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Siddiqui E, Alviar CL, Ramachandran A, Flattery E, Bernard S, Xia Y, Nayar A, Keller N, Bangalore S. Outcomes After Tricuspid Valve Operations in Patients With Drug-Use Infective Endocarditis. Am J Cardiol 2022; 185:80-86. [DOI: 10.1016/j.amjcard.2022.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/18/2022] [Accepted: 08/25/2022] [Indexed: 11/01/2022]
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You T, Ma YH, Yi K, Gao J, Xu JG, Xu XM, He SE, Wang W, Ji M. Impact of 3D Rigid Ring Annuloplasty for Tricuspid Regurgitation: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:725968. [PMID: 35345483 PMCID: PMC8957110 DOI: 10.3389/fcvm.2022.725968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/19/2022] [Indexed: 01/10/2023] Open
Abstract
BackgroundTricuspid annuloplasty (TAP) is accepted as the standard technique for correcting tricuspid regurgitation (TR). We conducted the present study to provide an overview of the contemporary results of 3D rigid ring annuloplasty for TR.MethodsA systematic literature search was carried out in eight databases to collect all relevant studies on the three-dimensional (3D) rigid ring annuloplasty treatment of TR published before October 1, 2020. The main outcomes of interest were postoperative TR grade, perioperative mortality, and recurrent TR.ResultsA total of eight studies were included, all of which were retrospective observational studies. Rigid 3D rings were compared with flexible bands, and there was no difference in perioperative mortality [odds ratio (OR) = 1.02; 95% CI (0.52, 2.02); p = 0.95], late mortality [OR = 0.99; 95% CI (0.28, 3.50); p = 0.98], or recurrent TR [OR = 0.59; 95% CI (0.29, 1.21); p = 0.15]. The postoperative TR grade associated with 3D rigid rings was 0.12 lower [mean difference (MD) = −0.12; 95% CI (−0.22, −0.01); p = 0.03], which indicated that 3D rigid rings result in better postoperative outcomes than flexible bands. Compared with suture annuloplasty, the postoperative TR grade of the 3D rigid ring group was 0.51 lower [MD = −0.51; 95% CI (−0.59, −0.43); p < 0.05]. Within the 5 years of follow-up, patients who underwent 3D rigid ring annuloplasty had lower TR recurrence [OR = 0.26; 95% CI (0.13, 0.50); p < 0.05].ConclusionsCompared with suture annuloplasty, 3D rigid rings present early advantages. The 3D rigid rings provide an acceptable short-term effect similar to that of the flexible bands, and a significant difference between these approaches was not discovered. However, the conclusion was based on the limited, short-term data available at the time of the study. Further research on the long-term effects of 3D rigid ring annuloplasty for TR is clearly needed.Systematic Review Registrationhttps://inplasy.com/inplasy-2021-3-0105/, identifier: 202130105.
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Affiliation(s)
- Tao You
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
- *Correspondence: Tao You
| | - Yu-Hu Ma
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Kang Yi
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
| | - Jie Gao
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Jian-Guo Xu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Xiao-Min Xu
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Shao-E He
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Wei Wang
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Meng Ji
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
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Algarni KD, Alfonso J, Pragliola C, Kheirallah H, Adam AI, Arafat AA. Long-term Outcomes of Tricuspid Valve Repair: The Influence of the Annuloplasty Prosthesis. Ann Thorac Surg 2021; 112:1493-1500. [DOI: 10.1016/j.athoracsur.2020.09.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 09/18/2020] [Accepted: 09/18/2020] [Indexed: 11/29/2022]
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Di Mauro M, Lorusso R, Parolari A, Ravaux JM, Bonalumi G, Guarracini S, Ricci F, Benedetto U, Calafiore AM. The best approach for functional tricuspid regurgitation: A network meta-analysis. J Card Surg 2021; 36:2072-2080. [PMID: 33651449 DOI: 10.1111/jocs.15378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE For many years, functional tricuspid regurgitation (FTR) was considered negligible after treatment of left-sided heart valve surgery. The aim of the present network meta-analysis is to summarize the results of four approaches to establish the possible gold standard. METHODS A systematic search was performed to identify all publications reporting the outcomes of four approaches for FTR, not tricuspid annuloplasty (no TA), suture annuloplasty (SA), flexible (FRA), rigid rings (RRA). All studies reporting at least one the four endpoints (early and late mortality, early and late moderate or more TFR) were included in a Bayesian network meta-analysis. RESULTS There were 31 included studies with 9663 patients. Aggregate early mortality was 5.3% no TA, 7.2% SA, 6.6% FRA, and 6.4% RRA; early TR moderate-or-more was 9.6%, 4.8%, 4.6%, and 3.8%; late mortality was 22.5%, 18.2%, 11.9%, and 11.9%; late TR moderate-or-more was 27.9%, 18.3%, 14.3%, and 6.4%. Rigid or semirigid ring annuloplasty was the most effective approach for decreasing the risk of late moderate or more FTR (-85% vs. no TA; -64% vs. SA; -32% vs. FRA). Concerning late mortality, no significant differences were found among different surgical approaches; however, flexible or rigid rings reduced significantly the risk of late mortality (78% and 47%, respectively) compared with not performing TA mortality. No differences were found for early outcomes. CONCLUSIONS Ring annuloplasty seems to offer better late outcomes compare to either suture annuloplasty or not performing TA. In particular rigid or semirigid rings provide more stable FTR across time.
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Affiliation(s)
- Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Alessandro Parolari
- IRCCS Policlinic S. Donato and Department of Biomedical Sciences for Health, UOC of University Cardiac Surgery and Translational Research, University of Milan, Milan, Italy
| | - Justine M Ravaux
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Giorgia Bonalumi
- Department of Cardiac Surgery, Centro Cardiologico Monzino-IRCCS, Milan, Italy
| | - Stefano Guarracini
- Department of Cardiovascular Disease, "Pierangeli" Hospital, Pescara, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Umberto Benedetto
- Department of Cardiothoracic Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
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Mangieri A, Pagnesi M, Regazzoli D, Laricchia A, Ho E, Goldberg Y, Chau M, Gallo F, Fisicaro A, Khokhar A, Colombo A, Giannini F, Latib A. Future Perspectives in Percutaneous Treatment of Tricuspid Regurgitation. Front Cardiovasc Med 2020; 7:581211. [PMID: 33173788 PMCID: PMC7591745 DOI: 10.3389/fcvm.2020.581211] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/07/2020] [Indexed: 11/30/2022] Open
Abstract
Tricuspid regurgitation (TR) has a not negligible prevalence and its severity is correlated with poorer outcomes. However, surgical options are rarely offered to these patients because of their high surgical risk. Given that medical therapy plays a limited role in the management of these patients, there is an increasing clinical need for transcatheter treatment options. Although, transcatheter tricuspid valve interventions (TTVIs) are still at an early stage, emerging data suggests their clinical effectiveness and safety, with preliminary results highlighting the potential benefits of transcatheter treatments over medical therapy. In this review, we highlight the challenges and future directions of current and emerging technologies dedicated to the treatment of TR along with an analysis of the next steps required in future clinical trials and studies dedicated to the treatment of the forgotten valve.
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Affiliation(s)
- Antonio Mangieri
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | | | - Damiano Regazzoli
- Unit of Cardiovascular Interventions, Humanitas Research Hospital, Rozzano, Italy
| | - Alessandra Laricchia
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Edwin Ho
- Department of Cardiology, Montefiore Medical Center, New York, NY, United States
| | - Ythan Goldberg
- Department of Cardiology, Montefiore Medical Center, New York, NY, United States
| | - Mei Chau
- Department of Cardiac Surgery, Montefiore Medical Center, New York, NY, United States
| | - Francesco Gallo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Andrea Fisicaro
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Arif Khokhar
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Antonio Colombo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Giannini
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, NY, United States
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Impact of Different Annuloplasty Methods for Tricuspid Regurgitation: A Network Meta-Analysis. Ann Thorac Surg 2020; 111:2004-2010. [PMID: 33011167 DOI: 10.1016/j.athoracsur.2020.07.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although moderate to severe tricuspid valve regurgitation (TR) is an independent risk factor for progressive heart failure and increased mortality, the best method for tricuspid valve repair remains controversial. Therefore, this study conducted a network meta-analysis to compare early and late outcomes for suture, flexible band, and rigid ring as tricuspid annuloplasty (TAP) in patients with TR. METHODS Medline and EMBASE were searched through February 15, 2020 to identify randomized controlled trials and observational trials that investigated early and late outcomes after TAP for TR. The outcomes of interest were perioperative mortality, all-cause mortality, and TR recurrence with more than 1-year follow-up. TR recurrence was defined as at least moderate (TR grade 2) on serial echocardiograms. RESULTS Two randomized controlled trials and 15 observational trials were identified, including 6138 patients who underwent TAP. The median follow-up period was 1 to 7.4 years. There were no significant differences of perioperative and all-cause mortality among 3 TAP methods. Rigid ring TAP was associated with a significant reduction in TR recurrence compared with suture TAP (hazard ratio, 0.42; 95% confidence interval, 0.23 to 0.78; P = .005). There were no significant differences in TR recurrence were observed between flexible band and suture TAP or flexible band and rigid ring TAP. CONCLUSIONS This network meta-analysis demonstrated significant reduction in TR recurrence for rigid ring TAP compared with suture TAP, although no significant differences were observed between suture and flexible band TAP or between flexible band and rigid ring TAP. There were no significant mortality differences among suture, flexible band, and rigid ring TAP procedures.
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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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Nosair A, Elkahely M, Nasr S, Alkady H. Tricuspid three-dimensional ring versus fashioned flexible band annuloplasty in management of functional tricuspid valve regurge: comparative long term study. THE CARDIOTHORACIC SURGEON 2020. [DOI: 10.1186/s43057-020-00023-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Functional tricuspid valve regurgitation due to left sided valve lesions remains a common finding. Nowadays, different types of three-dimensional rings and flexible bands are considered to be the gold standard techniques for repair of such functional regurgitation. Our study aimed for long-term comparison of the durability and effectiveness of those techniques.
Results
The data of 170 adult patients with moderate or more functional tricuspid regurgitation secondary to mitral stenosis or regurgitation receiving tricuspid valve repair using either rigid 3D rings (contour 3D or MC3 ring) or prosthetic fashioned bands (Dacron or PTFE) and mitral valve surgery between March 2013 and September 2018 were collected and analysed. Patients were classified in two matched groups: ring group (group A) consisting of 90 cases and band group (group B) consisting of 80 cases. follow-up period ranged from 55.2 to 78 months (mean 67.2 ± 10.8), during this period New York heart association for dyspnea functional class evaluation and full echocardiographic assessment were done and was scheduled as following: before hospital discharge, after 6 months of surgery and finally, every 2 years. In-hospital mortality was 1(1.1%) and 2 (2.5%) with p value 0.49 after ring or band annuloplasty, respectively. No significant differences in both groups regarding hospital mortality and morbidities. There was statistically significant decrease in NYHA class, degree of TR, and PASP within the 2 groups postoperatively with p value of 0.03, 0.04, and 0.033, respectively, with no statistically significant difference between both groups (p value > 0.05). There was statistically significant difference in the freedom from recurrent TR and need for reoperation during the follow-up period between both groups with lower recurrence and reoperation rates in group A, (p value 0.03 and 0.001, respectively).
Conclusion
Tricuspid valve repair with different annuloplasty rigid three dimensional rings or fashioned flexible bands for functional tricuspid regurgitation offers good long-term outcome. Yet, the rigid rings maintain their benefits on the rate of recurrent TR and the need for reoperation.
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Gao Y, Li S, Zhuang X, Gao F, Shi L, Meng X. Comparison of Mitral Valve Repair versus Replacement for the Progression of Functional Tricuspid Regurgitation. Ann Thorac Cardiovasc Surg 2020; 26:72-78. [PMID: 31495812 PMCID: PMC7184033 DOI: 10.5761/atcs.oa.19-00132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Function tricuspid regurgitation (TR) is frequently observed in patients undergoing mitral valve surgery. It is unclear that mitral valve repair (MVr) or mitral valve replacement (MVR) has influence on the likelihood of late TR progression. Methods: This study included 193 patients with degenerative mitral valve disease who underwent either MVr or MVR. Detailed preoperative materials, follow-up information, and echocardiographic data were collected and statistically analyzed. Results: At 6 and 12 months postoperatively, MVR patients were more likely to have New York Heart Association (NYHA) class III or IV symptoms than MVr patients (6 mo: 15.2% vs 5.0%, 12 mo: 13.0% vs 4.0%, both P <0.05). At 24 months, the incidence of Grade 1+ TR was significantly higher in MVR patients than MVr patients (25.0% vs 12.9%, P <0.05). In univariate analysis, age (odds ratio [OR] = 1.036, P = 0.036), MVR (OR = 2.256, P = 0.033), and preoperative TR area (TRA; OR = 1.541, P = 0.047) were significant predictors for TR progression. In multivariate logistics analysis, only MVR was independently risk factor (P = 0.006). Subsequently, patients were divided into tricuspid valve repair (TVr) group and untreated group. In both subgroups, MVR patients were associated with significantly larger TRA (P <0.01). Conclusion: MVR was an independent risk factor for TR progression, whether tricuspid valve was treated or not.
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Affiliation(s)
- Yang Gao
- Department of Cardiology Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shubin Li
- Department of Cardiology Surgery, Xinxiang Central Hospital, Xinxiang, China
| | - Xijing Zhuang
- Department of Cardiology Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Feng Gao
- Department of Cardiology Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Lei Shi
- Department of Cardiology Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Xu Meng
- Department of Cardiology Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Sohn SH, Kim KH, Lee Y, Choi JW, Hwang HY. Long-term outcomes of rigid ring versus De Vega annuloplasty for functional tricuspid regurgitation: A propensity score-matching analysis. J Thorac Cardiovasc Surg 2020; 161:1788-1798.e5. [PMID: 31948739 DOI: 10.1016/j.jtcvs.2019.11.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study was conducted to compare the outcomes of rigid ring versus De Vega annuloplasty for the treatment of functional tricuspid regurgitation (TR). METHODS From 2003 to 2017, De Vega annuloplasty (group D) was used in 231 patients, and rigid ring annuloplasty (group R) was used in 204 patients for the treatment of functional TR during left-sided valve surgery. A propensity score-matching analysis was used to pair group D (n = 109) with group R (n = 109). The primary outcomes were long-term overall survival and cardiac death, and the secondary outcomes were tricuspid valve-related events and TR recurrence (TR moderate or severe). The follow-up data were complete in 99.6% (447 out of 449) of the patients with a follow-up duration of 102 months. RESULTS There were no differences in the overall survival and cardiac death between the propensity score-matched groups (P = .793 and P = .175, respectively) up to 14 years after surgery. Tricuspid valve-related events, including cardiac death, permanent pacemaker implantation, thromboembolism, bleeding and tricuspid valve reoperation were also similar between the 2 matched groups during the follow-up (P > .999). However, cumulative incidence of TR recurrence was significantly higher in group R than in group D (P = .007). Multivariate analysis indicated the annuloplasty method (De Vega) and preoperative TR grade as risk factors for late TR recurrence. CONCLUSIONS In functional TR, annuloplasty methods did not influence long-term overall survival, cardiac mortality, and tricuspid valve-related events. However, rigid ring annuloplasty showed less late TR recurrence. Rigid ring annuloplasty can be considered for the treatment of functional TR in terms of its better durability.
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Affiliation(s)
- Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Yeiwon Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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Zhong Y, Bai W, Wang H, Tang H, Rao L. Functional tricuspid regurgitation in rheumatic mitral valve disease patients with and without tricuspid annuloplasty: a three-dimensional echocardiography study with one year follow up. Int J Cardiovasc Imaging 2019; 36:257-268. [DOI: 10.1007/s10554-019-01705-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022]
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Maslow A, Abisse S, Parikh L, Apruzzese P, Cilia L, Gleason P, Singh A, Poppas A. Echocardiographic Predictors of Tricuspid Ring Annuloplasty Repair Failure for Functional Tricuspid Regurgitation. J Cardiothorac Vasc Anesth 2019; 33:2624-2633. [DOI: 10.1053/j.jvca.2019.05.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/25/2019] [Accepted: 05/27/2019] [Indexed: 01/20/2023]
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Chang CC, Veen KM, Hahn RT, Bogers AJJC, Latib A, Oei FBS, Abdelghani M, Modolo R, Ho SY, Abdel-Wahab M, Fattouch K, Bosmans J, Caliskan K, Taramasso M, Serruys PW, Bax JJ, van Mieghem NMDA, Takkenberg JJM, Lurz P, Modine T, Soliman O. Uncertainties and challenges in surgical and transcatheter tricuspid valve therapy: a state-of-the-art expert review. Eur Heart J 2019; 41:1932-1940. [DOI: 10.1093/eurheartj/ehz614] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/04/2019] [Accepted: 08/09/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Tricuspid regurgitation (TR) is a frequent and complex problem, commonly combined with left-sided heart disease, such as mitral regurgitation. Significant TR is associated with increased mortality if left untreated or recurrent after therapy. Tricuspid regurgitation was historically often disregarded and remained undertreated. Surgery is currently the only Class I Guideline recommended therapy for TR, in the form of annuloplasty, leaflet repair, or valve replacement. As growing experience of transcatheter therapy in structural heart disease, many dedicated transcatheter tricuspid repair or replacement devices, which mimic well-established surgical techniques, are currently under development. Nevertheless, many aspects of TR are little understood, including the disease process, surgical or interventional risk stratification, and predictors of successful therapy. The optimal treatment timing and the choice of proper surgical or interventional technique for significant TR remain to be elucidated. In this context, we aim to highlight the current evidence, underline major controversial issues in this field and present a future roadmap for TR therapy.
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Affiliation(s)
- Chun Chin Chang
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Kevin M Veen
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Rebecca T Hahn
- Structural Heart & Valve Center, New York Presbyterian Hospital, Columbia University Medical Center,161 Fort Washington Avenue, New York, NY 10032, USA
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, 3400 Bainbridge Ave, The Bronx, New York, NY, USA
| | - Frans B S Oei
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Mohammad Abdelghani
- Heart Center, Segeberger Kliniken, Am Kurpark 1, 23795, Bad Segeberg, Germany
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Rodrigo Modolo
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Cardiology Division, Department of Internal Medicine, University of Campinas (UNICAMP), Campinas- SP, 13083-970, Brazil
| | - Siew Yen Ho
- Brompton Cardiac Morphology Unit, Royal Brompton Hospital, Imperial College London, London, SW7 2AZ UK
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig, University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Viale Regione Siciliana 1571, 90100 Palermo, Italy
- GVM Care and Research, Maria Cecilia Hospital, Via Madonna di Genova, 1, 48033, Cotignola, Italy
| | - Johan Bosmans
- Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Kadir Caliskan
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Patrick W Serruys
- National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, Chelsea, London SW3 6LY, UK
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Nicolas M D A van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Philip Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Thomas Modine
- Department of Cardiovascular Surgery, Hopital Cardiologique CHRU de Lille, 2 Avenue Oscar Lambret, 59000 Lille, France
| | - Osama Soliman
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
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14
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Choi JW, Kim KH, Chang HW, Jang MJ, Kim SH, Yeom SY, Hwang HY. Long-term results of annuloplasty in trivial-to-mild functional tricuspid regurgitation during mitral valve replacement: should we perform annuloplasty on the tricuspid valve or leave it alone? Eur J Cardiothorac Surg 2019; 53:756-763. [PMID: 29177448 DOI: 10.1093/ejcts/ezx395] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/23/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The benefits of concomitant tricuspid annuloplasty (TAP) for non-significant functional tricuspid regurgitation (TR) during mitral valve replacement (MVR) are controversial. We evaluated the long-term outcomes-particularly the long-term tricuspid valve (TV) functional outcomes-of MVR with or without tricuspid ring annuloplasty. METHODS From 2004 to 2014, 256 patients (56.4 ± 12.1 years) with trivial or mild functional TR who underwent MVR were enrolled. Eighty-two patients underwent concomitant tricuspid ring annuloplasty (TAP group), and 174 patients did not undergo the TV procedure (nTAP group). Propensity score-matched analysis was performed (n = 72 in each group). The follow-up duration was 77.4 ± 42.4 months. RESULTS The early clinical outcomes were similar between the 2 groups before and after propensity score matching with an early mortality rate of 3.5% (9 of 256). No patients experienced ring-related complications during follow-up. Eleven (6.3%) patients developed significant TR (≥moderate) in the nTAP group, while no patients developed significant TR in the TAP group. There were no significant differences in overall survival between the 2 groups before or after matching. However, propensity score-matched analysis revealed that the freedom from significant TR aggravation and freedom from TV-related event rates were significantly higher in the TAP group than in the nTAP group (P = 0.047 and P = 0.043, respectively). CONCLUSIONS Patients with untreated trivial or mild functional TR accompanied by mitral valve disease can develop significant TR during follow-up. TV ring annuloplasty can be performed without complications and can be beneficial for patients with trivial or mild functional TR who are undergoing MVR.
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Affiliation(s)
- Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyoung Woo Chang
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea
| | - Myoung-Jin Jang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sue Hyun Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Yoon Yeom
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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15
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Hata H, Fujita T, Miura S, Shimahara Y, Kume Y, Matsumoto Y, Yamashita K, Kobayashi J. Long-Term Outcomes of Suture vs. Ring Tricuspid Annuloplasty for Functional Tricuspid Regurgitation. Circ J 2017; 81:1432-1438. [DOI: 10.1253/circj.cj-17-0108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroki Hata
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Sayaka Miura
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Yusuke Shimahara
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Yuta Kume
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Yorihiko Matsumoto
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kizuku Yamashita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
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16
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Wang H, Liu X, Wang X, Lv Z, Liu X, Xu P. Comparison of outcomes of tricuspid annuloplasty with 3D-rigid versus flexible prosthetic ring for functional tricuspid regurgitation secondary to rheumatic mitral valve disease. J Thorac Dis 2016; 8:3087-3095. [PMID: 28066587 DOI: 10.21037/jtd.2016.11.97] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Annuloplasty bands and rings are widely used for repairing functional tricuspid regurgitation (FTR). However, the question regarding which is the ideal annuloplasty device remains unclear. The aim of this study was to compare the efficacy and mid-term durability of tricuspid ring annuloplasty for FTR secondary to rheumatic mitral valve disease using flexible Cosgrove-Edwards band and the rigid Edwards MC3 ring (Edwards Lifesciences, LLC, Irvine, CA, USA). METHODS We retrospectively collected the clinical data of those who underwent mitral valve replacement (MVR) in concomitant with tricuspid ring annuloplasty from 2009 to 2013. The flexible band was used in 46 patients (flexible group), and the 3D rigid ring was used in 60 patients (rigid group). Echocardiographic evaluation of tricuspid function was performed preoperatively and postoperatively. RESULTS The grade of TR was significantly improved compared to preoperative values in two groups. There was no significant difference regarding postoperative TR grade between the two groups at 1 week and 2-3 months but there was statistical significant difference at postoperative 6-12 months, and 2-3 years. During the follow up period, 25 of 46 patients (54.3%) in flexible group and 22 of 60 patients (30.3%) in rigid group developed recurrent TR. Freedom from recurrent TR in flexible group is significant lower than rigid group in each postoperative follow up period. CONCLUSIONS These findings suggest that 3D rigid ring annuloplasty might be more effective for tricuspid ring annuloplasty in FTR in mid-term postoperative periods when compared to flexible band.
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Affiliation(s)
- Haiping Wang
- Department of Cardiovascular Surgery, Qingdao University, Affiliated Hospital of Qingdao University, Qingdao 266000, China;; Department of Cardiovascular Surgery, Qingdao Fuwai Cardiovascular disease Hospital, Qingdao 266034, China
| | - Xiancheng Liu
- Department of Cardiovascular Surgery, Qingdao Fuwai Cardiovascular disease Hospital, Qingdao 266034, China
| | - Xin Wang
- Department of Cardiovascular Surgery, Qingdao Fuwai Cardiovascular disease Hospital, Qingdao 266034, China
| | - Zhenqian Lv
- Department of Cardiovascular Surgery, Qingdao Fuwai Cardiovascular disease Hospital, Qingdao 266034, China
| | - Xiaojun Liu
- Department of Cardiovascular Surgery, Qingdao Fuwai Cardiovascular disease Hospital, Qingdao 266034, China
| | - Ping Xu
- Department of Cardiovascular Surgery, Qingdao University, Affiliated Hospital of Qingdao University, Qingdao 266000, China
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17
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Trikuspidalklappenchirurgie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2016. [DOI: 10.1007/s00398-016-0102-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Tricuspid Annuloplasty for Tricuspid Regurgitation Secondary to Left-Sided Heart Valve Disease: Immediate Outcomes and Risk Factors for Late Failure. Can J Cardiol 2015; 32:760-6. [PMID: 26777269 DOI: 10.1016/j.cjca.2015.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/11/2015] [Accepted: 09/12/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Tricuspid valve annuloplasty is the treatment of choice for tricuspid regurgitation (TR) secondary to left-sided heart valve disease (functional TR). METHODS Between 1999 and 2014, 527 consecutive patients (mean age, 69.6 ± 9.5 years) with grade ≥ 1+ functional TR (graded from 0-3+) underwent tricuspid annuloplasty in addition to left-sided heart valve operations at the authors' institution. The operative risk (by the European System for Cardiac Operative Risk Evaluation II [EuroSCORE II]) was 10.4% ± 12.2%. Clinical data and echocardiographic studies were reviewed retrospectively during a mean follow-up of 5.2 ± 3.5 years. Risk factors for late repair failure were identified by multivariable analysis. RESULTS Either suture (De Vega) or device annuloplasty was used in 14.8% and 85.2% of patients, respectively. Concomitant mitral or aortic valve surgery was performed in 92.6% and 35.9% of cases, respectively. There were 48 (9.1%) hospital deaths. The 10-year nonparametric estimates of freedom from all-cause death, cardiac and cerebrovascular deaths, and grade ≥ 2+ TR were 51.2% (95% confidence interval [CI], 47.8%-54.6%) 69.9% (95% CI, 67%-72.8%), and 77.8% (95% CI, 74.2%-81.4%), respectively. A left ventricular ejection fraction < 50% (P = 0.027), tricuspid annular diameter > 40 mm (P = 0.001), and use of De Vega annuloplasty (P = 0.019) were predictors of grade ≥ 2+ TR during the follow-up period. There was a strong link between grade ≥ 2+ TR and new left-sided valvular lesions (odds ratio, 5.3; P < 0.0001), primarily mitral regurgitation. CONCLUSIONS After device annuloplasty and in the absence of preoperative left ventricular dysfunction and severe tricuspid annular dilatation, functional TR is generally controlled within grade 1+ during the follow-up period. Recurrent TR is associated with new left-sided valvular lesions.
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19
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Starck CT, Kempfert J, Falk V. Tricuspid valve interventions: surgical techniques and outcomes. EUROINTERVENTION 2015; 11 Suppl W:W128-32. [DOI: 10.4244/eijv11swa36] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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