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Beer BN, Kellner C, Sundermeyer J, Besch L, Dettling A, Kirchhof P, Blankenberg S, Magnussen C, Schrage B. Prediction of cardiac worsening through to cardiogenic shock in patients with acute heart failure. ESC Heart Fail 2024; 11:2249-2258. [PMID: 38632837 PMCID: PMC11287305 DOI: 10.1002/ehf2.14792] [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: 08/18/2023] [Revised: 02/08/2024] [Accepted: 03/16/2024] [Indexed: 04/19/2024] Open
Abstract
AIMS Acute heart failure (AHF) can result in worsening of heart failure (WHF), cardiogenic shock (CS), or death. Risk factors for these adverse outcomes are not well characterized. This study aimed to identify predictors for WHF or new-onset CS in patients hospitalized for AHF. METHODS AND RESULTS Prospective cohort study enrolling consecutive patients with AHF admitted to a large tertiary care centre with follow-up until death or discharge. WHF was defined by the RELAX-AHF-2 criteria. CS was defined as SCAI stages B-E. Potential predictors were assessed by fitting logistic regression models adjusted for age and sex. N = 233 patients were enrolled, median age was 78 years, and 80 were women (35.9%). Ischaemic cardiomyopathy was present in 82 patients (40.8%). Overall, 96 (44.2%) developed WHF and 18 (9.7%) CS. In-hospital death (8/223, 3.6%) was related to both events (WHF: OR 6.64, 95% CI 1.21-36.55, P = 0.03; CS: OR 38.27, 95% CI 6.32-231.81, P < 0.001). Chronic kidney disease (OR 2.20, 95% CI 1.25-3.93, P = 0.007), logarithmized serum creatinine (OR 2.90, 95% CI 1.51-5.82, P = 0.002), cystatin c (OR 1.86, 95% CI 1.27-2.77, P = 0.002), tricuspid valve regurgitation (OR 2.08, 95% CI 1.11-3.94, P = 0.023) and logarithmized pro-adrenomedullin (OR 3.01, 95% CI 1.75-5.38, P < 0.001) were significant predictors of WHF. Chronic kidney disease (OR 3.17, 95% CI 1.16-9.58, P = 0.03), cystatin c (OR 1.88, 95% CI 1.00-3.53, P = 0.045), logarithmized pro-adrenomedullin (OR 2.90, 95% CI 1.19-7.19, P = 0.019), and tricuspid valve regurgitation (OR 10.44, 95% CI 2.61-70.00, P = 0.003) were significantly with new-onset CS. CONCLUSIONS Half of patients admitted with AHF experience WHF or new-onset CS. Chronic kidney disease, tricuspid valve regurgitation, and elevated pro-adrenomedullin concentrations predict these events. They could potentially serve as early warning signs for further deterioration in AHF patients.
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Affiliation(s)
- Benedikt N. Beer
- Department of CardiologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/KielHamburgGermany
| | - Caroline Kellner
- Department of CardiologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Center for Population Health Innovation (POINT)University Medical Center Hamburg‐EppendorfHamburgGermany
| | - Jonas Sundermeyer
- Department of CardiologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/KielHamburgGermany
| | - Lisa Besch
- Department of CardiologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/KielHamburgGermany
| | - Angela Dettling
- Department of CardiologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/KielHamburgGermany
| | - Paulus Kirchhof
- Department of CardiologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/KielHamburgGermany
- Institute of Cardiovascular SciencesUniversity of BirminghamBirminghamUK
| | - Stefan Blankenberg
- Department of CardiologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/KielHamburgGermany
- Center for Population Health Innovation (POINT)University Medical Center Hamburg‐EppendorfHamburgGermany
| | - Christina Magnussen
- Department of CardiologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/KielHamburgGermany
- Center for Population Health Innovation (POINT)University Medical Center Hamburg‐EppendorfHamburgGermany
| | - Benedikt Schrage
- Department of CardiologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/KielHamburgGermany
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2
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Ji XY, Zhu L, Chen F, Lu FL, Feng Y, Chen M, Xiong TY. Risk stratification by systemic manifestations secondary to hemodynamic disorders of patients with severe tricuspid regurgitation. BMC Cardiovasc Disord 2024; 24:149. [PMID: 38475690 DOI: 10.1186/s12872-024-03805-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Tricuspid regurgitation (TR) is a prevalent disease that triggers systemic pathological changes including cardiac, respiratory, hepatic and digestive, hematopoietic, renal and skin issues. The burden of extra-cardiac manifestations has not been well described in TR patients and the clinical impact is unknown. METHODS Patients with severe or more-than-severe TR during hospitalization, who did not have any previous cardiac procedures, hemodynamically significant congenital heart disease or concomitant severe aortic or mitral valve disease, were retrospectively analyzed. Pre-specified criteria and diagnosis of baseline characteristics were used to evaluate the presence of extra-cardiac manifestations secondary to TR after excluding comorbidities that may also lead to corresponding abnormalities. Extra-cardiac involvements encompass respiratory, hepatic and, digestive, renal, hematopoietic and dermatic system. Staging criteria are defined as no extra-cardiac system involvement in Stage 1, one in Stage 2, at least two extra-cardiac involvements in Stage 3 and any end-stage organ failure in Stage 4. A telephone follow-up was conducted to record the composite endpoint namely all-cause death or cardiac rehospitalization after the index hospitalization. RESULTS A total of 258 patients were identified with a median age of 73 (interquartile range [IQR]: 62-83) years and 52.3% were female. Severe TR and more-than-severe TR patients accounted for 92.6% and 7.4% of the cohort. There were 20.5%, 27.5%, 37.6% and 14.3% of patients from Stage 1 to 4 respectively. The follow-up time was at a median of 251 (IQR: 183-324) days. TR Patients in Stage 3&4 were at an increased risk with borderline statistical significance to experience the composite endpoint compared to patients in Stage 1&2 (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.0 to 3.7, P = 0.049). CONCLUSIONS Approximately half of patients with at least severe TR presented with two or more extra-cardiac systemic manifestations, which may incur a 1.9-fold higher risk of all-cause death or cardiac rehospitalization than TR patients with one or less extra-cardiac involvement.
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Affiliation(s)
- Xing-Yu Ji
- Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Lei Zhu
- Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Fei Chen
- Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Fang-Lin Lu
- Department of Cardiovascular Surgery, The First People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yuan Feng
- Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Mao Chen
- Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China.
| | - Tian-Yuan Xiong
- Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China.
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3
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Chen V, Altisent OAJ, Puri R. A comprehensive overview of surgical and transcatheter therapies to treat tricuspid regurgitation in patients with heart failure. Curr Opin Cardiol 2024; 39:110-118. [PMID: 38116802 DOI: 10.1097/hco.0000000000001110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW The unique pathophysiologic considerations of severe tricuspid regurgitation (TR) have led to advancements in surgical and transcatheter treatments. The purpose of this review is to highlight the current surgical and transcatheter tricuspid valve interventions (TTVI) to functional TR. RECENT FINDINGS Surgical repair with ring annuloplasty consistently demonstrates better outcomes than surgical replacement or other repair approaches. However, surgical uptake of TR correction remains relatively low, and operative mortality rates are still high owing to multiple comorbidities and advanced tricuspid valve disease/right ventricular dysfunction at time of referral. Pivotal trials for tricuspid transcatheter edge-to-edge repair (T-TEER) and transcatheter TV replacement (TTVR) indicate improved quality of life compared to medical therapy alone for high-surgical-risk patients with severe symptomatic TR. Trials are underway to assess caval valve implantation (CAVI), which holds hope for many severe TR patients who are not ideal candidates for T-TEER or orthotopic TTVR. Peri-procedural optimization of right ventricular function remains critical to promote both device success and patient outcomes. SUMMARY Clinical outcomes after surgical TV intervention are poor, often due to intervening late in the disease course of TR. TTVI covers a treatment gap for patients deemed inoperable or high-surgical-risk, but earlier referral for TV interventions is still important prior to patients developing multiorgan dysfunction from chronic untreated TR.
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Affiliation(s)
- Vincent Chen
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland, Ohio, USA
| | | | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland, Ohio, USA
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Coisne A, Lancellotti P, Habib G, Garbi M, Dahl JS, Barbanti M, Vannan MA, Vassiliou VS, Dudek D, Chioncel O, Waltenberger JL, Johnson VL, De Paulis R, Citro R, Pibarot P. ACC/AHA and ESC/EACTS Guidelines for the Management of Valvular Heart Diseases: JACC Guideline Comparison. J Am Coll Cardiol 2023; 82:721-734. [PMID: 37587584 DOI: 10.1016/j.jacc.2023.05.061] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/01/2023] [Accepted: 05/17/2023] [Indexed: 08/18/2023]
Abstract
Valvular heart disease (VHD) is common and poses important challenges from the standpoints of diagnosis and therapeutic management. Clinical practice guidelines have been developed to help health care professionals to overcome these challenges and provide optimal management to patients with VHD. The American College of Cardiology, in collaboration with the American Heart Association, and the European Society of Cardiology, in collaboration with the European Association for Cardio-Thoracic Surgery, recently updated their guidelines on the management of VHD. Although these 2 sets of guidelines are generally concordant, there are some substantial differences between these guidelines, which may have significant implications for clinical practice. This review prepared on behalf of the EuroValve Consortium describes the consistencies and discrepancies between the guidelines and highlights the gaps in these guidelines and the future research perspectives to fill these gaps.
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Affiliation(s)
- Augustin Coisne
- University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France; Cardiovascular Research Foundation, New York, New York, USA.
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Gilbert Habib
- APHM, La Timone Hospital, Cardiology Department, Aix Marseille University, Marseille, France
| | - Madalina Garbi
- Royal Papworth Hospital, Cambridge University Health Partners, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | | | | | - Mani A Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Vassilios S Vassiliou
- Department of Cardiology, Norwich Medical School, University of East Anglia and Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu,' Bucharest, Romania; University of Medicine Carol Davila, Bucharest, Romania
| | - Johannes L Waltenberger
- University of Muenster, Medical Faculty, Muenster, Germany; Hirslanden Clinic in Park, Zurich, Switzerland
| | | | | | - Rodolfo Citro
- Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy; Department of Vascular Physiopathology, IRCCS Neuromed, Pozzilli, Italy
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Québec City, Quebec, Canada
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5
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Adamo M, Chioncel O, Benson L, Shahim B, Crespo-Leiro MG, Anker SD, Coats AJS, Filippatos G, Lainscak M, McDonagh T, Mebazaa A, Piepoli MF, Rosano GMC, Ruschitzka F, Savarese G, Seferovic P, Shahim A, Popescu BA, Iung B, Volterrani M, Maggioni AP, Metra M, Lund LH. Prevalence, clinical characteristics and outcomes of heart failure patients with or without isolated or combined mitral and tricuspid regurgitation: An analysis from the ESC-HFA Heart Failure Long-Term Registry. Eur J Heart Fail 2023; 25:1061-1071. [PMID: 37365841 DOI: 10.1002/ejhf.2929] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/04/2023] [Accepted: 06/11/2023] [Indexed: 06/28/2023] Open
Abstract
AIM Mitral regurgitation (MR) and tricuspid regurgitation (TR) are common in patients with heart failure (HF). The aim of this study was to investigate prevalence, clinical characteristics and outcomes of patients with or without isolated or combined MR and TR across the entire HF spectrum. METHODS AND RESULTS The ESC-HFA EORP HF Long-Term Registry is a prospective, multicentre, observational study including patients with HF and 1-year follow-up data. Outpatients without aortic valve disease were included and stratified according to isolated or combined moderate/severe MR and TR. Among 11 298 patients, 7541 (67%) had no MR/TR, 1931 (17%) isolated MR, 616 (5.5%) isolated TR and 1210 (11%) combined MR/TR. Baseline characteristics were differently distributed across MR/TR categories. Compared to HF with reduced ejection fraction, HF with mildly reduced ejection fraction was associated with a lower risk of isolated MR (odds ratio [OR] 0.69; 95% confidence interval [CI] 0.60-0.80), and distinctly lower risk of combined MR/TR (OR 0.51; 95% CI 0.41-0.62). HF with preserved ejection fraction (HFpEF) was associated with a distinctly lower risk of isolated MR (OR 0.42; 95% CI 0.36-0.49), and combined MR/TR (OR 0.59; 95% 0.50-0.70), but a distinctly increased risk of isolated TR (OR 1.94; 95% CI 1.61-2.33). All-cause death, cardiovascular death, HF hospitalization and combined outcomes occurred more frequently in combined MR/TR, isolated TR and isolated MR versus no MR/TR. The highest incident rates were observed in isolated TR and combined MR/TR. CONCLUSION In a large cohort of outpatients with HF, prevalence of isolated and combined MR and TR was relatively high. Isolated TR was driven by HFpEF and was burdened by an unexpectedly poor outcome.
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Affiliation(s)
- Marianna Adamo
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - Lina Benson
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Bahira Shahim
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Maria G Crespo-Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna, CHUAC, INIBIC, UDC, CIBERCV, La Coruna, Spain
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, University Hospital Attikon, National and Kapodistrian Univeristy of Athens, Athens, Greece
| | - Mitja Lainscak
- Division of Cardiology, Murska Sobota, Murska Sobota and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Alexander Mebazaa
- Department of Anesthesia-Burn-Critical Care, UMR 942 Inserm - MASCOT; University of Paris; APHP Saint Louis Lariboisière University Hospitals, Paris, France
| | - Massimo F Piepoli
- Clinical Cardiology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | | | | | - Gianluigi Savarese
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Petar Seferovic
- University of Belgrade Faculty of Medicine, Belgrade, Serbia
| | - Angiza Shahim
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Bogdan A Popescu
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - Bernard Iung
- Cardiology Department, Bichat Hospital, APHP, Université Paris Cité, Paris, France
| | | | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Lars H Lund
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Solna, Sweden
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6
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Soliman O. Tricuspid Transcatheter Edge-to-Edge Repair: The Known Knowns, and the Known Unknowns. JACC Cardiovasc Interv 2023; 16:718-721. [PMID: 36990562 DOI: 10.1016/j.jcin.2023.02.022] [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: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Osama Soliman
- Discipline of Cardiology, Galway University Hospital, Health Service Executive, Galway, Ireland; CORRIB Research Center for Advanced Imaging & Core Lab, and CÚRAM Centre for Medical Devices, University of Galway, Galway, Ireland.
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7
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Chen Y, Cai C, Qiao F, Li B, Xu Z, Lu F, An Z. Preoperative 6-minute walk test predicts prolonged hospitalization after transcatheter tricuspid valve replacement. Medicine (Baltimore) 2022; 101:e32379. [PMID: 36595770 PMCID: PMC9794248 DOI: 10.1097/md.0000000000032379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The purpose of this study is to determine whether preoperative 6-minute walk test (6MWT) is associated with prolonged postoperative hospitalization in high risk patients with severe tricuspid regurgitation (TR) after transcatheter tricuspid valve replacement (TTVR). Forty-one patients with severe TR who underwent TTVR and discharged between September 2018 and April 2021 were enrolled in this study. Patients were divided into 2 groups according to whether the postoperative hospital stay was >10 days and patients' data were retrospectively collected. 6MWT was performed before operation. Twenty-one patients were in the control group (≤10 days) and 20 patients were in the prolonged postoperative stay (PPS) group (>10 days). 6MWT distance was significantly decreased in PPS group (192.70 ± 62.34 vs 274.57 ± 52.09 m, P < .05). PPS group had more patients with severe liver disease (50.00% vs 19.05%, P < .05), higher systolic pulmonary artery pressure (45.05 ± 9.28 vs 35.57 ± 8.91 mm Hg, P < .05) and longer procedure time (159.85 ± 56.61 vs 124.43 ± 31.67 min, P < .05). Multivariable logistic regression analysis found 6MWT <267 m was an independent risk factor with the odds ratio of 10.95 (1.66-72.39, P < .05) for prolonged postoperative hospitalization in patients who received TTVR. In the present study, we identified that preoperative decreased 6MWT distance was an independent risk factor for prolonged hospitalization in high risk TR patients after TTVR.
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Affiliation(s)
- Yanjing Chen
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Chengliang Cai
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Fan Qiao
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Bailing Li
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhiyun Xu
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Fanglin Lu
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhao An
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
- * Correspondence: Zhao An, Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai 200433, China (e-mail: )
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8
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Nakagawa S, Takahama H, Hoshino K, Yanagi Y, Irie Y, Moriuchi K, Amano M, Okada A, Amaki M, Kanzaki H, Kusano K, Noguchi T, Yasuda S, Izumi C. Prevalence and predictive factors for clinical outcomes of isolated functional tricuspid regurgitation. J Cardiol 2022:S0914-5087(22)00325-2. [PMID: 36565994 DOI: 10.1016/j.jjcc.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/23/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND A substantial number of patients have functional tricuspid regurgitation (TR). Isolated functional TR has been undertreated and may be a next target for transcatheter intervention. However, the prevalence, patient characteristics, and predictive factors for prognosis remain unclear. METHODS From patients in our echocardiographic database (N = 64,242), we extracted those with severe TR and examined prognosis according to etiologies of TR. Thereafter, we focused on two types of isolated functional TR; progressive TR after left-sided valve surgery (postoperative TR) and TR associated with annular dilatation (atrial TR). Composite adverse events were defined as all-cause death or hospitalization for heart failure (HF). RESULTS Of 1001 patients with severe TR (median age, 77 years; female, 58 %), 71 (7 %) patients were classified as postoperative TR, and 149 (15 %) as atrial TR. During the follow-up period (median, 1.6 years), 30 composite adverse events were observed (postoperative TR, n = 14; atrial TR, n = 16). Composite adverse events were less frequent in these two types of functional TR than TR of other etiologies. Multivariate analysis adjusted for age and sex showed that a history of hospitalization for HF, history of cardiac surgery >2 times, loop diuretics, estimated glomerular filtration rate, blood urea nitrogen, hemoglobin, platelet level, left ventricular ejection fraction, and right ventricular dimension were associated with clinical adverse events (p < 0.05), while B-type natriuretic peptide level was not. CONCLUSIONS A considerable number of patients had isolated functional TR. Extracardiac factors such as renal function, hemoglobin and platelet are important in determining clinical outcomes.
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Affiliation(s)
- Shoko Nakagawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroyuki Takahama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Keiji Hoshino
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshiki Yanagi
- Department of Clinical Physiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuki Irie
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenji Moriuchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masashi Amano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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9
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Liu Y, Li W, Zhou D, Zhang X, Kong D, Ge Z, Chen H, Shu X, Pan C, Ge J. Real-Time Monitoring and Step-by-Step Guidance for Transcatheter Tricuspid Annuloplasty Using Transesophageal Echocardiography. J Cardiovasc Dev Dis 2022; 9:jcdd9120415. [PMID: 36547412 PMCID: PMC9781931 DOI: 10.3390/jcdd9120415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 11/29/2022] Open
Abstract
Transcatheter tricuspid valve intervention (TTVI) is a novel alternative to functional tricuspid regurgitation (FTR) for patients with prohibitive surgical risk. Devices have been designed according to different pathophysiological mechanisms of FTR, including ones to achieve an edge-to-edge repair and others aiming at direct annuloplasty. Recently, a transcatheter tricuspid valve repair system mimicking a surgical Kay procedure (K-Clip™ system, Huihe Medical Technology, Shanghai, China) completed its salvage-use trial. The system, which clips the posterior annulus to achieve bicuspidization of the TV, demonstrated acceptable procedural safety and efficacy. Each TTVI system has distinct characteristics for echocardiographic imaging and special consideration for intraoperative guidance. This review focuses on elaborating how two-dimensional and three-dimensional transesophageal echocardiography (TEE) are used in clinical practice to guide K-Clip™ implantation in comparison to other direct annular reduction devices. A limited number of TEE work planes are proposed for the procedure with the aim to provide a steeper learning curve for the echocardiographer and interventionalist while simplifying the implantation steps.
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Affiliation(s)
- Yu Liu
- Shanghai Institute of Medical Imaging, Shanghai 200032, China
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wei Li
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research Center for Interventional Therapy, Shanghai 200032, China
| | - Daxin Zhou
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research Center for Interventional Therapy, Shanghai 200032, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiaochun Zhang
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research Center for Interventional Therapy, Shanghai 200032, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Dehong Kong
- Shanghai Institute of Medical Imaging, Shanghai 200032, China
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research Center for Interventional Therapy, Shanghai 200032, China
| | - Zhenyi Ge
- Shanghai Institute of Medical Imaging, Shanghai 200032, China
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research Center for Interventional Therapy, Shanghai 200032, China
| | - Haiyan Chen
- Shanghai Institute of Medical Imaging, Shanghai 200032, China
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research Center for Interventional Therapy, Shanghai 200032, China
| | - Xianhong Shu
- Shanghai Institute of Medical Imaging, Shanghai 200032, China
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research Center for Interventional Therapy, Shanghai 200032, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Cuizhen Pan
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research Center for Interventional Therapy, Shanghai 200032, China
- Correspondence:
| | - Junbo Ge
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research Center for Interventional Therapy, Shanghai 200032, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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10
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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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11
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Schlotter F, Dietz MF, Stolz L, Kresoja KP, Besler C, Sannino A, Rommel KP, Unterhuber M, von Roeder M, Delgado V, Thiele H, Hausleiter J, Bax JJ, Lurz P. Atrial Functional Tricuspid Regurgitation: Novel Definition and Impact on Prognosis. Circ Cardiovasc Interv 2022; 15:e011958. [PMID: 36126130 DOI: 10.1161/circinterventions.122.011958] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial functional tricuspid regurgitation (atrial TR) has received growing recognition as a TR entity with a distinct cause owing to its independence from valvular tethering as the predominant mechanism underlying TR. However, characterization of atrial TR varies, and a universal definition is lacking. METHODS In total, 651 patients with significant functional TR were analyzed, including 438 conservatively treated individuals and 213 patients who received transcatheter tricuspid valve repair (TTVR). Based on a clustering approach, we defined atrial TR as tricuspid valve (TV) tenting height ≤10 mm, midventricular right ventricular diameter ≤38 mm, and left ventricular ejection fraction ≥50%. RESULTS Patients with atrial TR were more often females, had higher right ventricular fractional area change, higher left ventricular ejection fraction, and lower LV end-diastolic diameter, TV tenting area and height, lower right ventricular and tricuspid annular size, enlarged, but lower right atrial area and lower TV effective regurgitant orifice area (all P<0.05). Patients with atrial TR had significantly better long-term survival than non-atrial TR in the conservatively treated TR cohort (P<0.01, n=438). Atrial TR was independently associated with a lower rate of the combined end point of mortality and heart failure hospitalization at 1-year follow-up in the TTVR cohort (hazard ratio, 0.39; P<0.05, n=213). TR degree was significantly reduced after TTVR in non-atrial and atrial TR (P<0.01). Functional parameters significantly improved following TTVR independent of TR cause (P<0.05). CONCLUSIONS An echocardiography-based atrial TR definition is associated with prognostic relevance in patients with functional TR in conservatively treated TR and after TTVR.
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Affiliation(s)
- Florian Schlotter
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Germany (F.S., K.-P.K., C.B., K.-P.R., M.U., M.v.R., H.T., P.L.)
| | - Marlieke F Dietz
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, the Netherlands (M.F.D., V.D., J.J.B.)
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany (L.S., J.H.)
| | - Karl-Patrik Kresoja
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Germany (F.S., K.-P.K., C.B., K.-P.R., M.U., M.v.R., H.T., P.L.)
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Germany (F.S., K.-P.K., C.B., K.-P.R., M.U., M.v.R., H.T., P.L.)
| | - Anna Sannino
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (A.S.).,Department of Cardiovascular Research, Baylor Scott & White Research Institute, Plano, TX (A.S.)
| | - Karl-Philipp Rommel
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Germany (F.S., K.-P.K., C.B., K.-P.R., M.U., M.v.R., H.T., P.L.)
| | - Matthias Unterhuber
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Germany (F.S., K.-P.K., C.B., K.-P.R., M.U., M.v.R., H.T., P.L.)
| | - Maximilian von Roeder
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Germany (F.S., K.-P.K., C.B., K.-P.R., M.U., M.v.R., H.T., P.L.)
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, the Netherlands (M.F.D., V.D., J.J.B.)
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Germany (F.S., K.-P.K., C.B., K.-P.R., M.U., M.v.R., H.T., P.L.)
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany (L.S., J.H.).,Munich Heart Alliance, Partner site German Centre for Cardiovascular Research (DZHK), Berlin, Germany (J.H.)
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, the Netherlands (M.F.D., V.D., J.J.B.)
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Germany (F.S., K.-P.K., C.B., K.-P.R., M.U., M.v.R., H.T., P.L.)
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12
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Crea F. Challenges in the management of aortic stenosis, multiple valve disease, culture-negative endocarditis, and cardiac surgery during pregnancy. Eur Heart J 2022; 43:2715-2719. [PMID: 35908774 DOI: 10.1093/eurheartj/ehac381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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13
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Itelman E, Vatury O, Kuperstein R, Ben-Zekry S, Hay I, Fefer P, Barbash I, Klempfner R, Segev A, Feinberg M, Guetta V, Maor E. The Association of Severe Tricuspid Regurgitation with Poor Survival is Modified by Right Ventricular Pressure and Function. J Am Soc Echocardiogr 2022; 35:1028-1036. [PMID: 35817379 DOI: 10.1016/j.echo.2022.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 04/27/2022] [Accepted: 06/26/2022] [Indexed: 11/28/2022]
Abstract
Contemporary data on the independent association of severe TR with excess mortality is warranted. OBJECTIVES Describe the contemporary outcome of severe TR patients and identify its modifiers. METHODS Consecutive echocardiographic reports linked to clinical data of the largest medical center in Israel (2007-2019). The primary outcome was all-cause mortality. Cox regression and propensity score matching models were applied. RESULTS Final cohort included 97,096 patients. Mild, moderate, and severe TR was documented in 27,147(28%), 2,844(3%) and 1,805 (2%) patients, respectively. During a median follow-up of 5 years [IQR 2-8], 22,170 (23%) patients died. Kaplan-Meier survival analysis demonstrated an increased risk of death with an increasing degree of TR (p Log-rank <.001). Propensity score matching of 1,265 patients with severe TR and their matched controls showed that compared with non-severe TR, patients with severe TR were 17% more likely to die (95% 1.05-1.29 p = .003). The association of severe TR with survival was dependent on estimated right ventricular (RV) pressure, with a more pronounced effect among patients with estimated systolic pressure ≤ 40 mmHg (HR of 2.12 vs. 1.04, p for interaction < .001). A Landmark sub-analysis of 17,967 patients demonstrated that RV function deterioration on a follow-up echocardiographic exam modified the association of severe TR with survival. It was more significant among patients with preserved and stable RV function (p for interaction = 0.035). CONCLUSIONS The outcome of severe TR is modified by RV pressure and function. Once RV function deteriorates, differences in the outcome of patients with and without severe TR are less pronounced.
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Affiliation(s)
- Edwarזd Itelman
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Vatury
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raphael Kuperstein
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sagit Ben-Zekry
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Hay
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Paul Fefer
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Barbash
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Robert Klempfner
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Micha Feinberg
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victor Guetta
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Maor
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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14
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Latib A, Scotti A. Transfemoral Transcatheter Tricuspid Valve Replacement: Will TV Repair Be Replaced? JACC Cardiovasc Interv 2022; 15:492-495. [PMID: 35272773 DOI: 10.1016/j.jcin.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 01/16/2023]
Affiliation(s)
- Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
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15
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Kodali S, Hahn RT, George I, Davidson CJ, Narang A, Zahr F, Chadderdon S, Smith R, Grayburn PA, O'Neill WW, Wang DD, Herrmann H, Silvestry F, Elmariah S, Inglessis I, Passeri J, Lim DS, Salerno M, Makar M, Mack MJ, Leon MB, Makkar R. Transfemoral Tricuspid Valve Replacement in Patients With Tricuspid Regurgitation: TRISCEND Study 30-Day Results. JACC Cardiovasc Interv 2022; 15:471-480. [PMID: 35272771 DOI: 10.1016/j.jcin.2022.01.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The TRISCEND study (Edwards EVOQUE Tricuspid Valve Replacement: Investigation of Safety and Clinical Efficacy after Replacement of Tricuspid Valve with Transcatheter Device) is evaluating the safety and performance of transfemoral transcatheter tricuspid valve replacement in patients with clinically significant tricuspid regurgitation (TR) and elevated surgical risk. BACKGROUND Transcatheter valve replacement could lead to a paradigm shift in treating TR and improving patient quality of life. METHODS In the prospective, single-arm, multicenter TRISCEND study, patients with symptomatic moderate or greater TR, despite medical therapy, underwent percutaneous transcatheter tricuspid valve replacement with the EVOQUE system. A composite rate of major adverse events, echocardiographic parameters, and clinical, functional, and quality-of-life measures were assessed at 30 days. RESULTS Fifty-six patients (mean age of 79.3 years, 76.8% female, 91.1% TR severe or greater, 91.1% atrial fibrillation, and 87.5% New York Heart Association functional class III or IV) were treated. At 30 days, TR was reduced to mild or less in 98%. The composite major adverse events rate was 26.8% at 30 days caused by 1 cardiovascular death in a patient with a failed procedure, 2 reinterventions after device embolization, 1 major access site or vascular complication, and 15 severe bleeds, of which none were life-threatening or fatal. No myocardial infarction, stroke, renal failure, major cardiac structural complications, or device-related pulmonary embolism were observed. New York Heart Association significantly improved to functional class I or II (78.8%; P < 0.001), 6-minute walk distance improved 49.8 m (P < 0.001), and Kansas City Cardiomyopathy Questionnaire score improved 19 points (P < 0.001). CONCLUSIONS Early experience with the transfemoral EVOQUE system in patients with clinically significant TR demonstrated technical feasibility, acceptable safety, TR reduction, and symptomatic improvement at 30 days. The TRISCEND II randomized trial (NCT04482062) is underway.
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Affiliation(s)
- Susheel Kodali
- Columbia University Irving Medical Center, New York, New York, USA.
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Isaac George
- Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - Firas Zahr
- Oregon Health and Science University, Portland, Oregon, USA
| | | | - Robert Smith
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | - Paul A Grayburn
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | | | | | - Howard Herrmann
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frank Silvestry
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sammy Elmariah
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - D Scott Lim
- University of Virginia, Charlottesville, VA, USA
| | | | - Moody Makar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael J Mack
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York, USA
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
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16
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Crea F. A comprehensive update on valvular heart disease: from mechanisms to Guidelines. Eur Heart J 2022; 43:545-549. [PMID: 35165731 DOI: 10.1093/eurheartj/ehac038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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17
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Cardiohepatic Syndrome Is Associated With Poor Prognosis in Patients Undergoing Tricuspid Transcatheter Edge-to-Edge Valve Repair. JACC Cardiovasc Interv 2022; 15:179-189. [PMID: 35057989 DOI: 10.1016/j.jcin.2021.10.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the prevalence and prognostic implications of cardiohepatic syndrome (CHS) in patients with tricuspid regurgitation (TR) treated with tricuspid transcatheter edge-to-edge valve repair (T-TEER). BACKGROUND The role of CHS in patients undergoing T-TEER for severe TR has not been studied. METHODS This study included patients who underwent T-TEER for TR between 2016 and 2020 at 2 high-volume academic centers. CHS was defined as elevation of at least 2 of 3 cholestatic hepatic enzymes. The impact of CHS on 1-year all-cause mortality and clinical outcomes after T-TEER was investigated. RESULTS T-TEER reduced TR severity to ≤2+ in 257 of 305 included patients (86.2%). CHS was present in 45.2% of patients and was associated with a higher rate of mortality and of first hospitalization for heart failure (HHF) (CHS vs no CHS: estimated 1-year mortality, 34.0% vs 15.9% [P < 0.01]; HHF, 23.0% vs 12.2% [P = 0.01]). CHS was identified as an independent predictor of 1-year all-cause mortality (HR: 1.86; 95% CI: 1.10-3.14; P < 0.05). Irrespective of CHS, T-TEER improved New York Heart Association functional class and 6-minute walk distance in the majority of patients. In patients with impaired baseline hepatic function, laboratory liver parameters improved after T-TEER. CONCLUSIONS CHS is a strong predictor of mortality and HHF after T-TEER and should be evaluated in the process of procedural decision making for T-TEER. Nevertheless, T-TEER is associated with relevant symptomatic alleviation irrespective of CHS.
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18
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Russo M, Di Mauro M, Saitto G, Lio A, Berretta P, Taramasso M, Scrofani R, Della Corte A, Sponga S, Greco E, Saccocci M, Calafiore A, Bianchi G, Leviner DB, Biondi A, Livi U, Sharoni E, De Vincentiis C, Di Eusanio M, Antona C, Troise G, Solinas M, Laufer G, Musumeci F, Andreas M. OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6572113. [PMID: 35448903 DOI: 10.1093/ejcts/ezac230] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/15/2022] [Accepted: 03/29/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Marco Russo
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - Guglielmo Saitto
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Mil.se, Italy
| | - Antonio Lio
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Maurizio Taramasso
- Cardiac Surgery Department, University Heart Center of Zurich, Zurich, Switzerland
| | - Roberto Scrofani
- Cardiac Surgery Unit, Ospedale Fatenefratelli Sacco, Milano, Italy
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Unit of Cardiac Surgery, V Monaldi Hospital, Naples, Italy
| | - Sandro Sponga
- Cardiac Surgery Unit, University Hospital of Udine, Udine, Italy
| | - Ernesto Greco
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Sapienza University, Rome, Italy
| | - Matteo Saccocci
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | - Giacomo Bianchi
- Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | | | - Andrea Biondi
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Mil.se, Italy
| | - Ugolino Livi
- Cardiac Surgery Unit, University Hospital of Udine, Udine, Italy
| | | | - Carlo De Vincentiis
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Mil.se, Italy
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Carlo Antona
- Cardiac Surgery Unit, Ospedale Fatenefratelli Sacco, Milano, Italy
| | - Giovanni Troise
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Marco Solinas
- Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Guenther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Francesco Musumeci
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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19
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Putthapiban P, Amini MR, Abudayyeh I. Anatomy of the Tricuspid Valve and Pathophysiology of Tricuspid Regurgitation. Interv Cardiol Clin 2021; 11:1-9. [PMID: 34838292 DOI: 10.1016/j.iccl.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Transcatheter valve interventions have seen a significant increase in the past decade. The combination of improved techniques and available tools provides less invasive options supplementing surgical therapies. The tricuspid valve (TV) apparatus is a complex structure between the right atrium and the right ventricle; it generally consists of 3 leaflets (anterior, posterior, and septal) inserted in the fibrous tricuspid annulus and connected to the papillary muscle via the chordae tendinae. This article reviews TV anatomy, the pathophysiology of tricuspid regurgitation, and multimodality imaging to study TV, as well as provides an overview of transcatheter TV intervention.
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Affiliation(s)
- Prapaipan Putthapiban
- Division of Cardiology, Loma Linda University, 2068 Orange Tree Lane, Suite 215, Loma Linda, CA 92374, USA
| | - Mohammad Reza Amini
- Division of Cardiology, Loma Linda University, 2068 Orange Tree Lane, Suite 215, Loma Linda, CA 92374, USA
| | - Islam Abudayyeh
- Division of Cardiology, Loma Linda University, 2068 Orange Tree Lane, Suite 215, Loma Linda, CA 92374, USA.
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20
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Calabrò P, Gragnano F, Niccoli G, Marcucci R, Zimarino M, Spaccarotella C, Renda G, Patti G, Andò G, Moscarella E, Mancone M, Cesaro A, Giustino G, De Caterina R, Mehran R, Capodanno D, Valgimigli M, Windecker S, Dangas GD, Indolfi C, Angiolillo DJ. Antithrombotic Therapy in Patients Undergoing Transcatheter Interventions for Structural Heart Disease. Circulation 2021; 144:1323-1343. [PMID: 34662163 DOI: 10.1161/circulationaha.121.054305] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Contemporary evidence supports device-based transcatheter interventions for the management of patients with structural heart disease. These procedures, which include aortic valve implantation, mitral or tricuspid valve repair/implantation, left atrial appendage occlusion, and patent foramen ovale closure, profoundly differ with respect to clinical indications and procedural aspects. Yet, patients undergoing transcatheter cardiac interventions require antithrombotic therapy before, during, or after the procedure to prevent thromboembolic events. However, these therapies are associated with an increased risk of bleeding complications. To date, challenges and controversies exist regarding balancing the risk of thrombotic and bleeding complications in these patients such that the optimal antithrombotic regimens to adopt in each specific procedure is still unclear. In this review, we summarize current evidence on antithrombotic therapies for device-based transcatheter interventions targeting structural heart disease and emphasize the importance of a tailored approach in these patients.
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Affiliation(s)
- Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy (P.C., F.G., E.M., A.C.).,Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano," Caserta, Italy (P.C., F.G., E.M., A.C.)
| | - Felice Gragnano
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy (P.C., F.G., E.M., A.C.).,Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano," Caserta, Italy (P.C., F.G., E.M., A.C.)
| | - Giampaolo Niccoli
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (G.N.).,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy (G.N.).,Department of Medicine, University of Parma, Italy (G.N.)
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Italy (R. Marcucci.)
| | - Marco Zimarino
- Institute of Cardiology, University "G. D'Annuzio" of Chieti-Pescara, Italy (M.Z., G.R)
| | - Carmen Spaccarotella
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro, Italy (C.S., C.I.)
| | - Giulia Renda
- Institute of Cardiology, University "G. D'Annuzio" of Chieti-Pescara, Italy (M.Z., G.R)
| | - Giuseppe Patti
- Department of Translational Medicine, "Maggiore della Carità" Hospital, University of Eastern Piedmont, Via Solaroli, Novara, Italy (G.P.)
| | - Giuseppe Andò
- Unit of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy (G.A.)
| | - Elisabetta Moscarella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy (P.C., F.G., E.M., A.C.).,Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano," Caserta, Italy (P.C., F.G., E.M., A.C.)
| | - Massimo Mancone
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Italy (M.M.)
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy (P.C., F.G., E.M., A.C.).,Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano," Caserta, Italy (P.C., F.G., E.M., A.C.)
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.G., R. Mehran., G.D.D.)
| | - Raffaele De Caterina
- University Cardiology Division, University of Pisa, Pisa University Hospital, Italy; Fondazione Villa Serena per la Ricerca, Città Sant'Angelo, Italy (R.D.C.)
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.G., R. Mehran., G.D.D.)
| | - Davide Capodanno
- Cardio-Thoracic-Vascular Department, Centro Alte Specialità e Trapianti, Catania, Italy (D.C.).,Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Italy (D.C.)
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland (M.V.).,Department of Cardiology, Bern University Hospital, University of Bern, Switzerland (M.V., S.W.)
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Switzerland (M.V., S.W.)
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.G., R. Mehran., G.D.D.)
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro, Italy (C.S., C.I.).,Mediterranea Cardiocentro, Naples, Italy (C.I.)
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.)
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21
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Hakuno D, Fukae T, Takahashi M, Sueyoshi K. Causal relation of tricuspid regurgitation for heart failure outcomes: a mediation analysis of echocardiographic predictors. EUROPEAN HEART JOURNAL OPEN 2021; 1:oeab027. [PMID: 35919266 PMCID: PMC9241574 DOI: 10.1093/ehjopen/oeab027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/03/2021] [Accepted: 09/16/2021] [Indexed: 12/20/2022]
Abstract
Aims Although significant tricuspid regurgitation (TR) is critically associated with heart failure (HF) prognosis, the predictors for large TR impact on HF outcomes remain unknown. This study aimed to identify echocardiographic predictors for a causal relation of TR to HF outcomes. Methods and results In a retrospective, acute HF cohort of 462 patients, multivariate logistic regression analysis was performed to determine subgroups with strong association of greater-than-moderate TR with HF readmission or cardiovascular death in a year. We then conducted causal mediation analysis according to persistent atrial fibrillation (Af) or mitral regurgitation (MR) to identify the echocardiographic predictors. The association of TR with HF outcomes was prominent in subgroups of females, with Af, the enlarged indexed tricuspid annular diameter (TADi) or right atrial area, or within certain ranges of the left ventricular ejection fraction, indexed right ventricular end-systolic area, or fractional area change (FAC). Causal mediation analysis found that the TR impact was significant in patients with Af. Furthermore, combination of TADi ≥2.1 cm/m2 and FAC ≥30%, which accounted for half of TR patients, predicted a much larger TR impact irrespective of Af and MR. Its prediction ability was superior to that of the modified Model for End-stage Liver Disease score. Conclusion The causal impact and burden of TR on HF outcomes was significant in patients with Af, and combining TADi ≥2.1 cm/m2 with FAC ≥30% could provide superior echocardiographic prediction of larger TR impact in HF patients.
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Affiliation(s)
- Daihiko Hakuno
- Department of Cardiology, Kawasaki Municipal Hospital , 12-1 Shinkawa St, Kawasaki-ku , Kawasaki City, Kanagawa 210-0013, Japan
| | - Tomoaki Fukae
- Department of Internal Medicine, Kawasaki Municipal Hospital , 12-1 Shinkawa St, Kawasaki-ku , Kawasaki City, Kanagawa 210-0013, Japan
| | - Masashi Takahashi
- Department of Cardiology, Kawasaki Municipal Hospital , 12-1 Shinkawa St, Kawasaki-ku , Kawasaki City, Kanagawa 210-0013, Japan
| | - Koichiro Sueyoshi
- Department of Cardiology, Kawasaki Municipal Hospital , 12-1 Shinkawa St, Kawasaki-ku , Kawasaki City, Kanagawa 210-0013, Japan
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22
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Transcatheter Tricuspid Valve-in-Valve Procedure-An Illustrative Case Report and Review. J Clin Med 2021; 10:jcm10174004. [PMID: 34501452 PMCID: PMC8432540 DOI: 10.3390/jcm10174004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/21/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022] Open
Abstract
Severe tricuspid commitment is no longer understood as merely a marker of disease but is now widely thought of as a significant contributor to cardiac morbidity and mortality. However, isolated tricuspid valve surgery remains rare and to this day continues to be associated with the highest surgical risk among all valve procedures and high operative mortality rates, especially in reoperations. Therefore, the development of tricuspid transcatheter procedures is as necessary as it was for the other valves a couple of years ago. Recently, multiple percutaneous therapies have been developed for the management of severe tricuspid disease, initially only repair and more recently replacement, thus creating a new branch for the management of patients who have already undergone surgery and who present with dysfunctional bioprostheses. The purpose of this review and report is to demonstrate current and possible future challenges, and to show that the valve-in-valve procedure of the tricuspid valve is feasible and safe, and now can be performed in all its range, in the smallest to the largest sizes of presentation, without incurring the untoward risks of conventional surgery.
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23
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Volpato V, Badano LP, Figliozzi S, Florescu DR, Parati G, Muraru D. Multimodality cardiac imaging and new display options to broaden our understanding of the tricuspid valve. Curr Opin Cardiol 2021; 36:513-524. [PMID: 34292179 PMCID: PMC9904443 DOI: 10.1097/hco.0000000000000890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The prognostic impact of tricuspid regurgitation (TR) and the subsequent development of percutaneous procedures targeting the tricuspid valve (TV), has brought to the forefront the role of imaging for the assessment of the forgotten valve. As illustrated in several studies and summarized in this review, currently a multimodality imaging approach is required to understand the pathophysiology of TR, due to the complex TV anatomy and the close relationship between the severity of TR and the extent of the remodeling of the right heart chambers. RECENT FINDINGS Recently, the advance in the tranhscatheter treatment of the TV has led to a growing interest in the development of dedicated software packages and new display modalities to increase our understanding of the TV. As a consequence, a transversal knowledge of the different imaging modalities is required for contemporary cardiac-imaging physicians. SUMMARY This review highlights the main features, and the pros and cons of echocardiography, cardiac computed tomography, cardiac magnetic resonance and emerging technologies, as 3D printing and virtual reality, in the assessment of patients with TR.
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Affiliation(s)
- Valentina Volpato
- Department of Medicine and Surgery, University of Milano-Bicocca
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Luigi P. Badano
- Department of Medicine and Surgery, University of Milano-Bicocca
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Stefano Figliozzi
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Diana R. Florescu
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca
- Department of Cardiac, Neural and Metabolic Sciences – Istituto Auxologico Italiano IRCCS, Milan, Italy
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24
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Chen E, L'official G, Guérin A, Dreyfus J, Lavie-Badie Y, Sportouch C, Eicher JC, Maréchaux S, Le Tourneau T, Oger E, Donal E. Natural history of functional tricuspid regurgitation: impact of cardiac output. Eur Heart J Cardiovasc Imaging 2021; 22:878-885. [PMID: 33928339 DOI: 10.1093/ehjci/jeab070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/26/2021] [Indexed: 12/19/2022] Open
Abstract
AIMS Tricuspid regurgitation (TR) was long forgotten until recent studies alerting on its prognostic impact. Cardiac output (CO) is the main objective of heart mechanics. We sought to compare clinical and echocardiographic data of patients with TR from inclusion to 1-year follow-up according to initial CO. METHODS AND RESULTS Patients with isolated secondary TR and left ventricular ejection fraction (LVEF) ≥40% were prospectively included. All patients had a clinical and echocardiographic evaluation at baseline and after 1 year. Echocardiographic measurements were centralized. The patients were partitioned according to their CO at baseline. The primary outcome was all-cause death. Ninety-five patients completed their follow-up. The majority of patients had normal CO (n = 64, 67.4%), whereas 16 (16.8%) patients had low-CO and 12 (12.6%) had high-CO. right ventricular function was worse in the low-CO group but with improvement at 1 year (30% increase in tricuspid annular plane systolic excursion). LVEF and global longitudinal strain were significantly worse in the low-CO group. Overall, 18 (19%) patients died during follow-up, of which 10 (55%) patients had abnormal CO. There was a U-shaped association between CO and mortality. Normal CO patients had significantly better survival (87.5% vs. 62.5% and 66.67%) in the low- and high-CO groups, respectively, even after adjustment (heart rate 2.23 for the low-CO group and 9.08 for high-CO group; P = 0.0174). CONCLUSION Significant isolated secondary TR was associated with 19% of mortality. It is also associated with higher long-term mortality if CO is abnormal, suggesting a possible role for evaluating better and selecting patients for intervention.
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Affiliation(s)
- Elisabeth Chen
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35000 Rennes, France
| | | | - Anne Guérin
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35000 Rennes, France
| | - Julien Dreyfus
- Department of Cardiology, Centre Cardiologique du Nord, F-93000 St Denis, France
| | - Yoan Lavie-Badie
- Department of Cardiology, Rangueil University Hospital, F-31000 Toulouse, France
| | - Catherine Sportouch
- Department of Cardiology, Clinique du Millénaire, F-34000 Montpellier, France
| | | | - Sylvestre Maréchaux
- Groupement des Hôpitaux de l'Institut Catholique de Lille, Department of Cardiology, Lille Catholic University, France
| | | | - Emmanuel Oger
- Service de pharmacologie, Hôpital Pontchaillou, Rennes, France
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35000 Rennes, France
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25
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Ancona F, Melillo F, Calvo F, Attalla El Halabieh N, Stella S, Capogrosso C, Ingallina G, Tafciu E, Pascaretta A, Ancona MB, De Bonis M, Castiglioni A, Denti P, Montorfano M, Latib A, Colombo A, Alfieri O, Agricola E. Right ventricular systolic function in severe tricuspid regurgitation: prognostic relevance of longitudinal strain. Eur Heart J Cardiovasc Imaging 2021; 22:868-875. [PMID: 33623973 DOI: 10.1093/ehjci/jeab030] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/05/2021] [Indexed: 12/22/2022] Open
Abstract
AIMS The aim of this study is to analyse the prognostic implications of right ventricular (RV) dysfunction as detected by strain analysis in patients with severe tricuspid regurgitation (TR). The evaluation of RV systolic function in presence of severe TR is of paramount importance for operative risk stratification; however, it remains challenging, as conventional echocardiographic indexes usually lead to overestimation. METHODS AND RESULTS We enrolled 250 consecutive patients with severe TR referred to our centre. Baseline clinical and echocardiographic data and follow-up outcomes were collected. Patients were predominantly female, with multiple cardiovascular risk factors and comorbidities, history of heart failure, and atrial fibrillation. Most of them had presented with clinical signs of RV heart failure (RVHF) and advanced New York Heart Association class. The RV strain analysis [both RV free wall longitudinal strain (RVFWLS) and RV global longitudinal strain (RVGLS)] reclassified ∼42-56% of patients with normal RV systolic function according to conventional parameters in patients with impaired RV systolic function. RVFWLS ≤17% (absolute values, AUC: 0.66, P = 0.002) predicted the presence of RVHF [odds ratio (OR) 0.93, P = 0.01]. At follow-up, patients with RVFWLS >14% (absolute values, AUC: 0.70, P = 0.001, sensitivity 72%, specificity 54%) showed a better survival (P = 0.01). CONCLUSION Different ranges of RVFWLS have different implications in patients with severe TR, allowing to identify a preclinical and a clinical window, with correlations to RVHF and survival.
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Affiliation(s)
- Francesco Ancona
- Echocardiography Laboratory, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Francesco Melillo
- Echocardiography Laboratory, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Francesco Calvo
- Echocardiography Laboratory, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Nadia Attalla El Halabieh
- Echocardiography Laboratory, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Stefano Stella
- Echocardiography Laboratory, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Cristina Capogrosso
- Echocardiography Laboratory, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Giacomo Ingallina
- Echocardiography Laboratory, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Elvin Tafciu
- Echocardiography Laboratory, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Antonia Pascaretta
- Echocardiography Laboratory, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Marco Bruno Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele De Bonis
- Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Castiglioni
- Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Denti
- Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Antonio Colombo
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Ottavio Alfieri
- Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Eustachio Agricola
- Echocardiography Laboratory, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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26
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Veen KM, Mokhles MM, Soliman O, de By TMMH, Mohacsi P, Schoenrath F, Paluszkiewicz L, Netuka I, Bogers AJJC, Takkenberg JJM, Caliskan K. Clinical impact and 'natural' course of uncorrected tricuspid regurgitation after implantation of a left ventricular assist device: an analysis of the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). Eur J Cardiothorac Surg 2021; 59:207-216. [PMID: 33038216 PMCID: PMC7781523 DOI: 10.1093/ejcts/ezaa294] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/15/2020] [Accepted: 06/27/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES ![]()
Data on the impact and course of uncorrected tricuspid regurgitation (TR) during left ventricular assist device (LVAD) implantation are scarce and inconsistent. This study explores the clinical impact and natural course of uncorrected TR in patients after LVAD implantation.
METHODS The European Registry for Patients with Mechanical Circulatory Support was used to identify adult patients with LVAD implants without concomitant tricuspid valve surgery. A mediation model was developed to assess the association of TR with 30-day mortality via other risk factors. Generalized mixed models were used to model the course of post-LVAD TR. Joint models were used to perform sensitivity analyses. RESULTS A total of 2496 procedures were included (median age: 56 years; men: 83%). TR was not directly associated with higher 30-day mortality, but mediation analyses suggested an indirect association via preoperative elevated right atrial pressure and creatinine (P = 0.035) and bilirubin (P = 0.027) levels. Post-LVAD TR was also associated with increased late mortality [hazard ratio 1.16 (1.06–1.3); P = 0.001]. On average, uncorrected TR diminished after LVAD implantation. The probability of having moderate-to-severe TR immediately after an implant in patients with none-to-mild TR pre-LVAD was 10%; in patients with moderate-to-severe TR pre-LVAD, it was 35% and continued to decrease in patients with moderate-to-severe TR pre-LVAD, regardless of pre-LVAD right ventricular failure or pulmonary hypertension. CONCLUSIONS Uncorrected TR pre-LVAD and post-LVAD is associated with increased early and late mortality. Nevertheless, on average, TR diminishes progressively without intervention after an LVAD implant. Therefore, these data suggest that patient selection for concomitant tricuspid valve surgery should not be based solely on TR grade.
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Affiliation(s)
- Kevin M Veen
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, Netherlands
| | - Mostafa M Mokhles
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, Netherlands
| | - Osama Soliman
- Department of Cardiology, Erasmus MC, Rotterdam, Netherlands
| | | | - Paul Mohacsi
- Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Lech Paluszkiewicz
- Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Ivan Netuka
- Department of Cardiothoracic Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, Netherlands
| | | | - Kadir Caliskan
- Department of Cardiology, Erasmus MC, Rotterdam, Netherlands
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27
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Otto S, Velichkov M, Hamadanchi A, Schulze PC, Moebius-Winkler S. The impact of tricuspid annular geometry on outcome after percutaneous edge-to-edge repair for severe tricuspid regurgitation. Cardiol J 2021; 28:579-588. [PMID: 33942279 DOI: 10.5603/cj.a2021.0046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/19/2021] [Accepted: 02/25/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Percutaneous tricuspid repair using the edge-to-edge technique is a novel treatment option. More data are needed to better understand which aspects predict a favorable outcome. METHODS Twenty high-risk patients (78.6 ± 8.3 years, EuroScore II 9.1 ± 7.7%, STS score 8.8 ± 4.3) with severe symptomatic tricuspid regurgitation (TR) were treated with the MitraClip® system. All patients underwent standardized pre-, peri-, and post-procedural evaluation. Acute success was defined as successful edge-to-edge repair with TR reduction of ≥ 1 grade and survival until hospital discharge. RESULTS Fifteen (75%) patients showed acute success until discharge and 12 (60%) at 30-day followup. In 5 (25%) patients repair failed due to either unsuccessful clip implantation (n = 2), single leaflet device attachment (n = 1), TR reduction < 1 grade (n = 1), or in-hospital death (n = 1). Comparing patients with successful procedure versus those with failed repair revealed similar comorbidities but more severe right heart failure, lower left ventricular ejection fraction, worse renal function, and higher diuretic equivalent doses in the failed repair group. No differences in conventional echocardiographic parameters for TR severity but more dilated tricuspid annulus geometry (tricuspid valve annulus, coaptation depth, tenting area) in the failed repair group were observed. The success rate of non-central/non-anteroseptal jet location was only 25%. CONCLUSIONS Tricuspid annulus geometry assessment may be of crucial importance and seems to impact procedural outcomes in patients undergoing edge-to-edge tricuspid valve repair. Further investigations including advanced imaging are needed to better understand and treat this complex valve disease.
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Affiliation(s)
- Sylvia Otto
- Department of Internal Medicine I, Division of Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany.
| | - Marija Velichkov
- Department of Internal Medicine I, Division of Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany
| | - Ali Hamadanchi
- Department of Internal Medicine I, Division of Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany
| | - Sven Moebius-Winkler
- Department of Internal Medicine I, Division of Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany
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28
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Tagliari AP, Perez-Camargo D, Taramasso M. Tricuspid regurgitation: when is it time for surgery? Expert Rev Cardiovasc Ther 2021; 19:47-59. [DOI: 10.1080/14779072.2021.1854734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Ana Paula Tagliari
- Cardiac Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Postgraduate Program in Health Science: Cardiology and Cardiovascular Science, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Daniel Perez-Camargo
- Cardiac Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Fundación Interhospitalaria para la Investigación Cardiovascular, Madrid, Spain
| | - Maurizio Taramasso
- Cardiac Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- HerzZentrum Hirlsanden Zurich, Zurich, Switzerland
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Delgado V, Ajmone Marsan N, Bax JJ. The difficult decision of when and in whom to perform isolated tricuspid valve surgery. Eur Heart J 2020; 41:4318-4320. [PMID: 32984873 DOI: 10.1093/eurheartj/ehaa740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Predictores de eventos cardiovasculares tras cirugía por insuficiencia tricuspídea grave: estudio prospectivo con datos clínicos, de imagen y hemodinámicos. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Wang R, Gao C, Kawashima H, Modolo R, Rosseel L, Onuma Y, Soliman O, Serruys PW, Mylotte D. Valvular heart interventions: advances from 2019 to 2020. EUROINTERVENTION 2020; 16:808-823. [PMID: 32958460 DOI: 10.4244/eij-d-20-00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Rutao Wang
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
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Rodríguez-Palomares JF, Lozano-Torres J, Dentamaro I, Valente FX, Avilés AS, García-Moreno LG, Sabaté PR, Otaegui I, Rosique BM, Calabria HC, Masip AE, Mas PT, Ferreira-González I, González-Alujas MT. Predictors of cardiovascular outcomes after surgery in severe tricuspid regurgitation: clinical, imaging and hemodynamic prospective study. ACTA ACUST UNITED AC 2020; 74:655-663. [PMID: 33960932 DOI: 10.1016/j.rec.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Severe tricuspid regurgitation (TR) is a prevalent valve disease with a high mortality rate. Current guidelines do not define specific thresholds at which patients should be considered for surgery or percutaneous procedures. Thus, patients are usually referred for intervention at a late stage of the disease. This study aimed to assess predictors of cardiovascular outcomes in a prospective cohort of patients with severe TR referred for surgery. METHODS This was an observational, prospective, nonrandomized study. All patients underwent surgery for severe TR based on current clinical guidelines. Complete anamnesis, blood test, echocardiogram, cardiovascular magnetic resonance and right and left catheterization were performed. Patients were followed up in the outpatient department and a combined endpoint (hospitalization for heart failure and cardiovascular mortality) was registered. RESULTS Forty-three consecutive patients were included (age: 66.9 ± 9.6 years, 67.4% female). Tricuspid annuloplasty was performed in all patients. After a median follow-up of 38 months, 12 patients (27.9%) showed the combined endpoint and 7 (16.3%) died. Above all clinical, blood and imaging data, the indexed right ventricular end-diastolic volume constituted the best predictor of the combined endpoint (HR, 1.1; P = .02) and cardiovascular mortality (HR, 1.1; P = .05). Furthermore, indexed right ventricular end-diastolic volume was associated with TR recurrence after surgery, with no impact on clinical outcomes. CONCLUSIONS In patients with severe TR referred for surgery, right ventricular remodeling assessed by cardiovascular magnetic resonance constituted the best independent predictor of cardiovascular outcomes at follow-up.
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Affiliation(s)
- José F Rodríguez-Palomares
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Jordi Lozano-Torres
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ilaria Dentamaro
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Filipa X Valente
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Augusto Sao Avilés
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Unidad de Estadística y Bioinformática (UEB), Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Laura Gutiérrez García-Moreno
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Pau Rello Sabaté
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Imanol Otaegui
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Beatriz Mínguez Rosique
- Unidad de Hepatología, Departamento de Medicina Interna, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut of Research, CIBERehd, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hug Cuéllar Calabria
- Servicio de Radiología, Institut de Diagnòstic per la imatge (IDI), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Artur Evangelista Masip
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Pilar Tornos Mas
- Departamento de Cardiología, Hospital Quirónsalud, Barcelona, Spain
| | - Ignacio Ferreira-González
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María Teresa González-Alujas
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Cheng Y, Mo S, Wang K, Fan R, Liu Y, Li S, Zhang X, Yin S, Xu Y, Tang B, Wu Z. Mid-Term Outcome after Tricuspid Valve Replacement. Braz J Cardiovasc Surg 2020; 35:644-653. [PMID: 33118728 PMCID: PMC7598977 DOI: 10.21470/1678-9741-2019-0215] [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: 11/15/2022] Open
Abstract
Objective To evaluate the mid-term survival rate after tricuspid valve replacement (TVR). Methods We retrospectively studied 110 consecutive patients who underwent TVR from January 2007 to November 2017. A survival analysis was performed with the Kaplan-Meier method and the log-rank test. Results The median survival was 65.81 months. Mean age was 50 (range 39 to 59) years. Forty-eight patients (43.6%) were male, and 62 patients (56.4%) were female. Most of the patients (78.5%) were categorized into the New York Heart Association (NYHA) functional classes III/IV. Seventy-two patients (65.5%) had isolated TVR. Six-three patients (57.3%) had previously undergone heart surgery. The Kaplan-Meier survival rates at one year, three years, and five years were 59.0%±5%, 52.0%±6%, and 48.0%±6%, respectively. A Cox regression analysis demonstrated that the risk factors for mid-term mortality were advanced NYHA class (hazard ratio [HR] 2.430, 95% confidence interval [CI] 1.099-5.375, P=0.028), need for continuous renal replacement therapy (CRRT) treatment (HR 3.121, 95% CI 1.610-6.050, P=0.001), and need for intra-aortic balloon pump (IABP) treatment (HR 3.356, 95% CI 1.072-10.504, P=0.038). Conclusion In TVR, impaired cardiac function before the operation and a need for CRRT or IABP treatment after the operation is independently associated with increased mid-term mortality.
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Affiliation(s)
- Yanmei Cheng
- The First Affiliated Hospital of Sun Yat-sen University Department of Cardiothoracic Surgery ICU Guangzhou People's Republic of China Department of Cardiothoracic Surgery ICU, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shaoyan Mo
- The First Affiliated Hospital of Sun Yat-sen University Department of Cardiopulmonary Bypass Guangzhou People's Republic of China Department of Cardiopulmonary Bypass, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Keke Wang
- The First Affiliated Hospital of Sun Yat-sen University Department of Cardiopulmonary Bypass Guangzhou People's Republic of China Department of Cardiopulmonary Bypass, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Rui Fan
- The First Affiliated Hospital of Sun Yat-sen University Department of Echocardiography Guangzhou People's Republic of China Department of Echocardiography, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yunqi Liu
- The First Affiliated Hospital of Sun Yat-sen University Department of Cardiac Surgery Guangzhou People's Republic of China Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Si Li
- The First Affiliated Hospital of Sun Yat-sen University Department of Cardiothoracic Surgery ICU Guangzhou People's Republic of China Department of Cardiothoracic Surgery ICU, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xi Zhang
- The First Affiliated Hospital of Sun Yat-sen University Department of Cardiac Surgery Guangzhou People's Republic of China Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shengli Yin
- The First Affiliated Hospital of Sun Yat-sen University Department of Cardiac Surgery Guangzhou People's Republic of China Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yingqi Xu
- The First Affiliated Hospital of Sun Yat-sen University Department of Cardiac Surgery Guangzhou People's Republic of China Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Baiyun Tang
- The First Affiliated Hospital of Sun Yat-sen University Department of Cardiothoracic Surgery ICU Guangzhou People's Republic of China Department of Cardiothoracic Surgery ICU, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhongkai Wu
- The First Affiliated Hospital of Sun Yat-sen University Department of Cardiac Surgery Guangzhou People's Republic of China Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
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Santaló-Corcoy M, Asmarats L, Li CH, Arzamendi D. Catheter-based treatment of tricuspid regurgitation: state of the art. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:964. [PMID: 32953764 PMCID: PMC7475403 DOI: 10.21037/atm.2020.03.219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Tricuspid regurgitation is a highly prevalent condition, with detrimental effects on long-term survival. However, it has been historically neglected, and only surgically addressed when symptomatic diuretic agents proved insufficient to alleviate congestion. Besides, mortality rates of isolated tricuspid regurgitation surgery have been persistently high, even in contemporary series. This has led to the advent of a myriad of transcatheter tricuspid valve interventions mimicking current surgical technologies, for which a comprehensive imaging work-up holds the key for proper patient selection and intraprocedural monitoring. Although initially designed for compassionate use patients, growing experience and encouraging results of these less-invasive technologies are broadening the spectrum of beneficiaries. In this review, we will focus on the current picture of transcatheter tricuspid valve interventions, with special interest on the current understanding of pathoanatomic tricuspid regurgitation progression, preprocedural multimodality imaging and the latest experience on the different transcatheter devices.
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Affiliation(s)
- Marcel Santaló-Corcoy
- Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lluís Asmarats
- Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Chi-Hion Li
- Division of Cardiac Imaging, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Dabit Arzamendi
- Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Amedi A, Onohara D, Xu D, Suresh KS, Padala M. Hemodynamic outcomes after undersizing ring annuloplasty and focal suture annuloplasty for surgical repair of functional tricuspid regurgitation. J Thorac Cardiovasc Surg 2020; 164:76-87.e1. [PMID: 33041065 DOI: 10.1016/j.jtcvs.2020.08.085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/19/2020] [Accepted: 08/22/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Surgical annuloplasty for functional tricuspid regurgitation (FTR) is on the rise and can be performed in several ways with varied outcomes. In this study, we sought to compare the hemodynamic outcomes of tricuspid annuloplasty performed with a commercially available annuloplasty ring (tricuspid valve annuloplasty [TVA]) compared with focal suture annuloplasty (Hetzer) in an experimental FTR model. METHODS An ex vivo FTR model was developed by inducing right ventricular dilatation by acute afterload elevation, causing severe tricuspid valve tethering and annular dilatation, leading to regurgitation. Ten porcine hearts in which FTR was induced underwent TVA with a 26-mm Edwards MC3 ring and Hetzer annuloplasty with a pledgeted suture cinching the anteroposterior and septal annulus. FTR was measured before after each repair, and tenting geometry, valve kinematics, and subvalvular geometry were measured with echocardiography. RESULTS At baseline, none of the hearts had FTR, but upon afterload elevation an FTR volume of 17.7 ± 9.2 mL (26.38 ± 17.47% regurgitant fraction) was measured (P < .0001). TVA reduced regurgitation by 50% and Hetzer annuloplasty by 56% , respectively, but both left persistent FTR. Anteroseptal tenting area was 279.0 ± 158.9 mm2 before repair and decreased significantly to 147.2 ± 134.8 mm2 (P = .0195) with Hetzer but not with TVA. Posteroseptal tenting area was 425.1 ± 169.2 mm2 before repair and was significantly reduced by both techniques (TVA: 200.3 ± 102.9 mm2 [P = .0012]; Hetzer: 237.6 ± 127.6 mm2 [P = .0270]). CONCLUSIONS Tricuspid annuloplasty with a ring or a focal suture can reduce FTR but not eliminate it. Annular approaches did not relieve tricuspid valve tethering and reduced leaflet mobility persisted. Either subannular repairs or judicious use of valve replacement may be necessary.
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Affiliation(s)
- Alan Amedi
- Structural Heart Research & Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, Ga
| | - Daisuke Onohara
- Structural Heart Research & Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, Ga
| | - Dongyang Xu
- Structural Heart Research & Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, Ga
| | - Kirthana Sreerangathama Suresh
- Structural Heart Research & Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, Ga
| | - Muralidhar Padala
- Structural Heart Research & Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, Ga; Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.
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Zaccone G, Di Pasquale M, Fiorina C, Curello S, Metra M, Adamo M. Transcatheter therapies for tricuspid valve regurgitation. J Cardiovasc Med (Hagerstown) 2020; 21:964-974. [DOI: 10.2459/jcm.0000000000001062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lüscher TF. From TAVI to tricuspid cliping: fine-tuning the management of valvular heart disease. Eur Heart J 2020; 41:1863-1866. [PMID: 33216904 DOI: 10.1093/eurheartj/ehaa459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Professor of Cardiology, Imperial College and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals London, UK.,Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland.,Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, 8032 Zurich, Switzerland
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Gallet R, Ternacle J, Teiger E. [Transcatheter treatment of tricuspid regurgitation]. Ann Cardiol Angeiol (Paris) 2019; 68:480-485. [PMID: 31668340 DOI: 10.1016/j.ancard.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Tricuspid regurgitation is serious disease for which surgical correction is underperformed because of a prohibitive risk. It is responsible for a 50% mortality at 3 years which is decreased by surgical treatment. However, only a negligible proportion of patients undergoes surgery. In this context, there is currently an unmet need for percutaneous treatment technique. Several technologies are undergoing preclinical or early clinical development. These techniques aim to mimic the different surgical strategies used for the treatment of tricuspid regurgitation. Thus, some target the leaflets, the tricuspid annulus or offer a complete tricuspid valve replacement. Before planning a transcatheter tricuspid intervention, a comprehensive evaluation is mandatory, addressing the patient clinical status and comorbidities, the tricuspid regurgitation ad its consequences on right heart and, the anatomy of the tricuspid annulus and the right heart to determine if the patient is eligible for the chosen technique. This article will review the indications, contraindications and exams to perform before transcatheter tricuspid intervention and will then detail the different strategies available or undergoing development.
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Affiliation(s)
- R Gallet
- Service de Cardiologie, CHU Henri-Mondor, 51, avenue du Maréchal de Lattre de-Tassigny, 94010 Créteil, France.
| | - J Ternacle
- Service de Cardiologie, CHU Henri-Mondor, 51, avenue du Maréchal de Lattre de-Tassigny, 94010 Créteil, France
| | - E Teiger
- Service de Cardiologie, CHU Henri-Mondor, 51, avenue du Maréchal de Lattre de-Tassigny, 94010 Créteil, France
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