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Wang P, Huang Y, Sun L, Han Z. Surgical Treatment Strategy of Functional Tricuspid Regurgitation. Rev Cardiovasc Med 2024; 25:182. [PMID: 39076485 PMCID: PMC11267193 DOI: 10.31083/j.rcm2505182] [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: 07/29/2023] [Revised: 01/01/2024] [Accepted: 01/04/2024] [Indexed: 07/31/2024] Open
Abstract
Functional tricuspid regurgitation (FTR) is a common type of tricuspid regurgitation (TR), particularly in cases of left heart valve disease. Historically, cardiac surgeons have not placed much emphasis on FTR and instead focused primarily on managing left heart valve disease. However, as research has progressed, it has become evident that severe TR significantly impacts the prognosis of heart valve surgery. Furthermore, significant improvements in postoperative cardiac function and quality of life have been observed when addressing the tricuspid valve alongside left heart disease management. This article aims to review current approaches for and timing of the surgical management of FTR while also analyzing the limitations of existing tricuspid surgical strategies.
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Affiliation(s)
- Peihe Wang
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, 518000 Shenzhen, Guangdong, China
- Shenzhen Clinical Institute of Shantou University Medical College, 518000 Shenzhen, Guangdong, China
| | - Yu Huang
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, 518000 Shenzhen, Guangdong, China
| | - Lu Sun
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, 518000 Shenzhen, Guangdong, China
| | - Zhen Han
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, 518000 Shenzhen, Guangdong, China
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Santobuono VE, Basile P, Gentile M, Logiacco A, Amati F, Carella MC, Memeo R, Cillis ED, Bortone AS, Forleo C, Ciccone MM, Guaricci AI. Bifocal coronary sinus pacing and transcatheter tricuspid valve-in-valve implantation: an innovative combined approach. Future Cardiol 2024; 20:281-286. [PMID: 38975696 PMCID: PMC11318699 DOI: 10.1080/14796678.2024.2366095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/06/2024] [Indexed: 07/09/2024] Open
Abstract
One of the most common complications of tricuspid valve replacement is atrioventricular block (AVB), often requiring permanent pacing. The endocardial pacemaker lead, placed in the right ventricle, may sometimes interfere with the implanted prosthesis, causing its early dysfunction and the need for alternative sites of pacing. To the best of our knowledge, we present the first case of a successful combined percutaneous procedure consisting of the implantation of two leads in the coronary sinus for univentricular bifocal pacing and a transcatheter tricuspid valve-in-valve implantation in a young patient with severe dysfunction of the tricuspid bioprosthesis, requiring permanent pacing for a postsurgical complete atrioventricular block.
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Affiliation(s)
- Vincenzo Ezio Santobuono
- University Cardiology Unit, Interdisciplinary Department of Medicine, “Aldo Moro” University School of Medicine, Polyclinic University Hospital, Piazza Giulio Cesare 11, Bari70124, Italy
| | - Paolo Basile
- University Cardiology Unit, Interdisciplinary Department of Medicine, “Aldo Moro” University School of Medicine, Polyclinic University Hospital, Piazza Giulio Cesare 11, Bari70124, Italy
| | - Marco Gentile
- University Cardiology Unit, Interdisciplinary Department of Medicine, “Aldo Moro” University School of Medicine, Polyclinic University Hospital, Piazza Giulio Cesare 11, Bari70124, Italy
| | - Annalisa Logiacco
- University Cardiology Unit, Interdisciplinary Department of Medicine, “Aldo Moro” University School of Medicine, Polyclinic University Hospital, Piazza Giulio Cesare 11, Bari70124, Italy
| | - Francesca Amati
- University Cardiology Unit, Interdisciplinary Department of Medicine, “Aldo Moro” University School of Medicine, Polyclinic University Hospital, Piazza Giulio Cesare 11, Bari70124, Italy
| | - Maria Cristina Carella
- University Cardiology Unit, Interdisciplinary Department of Medicine, “Aldo Moro” University School of Medicine, Polyclinic University Hospital, Piazza Giulio Cesare 11, Bari70124, Italy
| | - Riccardo Memeo
- University Cardiology Unit, Interdisciplinary Department of Medicine, “Aldo Moro” University School of Medicine, Polyclinic University Hospital, Piazza Giulio Cesare 11, Bari70124, Italy
| | - Emanuela De Cillis
- Division of University Heart Surgery, Cardiothoracic Department, Polyclinic University Hospital, Piazza Giulio Cesare 11, Bari70124, Italy
| | - Alessandro Santo Bortone
- University Cardiology Unit, Interdisciplinary Department of Medicine, “Aldo Moro” University School of Medicine, Polyclinic University Hospital, Piazza Giulio Cesare 11, Bari70124, Italy
| | - Cinzia Forleo
- University Cardiology Unit, Interdisciplinary Department of Medicine, “Aldo Moro” University School of Medicine, Polyclinic University Hospital, Piazza Giulio Cesare 11, Bari70124, Italy
| | - Marco Matteo Ciccone
- University Cardiology Unit, Interdisciplinary Department of Medicine, “Aldo Moro” University School of Medicine, Polyclinic University Hospital, Piazza Giulio Cesare 11, Bari70124, Italy
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, “Aldo Moro” University School of Medicine, Polyclinic University Hospital, Piazza Giulio Cesare 11, Bari70124, Italy
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Salama AA, Abozied OA, Anderson JH, Miranda WR, Connolly HM, Jain C, Cabalka A, Egbe AC. Cardiac Reverse Remodeling and Changes in Heart Failure Indices After Transcatheter Tricuspid Valve Replacement in Adults With Congenital Heart Disease. Circ Cardiovasc Interv 2024; 17:e013334. [PMID: 37942627 PMCID: PMC10841471 DOI: 10.1161/circinterventions.123.013334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/11/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND There are limited data about changes in cardiac function (cardiac reverse remodeling) and heart failure indices after transcatheter tricuspid valve-in-valve replacement (TT-VIVR). The purpose of this study was to evaluate cardiac reverse remodeling and temporal changes in heart failure indices after TT-VIVR in adults with congenital heart disease. METHODS Retrospective cohort study of adults with congenital heart disease that underwent TT-VIVR and had >6 months of follow-up (January 1, 2011, to April 30, 2023). Echocardiographic indices of cardiac remodeling and heart failure indices (New York Heart Association class, NT-proBNP (N-terminal pro-brain natriuretic peptide), glomerular filtration rate, and model for end-stage liver disease excluding international normalized ratio score) were assessed preintervention and at 1-, 3-, and 5-year postintervention. RESULTS Of 39 patients (age 39 [32-46] years), 14 (36%) and 25 (64%) received Melody valve and Sapien valve prosthesis, respectively. At 1-year post-TT-VIVR, there was a temporal improvement in right atrial reservoir strain (17±8% versus 22±8%, P<0.001), right atrial volume (81 [59-108] versus 63 [48-82] mL/m2, P<0.001), right atrial pressure (12±4% versus 6±4%, P<0.001), and right ventricular global longitudinal strain (-15±7% versus -20±7%, P<0.001). Similarly, there was a temporal improvement in NT-proBNP, glomerular filtration rate, model for end-stage liver disease excluding international normalized ratio score, and New York Heart Association class. The temporal improvements in heart failure indices and valve function were maintained at 3- and 5-year post-TT-VIVR. CONCLUSIONS Considering the significant mortality risk associated with reoperations for tricuspid valve replacement, these data suggest favorable outcomes after TT-VIVR, and support TT-VIVR as a viable alternative to surgical tricuspid valve replacement, especially in high-risk patients.
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Affiliation(s)
- Abdalla A Salama
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN (A.A.S., O.A.A., J.H.A., W.R.M., H.M.C., C.J., A.C., A.C.E.)
- Department of Cardiovascular Diseases, Suez Canal University, Ismailia, Egypt (A.A.S.)
| | - Omar A Abozied
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN (A.A.S., O.A.A., J.H.A., W.R.M., H.M.C., C.J., A.C., A.C.E.)
| | - Jason H Anderson
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN (A.A.S., O.A.A., J.H.A., W.R.M., H.M.C., C.J., A.C., A.C.E.)
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN (A.A.S., O.A.A., J.H.A., W.R.M., H.M.C., C.J., A.C., A.C.E.)
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN (A.A.S., O.A.A., J.H.A., W.R.M., H.M.C., C.J., A.C., A.C.E.)
| | - Charles Jain
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN (A.A.S., O.A.A., J.H.A., W.R.M., H.M.C., C.J., A.C., A.C.E.)
| | - Allison Cabalka
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN (A.A.S., O.A.A., J.H.A., W.R.M., H.M.C., C.J., A.C., A.C.E.)
| | - Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN (A.A.S., O.A.A., J.H.A., W.R.M., H.M.C., C.J., A.C., A.C.E.)
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Chen J, Yang Y, Song W, Feng D, Yan Y, Wang C, Wei L. Transcatheter tricuspid valve-in-valve implantation for degenerated surgical bioprosthesis. Catheter Cardiovasc Interv 2023; 101:442-448. [PMID: 36617381 DOI: 10.1002/ccd.30554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/23/2022] [Accepted: 12/25/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Isolated redo surgery for degenerated tricuspid bioprosthesis is of very high risk. We aimed to evaluate the safety and efficacy of transcatheter valve-in-valve (TVIV) implantation using a novel balloon expandable Renato valve. METHODS A prospective multicenter study was conducted to enroll patients with degenerated tricuspid bioprostheses. A total of 12 patients underwent TVIV implantation using the Renato valve system via transfemoral, transjugular, or transatrial approaches at three institutions from May 2021 to October 2021. All-cause mortality and hemodynamic performance were evaluated up to 6 months after procedure. RESULTS The median age was 68.2 years, and 75.0% were female. Six patients had a history of rheumatic left-sided valve surgery and late tricuspid valve replacement. The median preoperative Society of Thoracic Surgeons score was 9.9%. The procedures were successful in all cases. Tricuspid regurgitation and paravalvular leak were none or mild in all patients. The median transvalvular gradient decreased from 7.8 mmHg preoperatively to 4.5 mmHg at 6 months after TVIV, respectively. No death occurred and all patients recovered to New York Heart Association functional class I or II during a 6-month follow-up. CONCLUSIONS TVIV implantation with the Renato valve was a safe and effective treatment for degenerated bioprostheses in high-risk patients.
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Affiliation(s)
- Jinmiao Chen
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ye Yang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenyu Song
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Deguang Feng
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yang Yan
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China
| | - Chunsheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lai Wei
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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