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Jia KY, Chen F, Peng Y, Wei JF, He S, Wei X, Tang H, Meng W, Feng Y, Chen M. Multidetector CT-derived tricuspid annulus measurements predict tricuspid regurgitation reduction after transcatheter aortic valve replacement. Clin Radiol 2023; 78:779-788. [PMID: 37574402 DOI: 10.1016/j.crad.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/13/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023]
Abstract
AIM To use multidetector row computed tomography (MDCT)-derived tricuspid annulus (TA) measurements to identify predictors for tricuspid regurgitation (TR) reduction after transcatheter aortic valve replacement (TAVR), and to investigate the impact of TR change on prognosis. MATERIALS AND METHODS A retrospective, single-centre study was conducted on consecutive patients who underwent TAVR with concomitant baseline mild or more severe TR from April 2012 to April 2022. TA parameters were measured using MDCT. RESULTS The study comprised 266 patients (mean age 74.2 ± 7.6 years, 147 men) and 45.1% had more than one grade of TR reduction at follow-up. Independent predictors of TR reduction at follow-up were distance between TA centroid and antero-septal commissure (odd ratio [OR] 0.776; 95% confidence interval [CI]: 0.672-0.896, p=0.001), baseline TR of moderate or worse (OR 4.599; 95% CI: 2.193-9.648, p<0.001), systolic pulmonary artery pressure (OR 1.018; 95% CI: 1.002-1.035, p=0.027), age (OR 0.955; 95% CI: 0.920-0.993, p=0.019), and pre-existing atrial fibrillation (OR 0.209; 95% CI: 0.101-0.433, p<0.001). Patients without TR reduction had higher rates of rehospitalisation (hazard ratio [HR] 0.642; 95% CI: 0.413-0.998, p=0.049). CONCLUSIONS The MDCT-derived TA parameter was predictive of TR reduction after TAVR. Persistent TR after TAVR was associated with higher rates of rehospitalisation.
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Affiliation(s)
- K-Y Jia
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, 610041 Chengdu, China
| | - F Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, 610041 Chengdu, China
| | - Y Peng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, 610041 Chengdu, China
| | - J-F Wei
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, 610041 Chengdu, China
| | - S He
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, 610041 Chengdu, China
| | - X Wei
- Department of Cardiology, Section of Cardiac Ultrasound, West China Hospital, Sichuan University, 37 Guoxue Road, 610041 Chengdu, China
| | - H Tang
- Department of Cardiology, Section of Cardiac Ultrasound, West China Hospital, Sichuan University, 37 Guoxue Road, 610041 Chengdu, China
| | - W Meng
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, 37 Guoxue Road, 610041 Chengdu, China.
| | - Y Feng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, 610041 Chengdu, China.
| | - M Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, 610041 Chengdu, China.
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Margonato D, Ancona F, Cesari A, Ghantous E, Ingallina G, Melillo F, Stella S, Biondi F, Belli M, Montalto C, Manini C, Montorfano M, De Bonis M, Maisano F, Topilsky Y, Agricola E. The long-term clinical course of moderate tricuspid regurgitation. Int J Cardiol 2023; 387:131135. [PMID: 37364718 DOI: 10.1016/j.ijcard.2023.131135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND To evaluate the long-term clinical outcome of a cohort of patients suffering from moderate tricuspid regurgitation (TR), regardless of its etiology. METHODS Clinical and echocardiographic follow-up were assessed in 250 patients diagnosed with moderate TR between January 2016 and July 2020. TR progression at follow-up was defined as TR grade increase to at least severe. The primary endpoint was all-cause death; secondary endpoints were cardiovascular (CV) death and the composite of heart failure (HF) hospitalization plus tricuspid valve (TV) intervention. RESULTS After a median follow-up of 3.6 years, TR progression occurred in 84 patients (34%). At multivariate analyses, atrial fibrillation (AF, OR 1.81, CI 1.01-3.29, p = 0.045) and right ventricular end-diastolic diameter (RVEDD, OR 2.19, CI 1.26-3.78, p = 0.005) were independent predictors of TR progression. The primary endpoint occurred in 59 patients (24%) and was significantly more frequent in the group with TR progression (p = 0.009). At multivariate analyses, chronic kideney disease (OR 2.80, CI 1.30-6.03, p = 0.009), left ventricular ejection fraction (OR 0.97, CI 0.94-0.99, p = 0.041) and TR progression (OR 2.32, CI 1.31-4.12, p = 0.004) were independent predictors of the primary outcome. Moreover, both the secondary endpoints of CV death and HF hospitalization plus TV intervention were more frequent in the TR progression group (p = 0.001 and p < 0.001, respectively). CONCLUSIONS Moderate TR progresses in a significant proportion of patients over a long-term follow-up, leading to a worse prognosis. TR progression is an independent determinant of hard clinical events and AF and RVEDD are associated with TR progression.
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Affiliation(s)
- Davide Margonato
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy.
| | - Francesco Ancona
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Andrea Cesari
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Eihab Ghantous
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Giacomo Ingallina
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Francesco Melillo
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Stefano Stella
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Federico Biondi
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Martina Belli
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Claudio Montalto
- Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Camilla Manini
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele De Bonis
- Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute University, San Raffaele, Milan, Italy
| | - Francesco Maisano
- Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute University, San Raffaele, Milan, Italy
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy; Vita-Salute University, San Raffaele, Milan, Italy
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3
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Kang M, Choi JW, Sohn SH, Hwang HY, Kim KH. Incidence of and Risk Factors for the Development of Significant Tricuspid Regurgitation after Isolated Aortic Valve Replacement. J Chest Surg 2023; 56:304-310. [PMID: 37248717 PMCID: PMC10480404 DOI: 10.5090/jcs.22.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/03/2023] [Accepted: 04/19/2023] [Indexed: 05/31/2023] Open
Abstract
Background The late progression of tricuspid regurgitation (TR) after mitral valve surgery is well known. However, few reports have described the progression of TR after aortic valve surgery. We investigated the incidence of and risk factors for the development of significant TR after isolated aortic valve replacement (AVR). Methods This study analyzed patients with less than moderate TR who underwent isolated AVR at Seoul National University Hospital from January 1990 to December 2018. Significant TR was defined as moderate or higher. Echocardiographic follow-up was performed in all patients. The Fine-Gray model was used to identify clinical risk factors for the development of significant TR. Results In total, 583 patients (61.7±14.2 years old) were included. Operative mortality occurred in 9 patients (1.5%), and the overall survival rates at 10, 20, and 25 years were 91.1%, 83.2%, and 78.9%, respectively. Sixteen patients (2.7%) developed significant TR during the follow-up period (13 moderate; 3 severe). The cumulative incidence of significant TR at 10, 20, and 25 years was 0.77%, 3.83%, and 6.42%, respectively. No patients underwent reoperation or reintervention of the tricuspid valve. Hemodialysis or peritoneal dialysis for chronic kidney disease (hazard ratio [HR], 5.188; 95% confidence interval [CI], 1.154-23.322) and preoperative mild TR (HR, 5.919; 95% CI, 2.059-17.017) were associated with the development of significant TR in the multivariable analysis. Conclusion TR progression after isolated AVR in patients with less than moderate TR is rare. Preoperative mild TR and hemodialysis or peritoneal dialysis for chronic kidney disease were significant risk factors for the development of TR.
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Affiliation(s)
- Minsang Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
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Bombace S, Meucci MC, Fortuni F, Ilardi F, Manzo R, Canciello G, Esposito G, Grayburn PA, Losi MA, Sannino A. Beyond Aortic Stenosis: Addressing the Challenges of Multivalvular Disease Assessment. Diagnostics (Basel) 2023; 13:2102. [PMID: 37370999 PMCID: PMC10297357 DOI: 10.3390/diagnostics13122102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Aortic stenosis (AS) can often coexist with other valvular diseases or be combined with aortic regurgitation (AR), leading to unique pathophysiological conditions. The combination of affected valves can vary widely, resulting in a lack of standardized diagnostic or therapeutic approaches. Echocardiography is crucial in assessing patients with valvular heart disease (VHD), but careful consideration of the hemodynamic interactions between combined valvular defects is necessary. This is important as it may affect the reliability of commonly used echocardiographic parameters, making the diagnosis challenging. Therefore, a multimodality imaging approach, including computed tomography or cardiac magnetic resonance, is often not just beneficial but crucial. It represents the future of diagnostics in this intricate field due to its unprecedented capacity to quantify and comprehend valvular pathology. The absence of definitive data and guidelines for the therapeutic management of AS in the context of multiple valve lesions makes this condition particularly challenging. As a result, an individualized, case-by-case approach is necessary, guided primarily by the recommendations for the predominant valve lesion. This review aims to summarize the pathophysiology of AS in the context of multiple and mixed valve disease, with a focus on the hemodynamic implications, diagnostic challenges, and therapeutic options.
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Affiliation(s)
| | - Maria Chiara Meucci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Federico Fortuni
- Department of Cardiology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, San Giovanni Battista Hospital, 06034 Foligno, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy
| | - Rachele Manzo
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy
| | - Grazia Canciello
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy
| | | | - Maria Angela Losi
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy
| | - Anna Sannino
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy
- Baylor Scott & White Research Institute, Plano, TX 75093, USA
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Chen Z, Wei D, Chen X, Huang Y, Shen Z, He W. RNA sequencing uncover crucial genes mediating progression of large-artery atherosclerotic and small-artery occlusion ischemic stroke. Brain Res 2022; 1796:148078. [PMID: 36096198 DOI: 10.1016/j.brainres.2022.148078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/04/2022] [Accepted: 09/04/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE The goal of our study is to uncover the pathogenesis of large-artery atherosclerotic ischemic stroke (LAAIS) and small-artery occlusion ischemic stroke (SAOIS) and analyze their difference using RNA sequencing. METHODS RNA sequencing was used to filtrate differentially expressed mRNAs (DEmRNAs) and differentially expressed lncRNAs (DElncRNAs) in LAAIS and SAOIS. Specific DEmRNAs and DElncRNAs in LAAIS and SAOIS were further found. Functional annotation and DElncRNA-DEmRNA co-expression network were built to reveal biological function of DEmRNAs. RESULTS A total of 832 DEmRNAs and 96 DElncRNAs were identified in LAAIS vs normal controls. 587 DEmRNAs and 105 DElncRNAs were identified in SAOIS vs normal controls. In LAAIS vs SAOIS, 636 DEmRNAs and 112 DElncRNAs were identified. Among which, 571 DEmRNAs and 61 DElncRNAs were LAAIS specific DEmRNAs and DElncRNAs, respectively. 325 DEmRNAs and 66 DElncRNAs were respectively SAOIS specific DEmRNAs and DElncRNAs. We also obtained 3086 LAAIS specific DElncRNA-DEmRNA co-expression pairs and 661 SAOIS specific DElncRNA-DEmRNA co-expression pairs. Oxidative phosphorylation and Alzheimer's disease were significantly enriched pathways in both LAAIS specific DEmRNAs and DEmRNAs in LAAIS specific DElncRNA-DEmRNA co-expression network. ECM-receptor interaction, hypertrophic cardiomyopathy and dilated cardiomyopathy were significantly enriched pathways in both SAOIS specific DEmRNAs and DEmRNAs in SAOIS specific DElncRNA-DEmRNA co-expression network. CONCLUSION This finding may help to understand the mechanisms of LAAIS and SAOIS and offer novel clues for finding specific biomarkers for LAAIS and SAOIS.
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Affiliation(s)
- Zhaolin Chen
- Department of Neurology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Duncai Wei
- Department of Pharmacy, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xiaopu Chen
- Department of Neurology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yinting Huang
- Department of Neurology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Zibin Shen
- Department of Neurology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Wenzhen He
- Department of Neurology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
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Suwanto D, Dewi IP, Budiarto M. Managing tricuspid valve pathology in multiple valvular heart disease. Ann Med Surg (Lond) 2022; 82:104719. [PMID: 36268395 PMCID: PMC9577839 DOI: 10.1016/j.amsu.2022.104719] [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: 05/29/2022] [Revised: 09/11/2022] [Accepted: 09/11/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Multiple valvular heart disease (MVD) is a general term to describe regurgitant and stenotic combination involving the same valve and/or occurring in ≥2 cardiac valves. Limited data and paucity in guidelines render the diagnosis and management. This article aims to provide a state-of-the-art review concerning the diagnosis and management strategies of MVD. Case presentation We report a 46-year-old female with worsening dyspnea and fatigue. We perform multiple echocardiography parameters. We diagnose patients with the stenotic mitral valve, stenotic-regurgitant aortic valve, and stenotic-regurgitant tricuspid valve (TV). Double mechanical valve replacement and TV commissurotomy with Kay procedure were done with excellent results. Clinical discussion The prevalence of MVD is 15% in those undergoing cardiac surgery; however only 1% of those who underwent triple valve surgery involve TV. The presence of TV lesion may complicate the natural history, clinical presentation, management, and outcomes. Echocardiography with valid method remains an important tool in assessment of patients with MVD. Multidiscipline heart team discussion is essential in determining individual risk, appropriate management methods, and long-term survival. Conclusion The expertise of multidisciplinary heart valve team is of utmost importance in determining diagnosis and optimal management strategy.
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Affiliation(s)
- Denny Suwanto
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia
- Cardiology and Vascular Medicine Department, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Ivana Purnama Dewi
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia
- Cardiology and Vascular Medicine Department, Dr. Soetomo General Hospital, Surabaya, Indonesia
- Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia
| | - Mohammad Budiarto
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia
- Cardiology and Vascular Medicine Department, Dr. Soetomo General Hospital, Surabaya, Indonesia
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Ben Ali W, Ruf T, Perrin N, Bouhout I, Fam N, Kresoja KP, Lurz P, von Bardeleben RS, Modine T, Ibrahim R. Indications, Limitations, and Development of Tricuspid Valve Interventions in Adults. Can J Cardiol 2022; 38:S66-S78. [PMID: 34464691 DOI: 10.1016/j.cjca.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/19/2021] [Accepted: 08/03/2021] [Indexed: 12/30/2022] Open
Abstract
Tricuspid regurgitation is associated with excessive mortality and poor outcomes regardless of the cause and associated comorbidities. Despite this clear association with mortality, tricuspid valve diseases remain undertreated. Tricuspid valve surgery, either repair or replacement, has shown little detectable survival benefit. Transcatheter tricuspid valve interventions have emerged as a less invasive approach to tricuspid valve diseases. They can be categorised into coaptation devices, annuloplasty devices, transcatheter tricuspid valve replacement, heterotopic caval valve implantation, and tricuspid valve-in-valve. Despite the late referral and the patient's profile, results remain fairly acceptable at least in the short term, with good procedural device success, excellent safety profile, and sustained reduction of tricuspid regurgitation for up to 1 year. Because results are limited to the mid-term, transcatheter tricuspid valve intervention durability will need to be established before broader adoption of these technologies.
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Affiliation(s)
- Walid Ben Ali
- Structural Heart Program and Interventional Cardiology, Université de Montréal, Montréal Heart Institute, Montréal, Québec, Canada; Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France.
| | - Tobias Ruf
- Heart Valve Center Mainz, Universitätsmedizin, Mainz, Germany
| | - Nils Perrin
- Structural Heart Program and Interventional Cardiology, Université de Montréal, Montréal Heart Institute, Montréal, Québec, Canada; Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Ismail Bouhout
- Structural Heart Program and Interventional Cardiology, Université de Montréal, Montréal Heart Institute, Montréal, Québec, Canada
| | - Neil Fam
- Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Philipp Lurz
- Heart Center Leipzig-University Hospital, Leipzig, Germany
| | | | - Thomas Modine
- Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France
| | - Reda Ibrahim
- Structural Heart Program and Interventional Cardiology, Université de Montréal, Montréal Heart Institute, Montréal, Québec, Canada
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Rodriguez Torres D, Torres Quintero L, Segura Rodríguez D, Garrido Jimenez JM, Esteban Molina M, Gomera Martínez F, Moreno Escobar E, Garcia Orta R. Surgical management of tricuspid regurgitation: a new algorithm to minimise recurrent tricuspid regurgitation. Open Heart 2022; 9:openhrt-2022-002011. [PMID: 35878960 PMCID: PMC9328083 DOI: 10.1136/openhrt-2022-002011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Recurrent tricuspid regurgitation (TR) is frequently observed after cardiac surgery; however, the correct approach remains controversial. We developed an algorithm for action on the tricuspid valve (TV) and conducted a 1-year follow-up study. The aim was to assess the efficacy of the algorithm to minimise residual TR after TV surgery. The hypothesis was that the TR rate at 1 year would be reduced by selecting the surgical approach in accordance with a set of preoperative clinical and echocardiographic variables. Methods A prospective, observational, single-centre study was performed in 76 consecutive patients with TV involvement. A protocol was designed for their inclusion, and data on their clinical and echocardiographic characteristics were gathered at 3 months and 1-year postsurgery. The treatment of patients depended on the degree of TR. Surgery was performed in all patients with severe or moderate-to-severe TR and in those with mild or moderate TR alongside the presence of certain clinical or echocardiographic factors. They underwent annuloplasty or extended valve repair when the TV was distorted. If repair techniques were not feasible, a prosthesis was implanted. Residual TR rates were compared with published reports, and predictors of early/late mortality and residual TR were evaluated. Results TR was functional in 69.9% of patients. Rigid ring annuloplasty was performed in 35.7% of patients, De Vega annuloplasty in 27.1%, extended repair in 11.4% and prosthetic replacement in 25.7%. TR was moderate or worse in 8.19% of patients (severe in 3.27%) at 1 year postintervention. No clinical, surgical or epidemiological variables were significantly associated with residual TR persistence, although annulus diameter showed a close-to-significant association. Total mortality was 12.85% for all causes and 10% for cardiovascular causes. In multivariate analysis, left ventricular ejection fraction was related to both early and late mortality. Conclusions Severe residual TR was significantly less frequent than reported in other series, being observed in less than 4% of patients at 1-year postsurgery.
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Affiliation(s)
| | | | | | | | - Maria Esteban Molina
- Cardiovascular Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | | | - Rocio Garcia Orta
- Cardiology, Hospital Universitario Virgen de las Nieves, Granada, Spain
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Vinciguerra M, Sitges M, Luis Pomar J, Romiti S, Domenech-Ximenos B, D'Abramo M, Wretschko E, Miraldi F, Greco E. Functional Tricuspid Regurgitation: Behind the Scenes of a Long-Time Neglected Disease. Front Cardiovasc Med 2022; 9:836441. [PMID: 35265685 PMCID: PMC8899114 DOI: 10.3389/fcvm.2022.836441] [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: 12/15/2021] [Accepted: 01/24/2022] [Indexed: 11/17/2022] Open
Abstract
Severe tricuspid valve regurgitation has been for a long time a neglected valve disease, which has only recently attracted an increasing interest due to the notable negative impact on the prognosis of patients with cardiovascular disease. It is estimated that around 90% of tricuspid regurgitation is diagnosed as “functional” and mostly secondary to a primary left-sided heart disease and, therefore, has been usually interpreted as a benign condition that did not require a surgical management. Nevertheless, the persistence of severe tricuspid regurgitation after left-sided surgical correction of a valve disease, particularly mitral valve surgery, has been associated to adverse outcomes, worsening of the quality of life, and a significant increase in mortality rate. Similar results have been found when the impact of isolated severe tricuspid regurgitation has been studied. Current knowledge is shifting the “functional” categorization toward a more complex and detailed pathophysiological classification, identifying various phenotypes with completely different etiology, natural history and, potentially, an invasive management. The aim of this review is to offer a comprehensive guide for clinicians and surgeons with a systematic description of “functional” tricuspid regurgitation subtypes, an analysis centered on the effectiveness of existing surgical techniques and a focus on the emergent percutaneous procedures. This latter may be an attractive alternative to a standard surgical approach in patients with high-operative risk or isolated tricuspid regurgitation.
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Affiliation(s)
- Mattia Vinciguerra
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
- *Correspondence: Mattia Vinciguerra
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
- Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose Luis Pomar
- Department of Cardiac Surgery, Clinic Barcelona Hospital University, Barcelona, Spain
- Department of Cardiac Surgery, Barnaclinic, Barcelona, Spain
| | - Silvia Romiti
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Blanca Domenech-Ximenos
- Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Radiology, Hospital Clínic, Barcelona, Spain
| | - Mizar D'Abramo
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Eleonora Wretschko
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Fabio Miraldi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Ernesto Greco
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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Donal E, Leurent G, Ganivet A, Lurz P, Coisne A, De Groote P, Lafitte S, Leroux L, Karam N, Biere L, Rouleau F, Sportouch C, Dreyfus J, Nejjari M, Josselin JM, Anselmi A, Galli E, Bajeux E, Guerin P, Obadia JF, Trochu JN, Oger E. Multicentric randomized evaluation of a tricuspid valve percutaneous repair system (clip for the tricuspid valve) in the treatment of severe secondary tricuspid regurgitation Tri.Fr Design paper. Eur Heart J Cardiovasc Imaging 2021; 23:1617-1627. [PMID: 34871375 DOI: 10.1093/ehjci/jeab255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/11/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Tricuspid regurgitation (TR) is associated with significant morbidity and mortality. Its independent prognostic role has been repeatedly demonstrated. However, this valvular heart condition is largely undertreated because of the increased risk of surgical repair. Recently, transcatheter techniques for the treatment of TR have emerged, but their implications for the clinical endpoints are still unknown. METHODS AND RESULTS The Tri.fr trial will be a multicentre, controlled, randomized (1:1 ratio), superior, open-label, and parallel-group study conducted in 300 patients with severe secondary TR that is considered non-surgical by heart teams. Inclusion will be possible only after core laboratory review of transthoracic and transoesophageal echocardiography and after validation by the clinical eligibility committee. A description of the mechanisms of the TR will be conducted by the core laboratory. Atrial or ventricular impacts on the severity of the secondary TR will be taken into account for the randomization. The patients will be followed for 12-month, and the primary outcome will be the Packer composite clinical endpoint [combining New York Heart Association class, patient global assessment (PGA), and major cardiovascular events]. It will test the hypothesis that a tricuspid valve percutaneous repair strategy using a clip dedicated to the tricuspid valve is superior to best guideline-directed medical therapy in symptomatic patients with severe secondary TR. CONCLUSION Tri.fr will be the first randomized, academic, multicentre study testing the value of percutaneous correction in patients with severe secondary TR.
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Affiliation(s)
- Erwan Donal
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR, 1099 Rennes, France
| | | | - Anne Ganivet
- Direction for Research and Innovation, CHU Rennes, Rennes, France
| | - Philip Lurz
- Heart Center at University of Leipzig, Leipzig, Germany
| | - Augustin Coisne
- CHU Lille, Department of Clinical Physiology and Echocardiography, Univ Lille, U1011 -EGID Lille, France
| | - Pascal De Groote
- CHU Lille, Department of Clinical Physiology and Echocardiography, Univ Lille, U1011 -EGID Lille, France
| | | | - Lionel Leroux
- CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Nicole Karam
- University of Paris, Medico-Surgical Heart Valve Unit, European Hospital Georges-Pompidou, INSERM, U970 Paris, France
| | - Loic Biere
- Institute MitoVasc, Angers University, CHU Angers, CNRS UMR6015, INSERM U, 1083 Angers, France
| | - Frederic Rouleau
- Institute MitoVasc, Angers University, CHU Angers, CNRS UMR6015, INSERM U, 1083 Angers, France
| | | | | | | | | | - Amedeo Anselmi
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR, 1099 Rennes, France
| | - Elena Galli
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR, 1099 Rennes, France
| | - Emma Bajeux
- INSERM1085, IRSET, University Rennes, CHU Rennes, Rennes, France
| | - Patrice Guerin
- Institut du Thorax, CHU Nantes, University Nantes, Nantes, France
| | - Jean-François Obadia
- Department of Cardiac Surgery, Cardiologic CHU Lyon, University Lyon, Lyon, France
| | - Jean-Noel Trochu
- Institut du Thorax, CHU Nantes, University Nantes, Nantes, France
| | - Emmanuel Oger
- EA Reperes, CHU Rennes, University Rennes, Rennes, France
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11
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Mantovani F, Fanti D, Tafciu E, Fezzi S, Setti M, Rossi A, Ribichini F, Benfari G. When Aortic Stenosis Is Not Alone: Epidemiology, Pathophysiology, Diagnosis and Management in Mixed and Combined Valvular Disease. Front Cardiovasc Med 2021; 8:744497. [PMID: 34722676 PMCID: PMC8554031 DOI: 10.3389/fcvm.2021.744497] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/13/2021] [Indexed: 11/24/2022] Open
Abstract
Aortic stenosis (AS) may present frequently combined with other valvular diseases or mixed with aortic regurgitation, with peculiar physio-pathological and clinical implications. The hemodynamic interactions between AS in mixed or combined valve disease depend on the specific combination of valve lesions and may result in diagnostic pitfalls at echocardiography; other imaging modalities may be helpful. Indeed, diagnosis is challenging because several echocardiographic methods commonly used to assess stenosis or regurgitation have been validated only in patients with the single-valve disease. Moreover, in the developed world, patients with multiple valve diseases tend to be older and more fragile over time; also, when more than one valvular lesion needs to address the surgical risk rises together with the long-term risk of morbidity and mortality associated with multiple valve prostheses, and the likelihood and risk of reoperation. Therefore, when AS presents mixed or combined valve disease, the heart valve team must integrate various parameters into the diagnosis and management strategy, including suitability for single or multiple transcatheter valve procedures. This review aims to summarize the most critical pathophysiological mechanisms underlying AS when associated with mitral regurgitation, mitral stenosis, aortic regurgitation, and tricuspid regurgitation. We will focus on echocardiography, clinical implications, and the most important treatment strategies.
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Affiliation(s)
| | - Diego Fanti
- University of Verona, Section of Cardiology, Verona, Italy
| | - Elvin Tafciu
- University of Verona, Section of Cardiology, Verona, Italy
| | - Simone Fezzi
- University of Verona, Section of Cardiology, Verona, Italy
| | - Martina Setti
- University of Verona, Section of Cardiology, Verona, Italy
| | - Andrea Rossi
- University of Verona, Section of Cardiology, Verona, Italy
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12
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Chancellor WZ, Mehaffey JH, Beller JP, Hawkins RB, Speir AM, Quader MA, Yarboro LT, Teman NR, Ailawadi G. Impact of tricuspid regurgitation with and without repair during aortic valve replacement. J Thorac Cardiovasc Surg 2021; 162:44-50.e2. [PMID: 32173103 PMCID: PMC11439482 DOI: 10.1016/j.jtcvs.2020.02.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 01/22/2020] [Accepted: 02/05/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Long-term outcomes of aortic valve replacement (AVR) are worse in patients with tricuspid regurgitation (TR), but the impact of concomitant tricuspid valve intervention remains unclear. The purpose of this study was to determine the effect of tricuspid intervention in patients with TR undergoing AVR. METHODS Patients undergoing AVR in a regional Society of Thoracic Surgeons database (2001-2017) were stratified by severity of TR and whether or not they underwent concomitant tricuspid intervention. Operative morbidity and mortality were compared between the 2 groups. Further analysis was performed using propensity score-matched pairs. RESULTS Among 17,483 patients undergoing AVR, 8984 (51%) had no TR, 7252 (41%) had mild TR, 1060 (6%) had moderate TR, and 187 (1%) had severe TR. Overall, more severe TR was associated with higher morbidity and mortality. Tricuspid intervention was performed in 104 patients (0.6%), including 0.2% of patients with mild TR, 2% of those with moderate TR, and 31% of those with severe TR. In the propensity score-matched analysis, there was not a statistically significant difference in operative mortality between the 2 groups (18% vs 9%; P = .16), but there was significantly higher composite major morbidity (51% vs 26%; P = .006) in the tricuspid intervention group compared with those without surgical TR correction. CONCLUSIONS Increasing severity of TR is associated with higher rates of morbidity and mortality after AVR. Correction of TR at the time of surgical AVR is not associated with increased operative mortality and has been shown to improve long-term outcomes.
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Affiliation(s)
| | - J Hunter Mehaffey
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
| | - Jared P Beller
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
| | - Robert B Hawkins
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
| | - Alan M Speir
- INOVA Heart and Vascular Institute, Falls Church, Va
| | - Mohammed A Quader
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Va
| | - Leora T Yarboro
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
| | - Nicholas R Teman
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
| | - Gorav Ailawadi
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va.
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13
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14
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Tricuspid Annular Diameter Measurement on Routine Chest CT Can Detect Significant Tricuspid Regurgitation. AJR Am J Roentgenol 2019; 213:W257-W263. [DOI: 10.2214/ajr.19.21602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Schmidt T, Frerker C. Treatment Challenges in Patients with Acute Heart Failure and Severe Aortic Valve Stenosis. Curr Cardiol Rep 2019; 21:47. [PMID: 31011842 DOI: 10.1007/s11886-019-1135-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The goal of this paper is to describe the treatment challenges in patients with aortic stenosis in combination with a reduced left ventricular function. RECENT FINDINGS Since the risk of mortality is increased in this patient population, transcatheter aortic valve implantation emerged as an important treatment option. Concomitant factors such as mitral regurgitation or coronary artery disease are important co-factors that need to be evaluated and taken into account for treatment decision. Treatment of the severe aortic stenosis is key in this complex setting. Since several co-factors may exist in addition to aortic stenosis, treatment needs to be decided by a Heart Team.
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Affiliation(s)
- Tobias Schmidt
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany.
| | - Christian Frerker
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
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17
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Prihadi EA, Delgado V, Leon MB, Enriquez-Sarano M, Topilsky Y, Bax JJ. Morphologic Types of Tricuspid Regurgitation. JACC Cardiovasc Imaging 2019; 12:491-499. [DOI: 10.1016/j.jcmg.2018.09.027] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/17/2018] [Accepted: 09/20/2018] [Indexed: 12/18/2022]
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Edvardsen T, Haugaa KH, Gerber BL, Maurovich-Horvat P, Donal E, Maurer G, Popescu BA. The year 2017 in the European Heart Journal-Cardiovascular Imaging: Part II. Eur Heart J Cardiovasc Imaging 2018; 19:1222-1229. [PMID: 30084988 DOI: 10.1093/ehjci/jey110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
European Heart Journal - Cardiovascular Imaging was launched in 2012 as a multimodality cardiovascular imaging journal. It has gained an impressive impact factor of 8.366 during its first 5 years and is now established as one of the top 10 cardiovascular journals and has become the most important cardiovascular imaging journal in Europe. The most important studies from 2017 will be highlighted in two reports. Part I of the review will focus on studies about myocardial function and risk prediction, myocardial ischaemia, and emerging techniques in cardiovascular imaging, while Part II will focus on valvular heart disease, heart failure, cardiomyopathies, and congenital heart disease.
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Affiliation(s)
- Thor Edvardsen
- Department of Cardiology, Centre of Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, NO-0027 Oslo, Norway and Institute for Clinical Medicine, University of Oslo, Sognsvannsveien 20, Oslo, Norway
| | - Kristina H Haugaa
- Department of Cardiology, Centre of Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, NO-0027 Oslo, Norway and Institute for Clinical Medicine, University of Oslo, Sognsvannsveien 20, Oslo, Norway
| | - Bernhard L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires St. Luc, Université Catholique de Louvain, Av Hippocrate 10/2803, Woluwe St. Lambert, Belgium
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group (CIRG), Heart and Vascular Center, Semmelweis University, 68 Varosmajor u., Budapest, Hungary
| | - Erwan Donal
- Cardiologie Department and CIC-IT 1414 - CHU Rennes - Hôpital Pontchaillou, LTSI INSERM U 1099 - University Rennes-1, Rennes, France
| | - Gerald Maurer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, Wien, Austria
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila" - Euroecolab, Emergency Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, sector 2, Bucharest, Romania
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19
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Bavishi C, Kolte D, Gordon PC, Abbott JD. Transcatheter aortic valve replacement in patients with severe aortic stenosis and heart failure. Heart Fail Rev 2018; 23:821-829. [DOI: 10.1007/s10741-018-9726-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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20
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Amano M, Izumi C, Taniguchi T, Morimoto T, Miyake M, Nishimura S, Kitai T, Kato T, Kadota K, Ando K, Furukawa Y, Inada T, Inoko M, Ishii K, Sakaguchi G, Yamazaki F, Koyama T, Komiya T, Yamanaka K, Nishiwaki N, Kanemitsu N, Saga T, Ogawa T, Nakayama S, Tsuneyoshi H, Iwakura A, Shiraga K, Hanyu M, Ohno N, Fukumoto A, Yamada T, Nishizawa J, Esaki J, Minatoya K, Nakagawa Y, Kimura T. Impact of concomitant tricuspid regurgitation on long-term outcomes in severe aortic stenosis. Eur Heart J Cardiovasc Imaging 2018; 20:353-360. [DOI: 10.1093/ehjci/jey105] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/16/2018] [Accepted: 07/04/2018] [Indexed: 02/07/2023] Open
Affiliation(s)
- Masashi Amano
- Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, Japan
| | - Chisato Izumi
- Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, Japan
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Makoto Miyake
- Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, Japan
| | - Shunsuke Nishimura
- Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, Japan
| | - Takeshi Kitai
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyusyu, Japan
| | - Yutaka Furukawa
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tsukasa Inada
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Moriaki Inoko
- Cardiovascular Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Katsuhisa Ishii
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Fumio Yamazaki
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kazuo Yamanaka
- Department of Cardiovascular Surgery, Tenri Hospital, Tenri, Japan
| | - Noboru Nishiwaki
- Department of Cardiovascular Surgery, Kindai University Nara Hospital, Ikoma, Japan
| | - Naoki Kanemitsu
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Toshihiko Saga
- Department of Cardiovascular Surgery, Kindai University Hospital, Osakasayama, Japan
| | - Tatsuya Ogawa
- Department of Cardiovascular Surgery, Kishiwada City Hospital, Kishiwada, Japan
| | - Shogo Nakayama
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Hiroshi Tsuneyoshi
- Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Atsushi Iwakura
- Department of Cardiovascular Surgery, Japan Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Kotaro Shiraga
- Department of Cardiovascular Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, Cardiovascular Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Atsushi Fukumoto
- Department of Cardiovascular Surgery, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Tomoyuki Yamada
- Department of Cardiovascular Surgery, Shiga Medical Center for Adults, Moriyama, Japan
| | - Junichiro Nishizawa
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Jiro Esaki
- Department of Cardiovascular Surgery, Otsu Red Cross Hospital, Otsu, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Prihadi EA, van der Bijl P, Gursoy E, Abou R, Mara Vollema E, Hahn RT, Stone GW, Leon MB, Ajmone Marsan N, Delgado V, Bax JJ. Development of significant tricuspid regurgitation over time and prognostic implications: new insights into natural history. Eur Heart J 2018; 39:3574-3581. [PMID: 30010848 DOI: 10.1093/eurheartj/ehy352] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 06/01/2018] [Indexed: 01/12/2023] Open
Affiliation(s)
- Edgard A Prihadi
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
- Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium
| | - Pieter van der Bijl
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
| | - Erhan Gursoy
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
| | - Rachid Abou
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
| | - E Mara Vollema
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
| | - Rebecca T Hahn
- New York Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, 630 West 168th Street, New York, NY, USA
| | - Gregg W Stone
- New York Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, 630 West 168th Street, New York, NY, USA
| | - Martin B Leon
- New York Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, 630 West 168th Street, New York, NY, USA
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
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Exploring Tricuspid Regurgitation in Treating Degenerated Bioprosthetic Aortic Valves. JACC Cardiovasc Interv 2018; 11:1161-1163. [PMID: 29929638 DOI: 10.1016/j.jcin.2018.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/10/2018] [Indexed: 11/20/2022]
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Predictors of Persistent Tricuspid Regurgitation after Transcatheter Aortic Valve Replacement in Patients with Baseline Tricuspid Regurgitation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:190-199. [DOI: 10.1097/imi.0000000000000504] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective This study sought to analyze outcomes in patients with moderate-severe tricuspid regurgitation (TR) undergoing transcatheter aortic valve replacement (TAVR). The consequences of uncorrected significant TR in patients undergoing TAVR remain undefined. Methods Between 2009 and 2014, 369 patients underwent TAVR at our institution, and 58 of these had baseline moderate-severe TR. Preoperative, 30-day, and 1-year transthoracic echocardiograms were analyzed. Predictors of persistent TR at 30 days and survival were assessed. Results Fifty-eight patients with baseline moderate-severe TR underwent TAVR. Transcatheter aortic valve replacement resulted in significant reductions in pulmonary artery pressures and TR severity (100% vs 64%; P < 0.001) at 30 days. This was sustained at 1 year and was associated with significant improvements in stroke volume index and New York Heart Association functional class. No changes in right ventricular function or size were noted. The only independent predictor of persistent moderate-severe TR at 30 days was preoperative atrial fibrillation [AF; odds ratio (OR), 4.56; 95% confidence interval, 1.1–18.3; P = 0.033]. Independent predictors of overall long-term survival included AF (OR, 0.41; P = 0.001) and chronic lung disease (OR, 0.47; P = 0.011), but not baseline moderate-severe TR. In patients with baseline moderate-severe TR, persistent moderate-severe TR at 30 days was associated with worsened overall survival (log-rank P = 0.02). Conclusions Baseline moderate-severe TR is not uncommon in patients undergoing TAVR, and frequently improves. However, the presence of AF suggests that that TR is likely to persist after TAVR and is also indicative of a poor long-term outcome. Whether redirecting such patients to surgery for concomitant tricuspid valve repair will further improve outcomes requires further study.
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Worku B, Valovska MT, Elmously A, Kampaktsis P, Castillo C, Wong SC, Salemi A. Predictors of Persistent Tricuspid Regurgitation after Transcatheter Aortic Valve Replacement in Patients with Baseline Tricuspid Regurgitation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Berhane Worku
- Department of Cardiothoracic Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY USA
- Department of Cardiothoracic Surgery, New York Presbyterian/Brooklyn Methodist Hospital, Brooklyn, NY USA
| | - Marie-Therese Valovska
- Department of Cardiothoracic Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY USA
| | - Adham Elmously
- Department of Cardiothoracic Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY USA
| | - Polydoros Kampaktsis
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY USA
| | - Catherine Castillo
- Department of Cardiothoracic Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY USA
- Department of Cardiothoracic Surgery, New York Presbyterian/Brooklyn Methodist Hospital, Brooklyn, NY USA
| | - Shing-Chiu Wong
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY USA
| | - Arash Salemi
- Department of Cardiothoracic Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY USA
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Tatsuishi W, Nakano K. Progression of Functional Tricuspid Regurgitation With Aortic Valve Stenosis After Intervention. Circ J 2018. [PMID: 29515048 DOI: 10.1253/circj.cj-18-0226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Wataru Tatsuishi
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Medical Center East
| | - Kiyoharu Nakano
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Medical Center East
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Abstract
PURPOSE OF REVIEW Transcatheter aortic valve replacement (TAVR) is underpinned by an array of imaging techniques designed to not only select an appropriately sized implant but also to identify potential obstacles to procedural success. This review presents currently important aspects of TAVR imaging, describing the salient features of each modality as well as recent developments in the field. RECENT FINDINGS The latest data on TAVR outcomes reflects the increasing experience of operators and the significant role of pre-procedural imaging. Debate continues as to which modality sizes the aortic annulus most accurately, 3D transoesophageal echocardiography (TEE) or MDCT, as well as to whether the merits of real-time peri-procedural 3D imaging guidance outweigh the possible adverse consequences of general anaesthesia which is requisite for intraprocedural 3D TEE. TAVR is now largely based on pre-acquired roadmaps of the truncal vasculature and intense pre-procedural planning. TEE and Multi-detector computed tomography (MDCT) have been shown to perform similarly in annulus sizing. However, given the complexity of many TAVR patients and the importance of identifying the most suitable pathway to the valve as well as any potentially confounding other structural or functional heart disease, both modalities remain relevant in current TAVR.
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