-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/13/2020] [Indexed: 11/11/2022] Open
Abstract
Background Mitral valve stenosis in adults especially due to rheumatic heart disease may be associated with a smaller than normal left ventricular cavity. Mitral valve replacement in such cases may lead to hemodynamic instability either during weaning from cardiopulmonary bypass or in the early postoperative period manifested by the need for inotropic support and even mortality due to low cardiac output syndrome. Patients and methods 184 patients with predominately severe stenotic mitral valves who underwent elective isolated mitral valve replacement in the period between January 2012 and January 2018 at our hospital were included in this study. Patients were divided into 2 matched groups; (small LV group) consisting of 86 cases and (normal or dilated LV group) consisting of 98 cases. Results There were no statistically significant differences in operative details among both groups apart from the need for inotropic support and intra-aortic balloon pump due to low cardiac output which were statistically significantly higher in (small LV group) than (normal or dilated LV group) with a p-values of 0.01 and 0.03 respectively. Within the ICU stay only the incidence of occurrence of heart failure was significantly higher in (small LV group) with a p-value of 0.008. No statistically significant difference could be elicited in the in-hospital mortality between both groups (p-value = 0.1). Conclusion Patients with mitral valve stenosis and small left ventricular cavity are in a higher need for inotropic and even mechanical support after mitral valve replacement as well as at a higher risk for the development of heart failure before hospital discharge than patients with mitral stenosis and normal-sized left ventricular cavity.
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Affiliation(s)
- Hesham Alkady
- Department of cardiothoracic surgery, Cairo University, Kasralaini str., Almanial, Cairo, Egypt.
| | - Ahmed Saber
- Department of cardiothoracic surgery, Cairo University, Kasralaini str., Almanial, Cairo, Egypt
| | - Sobhy Abouramadan
- Department of cardiothoracic surgery, Cairo University, Kasralaini str., Almanial, Cairo, Egypt
| | - Ahmed Elnaggar
- Department of cardiothoracic surgery, Cairo University, Kasralaini str., Almanial, Cairo, Egypt
| | - Sherif Nasr
- Department of cardiothoracic surgery, Fayoum University, Fayoum, Egypt
| | - Eman Mahmoud
- Department of cardiology, Fayoum University, Fayoum, Egypt
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4
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Gao Y, Li S, Zhuang X, Gao F, Shi L, Meng X. Comparison of Mitral Valve Repair versus Replacement for the Progression of Functional Tricuspid Regurgitation. Ann Thorac Cardiovasc Surg 2020; 26:72-78. [PMID: 31495812 PMCID: PMC7184033 DOI: 10.5761/atcs.oa.19-00132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Function tricuspid regurgitation (TR) is frequently observed in patients undergoing mitral valve surgery. It is unclear that mitral valve repair (MVr) or mitral valve replacement (MVR) has influence on the likelihood of late TR progression. Methods: This study included 193 patients with degenerative mitral valve disease who underwent either MVr or MVR. Detailed preoperative materials, follow-up information, and echocardiographic data were collected and statistically analyzed. Results: At 6 and 12 months postoperatively, MVR patients were more likely to have New York Heart Association (NYHA) class III or IV symptoms than MVr patients (6 mo: 15.2% vs 5.0%, 12 mo: 13.0% vs 4.0%, both P <0.05). At 24 months, the incidence of Grade 1+ TR was significantly higher in MVR patients than MVr patients (25.0% vs 12.9%, P <0.05). In univariate analysis, age (odds ratio [OR] = 1.036, P = 0.036), MVR (OR = 2.256, P = 0.033), and preoperative TR area (TRA; OR = 1.541, P = 0.047) were significant predictors for TR progression. In multivariate logistics analysis, only MVR was independently risk factor (P = 0.006). Subsequently, patients were divided into tricuspid valve repair (TVr) group and untreated group. In both subgroups, MVR patients were associated with significantly larger TRA (P <0.01). Conclusion: MVR was an independent risk factor for TR progression, whether tricuspid valve was treated or not.
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Affiliation(s)
- Yang Gao
- Department of Cardiology Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shubin Li
- Department of Cardiology Surgery, Xinxiang Central Hospital, Xinxiang, China
| | - Xijing Zhuang
- Department of Cardiology Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Feng Gao
- Department of Cardiology Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Lei Shi
- Department of Cardiology Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Xu Meng
- Department of Cardiology Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Cao JY, Wales KM, Zhao DF, Seco M, Celermajer DS, Bannon PG. Repair of Less Than Severe Tricuspid Regurgitation During Left-Sided Valve Surgery: A Meta-Analysis. Ann Thorac Surg 2020; 109:950-958. [DOI: 10.1016/j.athoracsur.2019.08.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/08/2019] [Accepted: 08/21/2019] [Indexed: 12/26/2022]
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6
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Benfari G, Antoine C, Miller WL, Thapa P, Topilsky Y, Rossi A, Michelena HI, Pislaru S, Enriquez-Sarano M. Excess Mortality Associated With Functional Tricuspid Regurgitation Complicating Heart Failure With Reduced Ejection Fraction. Circulation 2019; 140:196-206. [DOI: 10.1161/circulationaha.118.038946] [Citation(s) in RCA: 141] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Giovanni Benfari
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (G.B., C.A., W.L.M., P.T., Y.T., H.I.M., S.P., M.E.-S.)
- Division of Cardiology, Department of Medicine, University of Verona, Italy (G.B., A.R.)
| | - Clemence Antoine
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (G.B., C.A., W.L.M., P.T., Y.T., H.I.M., S.P., M.E.-S.)
| | - Wayne L. Miller
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (G.B., C.A., W.L.M., P.T., Y.T., H.I.M., S.P., M.E.-S.)
| | - Prabin Thapa
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (G.B., C.A., W.L.M., P.T., Y.T., H.I.M., S.P., M.E.-S.)
| | - Yan Topilsky
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (G.B., C.A., W.L.M., P.T., Y.T., H.I.M., S.P., M.E.-S.)
- Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Israel (Y.T.)
| | - Andrea Rossi
- Division of Cardiology, Department of Medicine, University of Verona, Italy (G.B., A.R.)
| | - Hector I. Michelena
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (G.B., C.A., W.L.M., P.T., Y.T., H.I.M., S.P., M.E.-S.)
| | - Sorin Pislaru
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (G.B., C.A., W.L.M., P.T., Y.T., H.I.M., S.P., M.E.-S.)
| | - Maurice Enriquez-Sarano
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (G.B., C.A., W.L.M., P.T., Y.T., H.I.M., S.P., M.E.-S.)
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7
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Mid-term results of a randomized trial of tricuspid annuloplasty for less-than-severe functional tricuspid regurgitation at the time of mitral valve surgery†. Eur J Cardiothorac Surg 2018; 55:851-858. [DOI: 10.1093/ejcts/ezy378] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/30/2018] [Accepted: 10/10/2018] [Indexed: 12/28/2022] Open
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Kelly BJ, Ho Luxford JM, Butler CG, Huang CC, Wilusz K, Ejiofor JI, Rawn JD, Fox JA, Shernan SK, Muehlschlegel JD. Severity of tricuspid regurgitation is associated with long-term mortality. J Thorac Cardiovasc Surg 2017; 155:1032-1038.e2. [PMID: 29246545 DOI: 10.1016/j.jtcvs.2017.09.141] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/24/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To determine the association between intraoperative/presurgical grade of tricuspid regurgitation (TR) and mortality, and to determine whether surgical correction of TR correlated with an increased chance of survival compared with patients with uncorrected TR. METHODS The grade of TR assessed by intraoperative transesophageal echocardiography (TEE) before surgical intervention was reviewed for 23,685 cardiac surgery patients between 1990 and 2014. Cox proportional hazard regression models were used to determine association between grade of TR and the primary endpoint of all-cause mortality. Association between tricuspid valve (TV) surgery and survival was determined with Cox proportional hazard regression models after matching for grade of TR. RESULTS Kaplan-Meier survival curves demonstrated a relationship between all grades of TR. Multivariable analysis of the entire cohort demonstrated significantly increased mortality for moderate (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.1-1.4; P < .0001) and severe TR (HR, 2.02; 95% CI, 1.57-2.6; P < .0001). Mild TR displayed a trend for mortality (HR, 1.07; 95% CI, 0.99-1.16; P = .075). After matching for grade of TR and additional confounders, patients who underwent TV surgery had a statistically significant increased likelihood of survival (HR, 0.74; 95% CI, 0.61-0.91; P = .004). CONCLUSIONS Our study of more than 20,000 patients demonstrates that grade of TR is associated with increased risk of mortality after cardiac surgery. In addition, all patients who underwent TV surgery had a statistically significantly increased likelihood of survival compared with those with the same degree of TR who did not undergo TV surgery.
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Affiliation(s)
- Brian J Kelly
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | | | - Carolyn Goldberg Butler
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Chuan-Chin Huang
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Kerry Wilusz
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Julius I Ejiofor
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - James D Rawn
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - John A Fox
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Stanton K Shernan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Jochen Daniel Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
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9
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Mangieri A, Montalto C, Pagnesi M, Jabbour RJ, Rodés-Cabau J, Moat N, Colombo A, Latib A. Mechanism and Implications of the Tricuspid Regurgitation. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005043. [DOI: 10.1161/circinterventions.117.005043] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/15/2017] [Indexed: 01/28/2023]
Abstract
The tricuspid valve was virtually ignored for a long time in the past. However, significant tricuspid regurgitation (TR) often accompanies left-side heart valve pathology and does not always reverse with its correction. If left untreated, TR can progress and result in progressive right ventricular failure. Current guideline recommendations still hold minor differences. Nevertheless, there is a consensus to operate on patients with severe TR undergoing left-sided valve surgery (class I) or those with mild to moderate TR with a dilated annulus (≥40 or ≥21 mm
2
, Class IIa). However, in case of the primary TR, surgical options is limited by a relatively high risk of mortality and morbidity. For these patients, new percutaneous approaches are becoming available but no long-term data are still available. In this review, we provide a comprehensive overview of the epidemiological and pathophysiological aspects of TR, and the current and future directions of therapy.
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Affiliation(s)
- Antonio Mangieri
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Claudio Montalto
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Matteo Pagnesi
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Richard J. Jabbour
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Josep Rodés-Cabau
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Neil Moat
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Antonio Colombo
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Azeem Latib
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
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10
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David TE, David CM, Fan CPS, Manlhiot C. Tricuspid regurgitation is uncommon after mitral valve repair for degenerative diseases. J Thorac Cardiovasc Surg 2017; 154:110-122.e1. [DOI: 10.1016/j.jtcvs.2016.12.046] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 11/30/2016] [Accepted: 12/16/2016] [Indexed: 11/28/2022]
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11
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Prosthesis Size Selection for Patients With Severe Mitral Stenosis. Ann Thorac Surg 2017; 103:1361. [PMID: 28359479 DOI: 10.1016/j.athoracsur.2016.08.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/13/2016] [Indexed: 10/19/2022]
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12
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Performing Concomitant Tricuspid Valve Repair at the Time of Mitral Valve Operations Is Not Associated With Increased Operative Mortality. Ann Thorac Surg 2017; 103:587-593. [DOI: 10.1016/j.athoracsur.2016.06.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 05/13/2016] [Accepted: 06/06/2016] [Indexed: 01/15/2023]
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13
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Zehr KJ. To Fix or Not to Fix? That is the Question. Semin Thorac Cardiovasc Surg 2016; 28:46-7. [PMID: 27568133 DOI: 10.1053/j.semtcvs.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Kenton J Zehr
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
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14
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Sordelli C, Lancellotti P, Carlomagno G, Di Giannuario G, Alati E, De Bonis M, Alfieri O, La Canna G. Tricuspid Annular Size and Regurgitation Progression After Surgical Repair for Degenerative Mitral Regurgitation. Am J Cardiol 2016; 118:424-31. [PMID: 27287061 DOI: 10.1016/j.amjcard.2016.05.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/05/2016] [Accepted: 05/05/2016] [Indexed: 11/26/2022]
Abstract
The late worsening of nonsevere tricuspid regurgitation (TR) after mitral valve surgery is a relevant clinical problem that can lead to high-risk reoperation. Although tricuspid annulus (TA) dilatation has been proposed for prophylactic annuloplasty to prevent TR worsening, prospective data in degenerative mitral regurgitation (MR) are lacking. The aim of this prospective cohort study was to evaluate TA dimension to predict TR progression after valve repair for degenerative MR. Clinical and echocardiographic evaluation of 706 patients with degenerative MR and no significant TR was obtained preoperatively and at follow-up after isolated mitral valve repair. Together with standard cardiac chamber and valve analysis, 3-dimensional (3D) transesophageal echocardiography was performed to evaluate TA, including the anteroposterior and septolateral diameters. After a mean follow-up of 24 ± 15 months (range 6 to 60), 2 patients died while 14 developed severe MR. Compared with preoperative values, TR decreased (≤1 degree) in 227 patients, was unchanged in 437, and increased (≥1 degree) in 39 patients, with the development of significant TR (3 to 4 degree) in 3 patients. Receiver-operating characteristic curve analysis did not identify significant TA values predicting postoperative TR worsening. On multivariate regression analysis, recurrent MR and pulmonary hypertension at follow-up emerged as significant positive predictors of TR progression. Newly developed significant TR is a rare event after successful repair of degenerative MR. Although more accurate than conventional 2D measurement, 3D analysis of TA does not predict early to midterm subsequent TR progression.
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15
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Tricuspid surgery for tricuspid regurgitation: review. Gen Thorac Cardiovasc Surg 2016; 64:577-83. [DOI: 10.1007/s11748-016-0678-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/17/2016] [Indexed: 12/14/2022]
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16
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Godino C, Salerno A, Cera M, Agricola E, Fragasso G, Rosa I, Oppizzi M, Monello A, Scotti A, Magni V, Montorfano M, Cappelletti A, Margonato A, Colombo A. Impact and evolution of right ventricular dysfunction after successful MitraClip implantation in patients with functional mitral regurgitation. IJC HEART & VASCULATURE 2016; 11:90-98. [PMID: 28616532 PMCID: PMC5441334 DOI: 10.1016/j.ijcha.2016.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 05/02/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Right ventricular dysfunction (RVdysf) is a predictor of poor outcome in patients with heart failure and valvular disease. The aim of this study was to evaluate the evolution and the impact of RVdysf in patients with moderate-severe functional mitral regurgitation (FMR) successfully treated with MitraClip. METHODS AND RESULTS From October 2008 to July 2014, 60 consecutive high surgical risk FMR patients were evaluated and stratified into two groups: RVdysf group (TAPSE < 16 mm and/or S'TDI < 10 cm/s, 21 patients) and No-RVdysf group (38 patients). The overall mean age of patients was 73 ± 8 (83% male). Ischemic FMR etiology was present in 67%. Mean LVEF was 30 ± 10%. Overall mean time follow-up was 565 ± 310 days. The only significant difference between the two groups was a greater prevalence of stroke, ICD and use of aldosterone antagonist in RVdysf group. Acute procedural success was achieved in 90% of patients. At 6-month echo-matched analysis significant RV function improvement was observed in patients with baseline RVdysf (TAPSE 15 ± 3.0 vs. 19 ± 4.5, p = 0.007; S'TDI 7 ± 1.2 vs. 11 ± 2.8, p < 0.0001; baseline vs. 6-month, respectively). The mean improvement in the 6-min walking test was significant in both groups (120 and 143 m, RVdysf and No-RVdysf groups, respectively). At Kaplan-Meier analysis, the presence of RVdysf did not affect the outcome in terms of freedom from composite efficacy endpoint. CONCLUSIONS This study shows that successful MitraClip implantation in patients with FMR and concomitant right ventricular dysfunction yields significant improvement of RV function at mid-term follow-up. Further data on larger population will be required to confirm our observations.
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Affiliation(s)
- Cosmo Godino
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
- Corresponding author at: Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.Cardio-Thoracic-Vascular DepartmentSan Raffaele Scientific InstituteVia Olgettina 60Milan20132Italy
| | - Anna Salerno
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Michela Cera
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Fragasso
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Isabella Rosa
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Michele Oppizzi
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Monello
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Scotti
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Valeria Magni
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Cappelletti
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Margonato
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
- EMO-GVM Centro Cuore Columbus, Milan, Italy
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17
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Lee H, Sung K, Kim WS, Lee YT, Park SJ, Carriere KC, Park PW. Clinical and hemodynamic influences of prophylactic tricuspid annuloplasty in mechanical mitral valve replacement. J Thorac Cardiovasc Surg 2016; 151:788-795. [DOI: 10.1016/j.jtcvs.2015.10.104] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/20/2015] [Accepted: 10/26/2015] [Indexed: 12/01/2022]
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18
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Huttin O, Voilliot D, Mandry D, Venner C, Juillière Y, Selton-Suty C. All you need to know about the tricuspid valve: Tricuspid valve imaging and tricuspid regurgitation analysis. Arch Cardiovasc Dis 2016; 109:67-80. [DOI: 10.1016/j.acvd.2015.08.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/24/2015] [Accepted: 08/27/2015] [Indexed: 11/17/2022]
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19
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Mehaffey JH, Kron IL. How much is enough to warrant prophylactic tricuspid repair? J Thorac Cardiovasc Surg 2015; 151:796-797. [PMID: 26651962 DOI: 10.1016/j.jtcvs.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/04/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J Hunter Mehaffey
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
| | - Irving L Kron
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va.
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20
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Taramasso M, Maisano F, De Bonis M, Pozzoli A, Schiavi D, Benussi S, Grimaldi A, La Canna G, Alfieri O. Prognostic Impact and Late Evolution of Untreated Moderate (2/4+) Functional Tricuspid Regurgitation in Patients Undergoing Aortic Valve Replacement. J Card Surg 2015; 31:9-14. [DOI: 10.1111/jocs.12656] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Maurizio Taramasso
- Klinik für Herz- und Gefässchirurgie; UniversitätsSpital Zürich; Zürich Switzerland
| | - Francesco Maisano
- Klinik für Herz- und Gefässchirurgie; UniversitätsSpital Zürich; Zürich Switzerland
| | - Michele De Bonis
- Cardiac Surgery Department; San Raffaele University Hospital; Milan Italy
| | - Alberto Pozzoli
- Cardiac Surgery Department; San Raffaele University Hospital; Milan Italy
| | - Davide Schiavi
- Cardiac Surgery Department; San Raffaele University Hospital; Milan Italy
| | - Stefano Benussi
- Klinik für Herz- und Gefässchirurgie; UniversitätsSpital Zürich; Zürich Switzerland
| | - Antonio Grimaldi
- Cardiac Surgery Department; San Raffaele University Hospital; Milan Italy
| | - Giovanni La Canna
- Cardiac Surgery Department; San Raffaele University Hospital; Milan Italy
| | - Ottavio Alfieri
- Cardiac Surgery Department; San Raffaele University Hospital; Milan Italy
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21
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Abstract
For the year 2014, more than 17,000 published references can be found in Pubmed when entering the search term "cardiac surgery". The last year has been characterized by a vivid discussion in the fields where classic cardiac surgery and modern interventional techniques overlap. Specifically, there have been important contributions in the field of coronary revascularization with either percutaneous coronary intervention or bypass surgery as well as in the fields of interventional valve therapy. Here, the US core valve trial with the first demonstration of a survival advantage at 1 year with transcatheter valves compared to surgical aortic valve replacement or the 5-year outcome of the SYNTAX trial with significant advantages for bypass surgery has been the landmark. However, in addition to these most visible publications, there have been several highly relevant and interesting contributions. This review article will summarize the most pertinent publications in the fields of coronary revascularization, surgical treatment of valve disease, heart failure (i.e., transplantation and ventricular assist devices) and aortic surgery. This condensed summary will provide the reader with "solid ground" for up-to-date decision-making in cardiac surgery.
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22
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Fukunaga N, Okada Y, Konishi Y, Murashita T, Koyama T. Late Outcome of Tricuspid Annuloplasty Using a Flexible Band/Ring for Functional Tricuspid Regurgitation. Circ J 2015; 79:1299-306. [DOI: 10.1253/circj.cj-14-1282] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Naoto Fukunaga
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital
| | - Yukikatsu Okada
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital
| | - Yasunobu Konishi
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital
| | - Takashi Murashita
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital
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23
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Abstract
Despite the fact that tricuspid regurgitation (TR) can result in significant symptoms, patients are rarely referred for isolated surgical repair, or replacement, and most surgeries are performed in the context of other planned cardiac surgery. In this article, we review the different causes of TR, the natural history of untreated severe TR, indications and timing for isolated TR surgery, indications for TR surgery performed at the time of left-sided valve surgery, and surgical approaches for correction of TR.
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Affiliation(s)
- Yan Topilsky
- Director of Echo Lab, Tel Aviv Medical Center, Israel
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24
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Suri RM, Topilsky Y. The role of cognitive dissonance in the management of functional tricuspid regurgitation at the time of degenerative mitral valve repair. J Thorac Cardiovasc Surg 2014; 148:2810-2. [DOI: 10.1016/j.jtcvs.2014.08.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 11/30/2022]
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25
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Stephens EH, Borger MA. "Forgotten" valve or "enigmatic" valve? Further insights into the tricuspid valve in patients undergoing mitral valve surgery. J Thorac Cardiovasc Surg 2014; 148:1962-4. [PMID: 25444187 DOI: 10.1016/j.jtcvs.2014.09.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 09/15/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Elizabeth H Stephens
- Department of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY
| | - Michael A Borger
- Department of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY.
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