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Ning X, Xu H, Cao J, Li N, Wang W, Qiao F, Han L, Lu F, Xu Z. Transcatheter tricuspid valve interventions: Current devices and clinical evidence. J Cardiol 2024; 84:73-79. [PMID: 38583664 DOI: 10.1016/j.jjcc.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
The tricuspid valve is known as "the forgotten valve". Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease. TR is often late in the course of the disease when it becomes symptomatic, often being a marker of late-stage chronic heart failure with a poor prognosis and high mortality rate at long-term follow-up. Despite the clear correlation between TR and mortality, most TR patients are under-treated. Neither pharmacologic nor surgical treatment demonstrates a significant survival benefit. Isolated tricuspid valve surgery has the highest mortality rate of all valve surgeries. Therefore, there is an urgent clinical need for minimally invasive therapies to meet the needs of patients with TR. In recent years, a variety of transcatheter tricuspid valve interventions representing less invasive alternatives to surgery have shown promising results, which bring hope to patients with severe TR. The purpose of this review is to provide a complete and updated overview on current transcatheter tricuspid valve interventions and clinical evidence.
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Affiliation(s)
- Xiaoping Ning
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Hongjie Xu
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Jingyi Cao
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Ning Li
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Wei Wang
- Department of Cardiovascular Surgery, The First People's Hospital of Shanghai Transportation University, Shanghai, China
| | - Fan Qiao
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Lin Han
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Fanglin Lu
- Department of Cardiovascular Surgery, The First People's Hospital of Shanghai Transportation University, Shanghai, China.
| | - Zhiyun Xu
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China.
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Welle GA, Hahn RT, Lindenfeld J, Lin G, Nkomo VT, Hausleiter J, Lurz PC, Pislaru SV, Davidson CJ, Eleid MF. New Approaches to Assessment and Management of Tricuspid Regurgitation Before Intervention. JACC Cardiovasc Interv 2024; 17:837-858. [PMID: 38599687 DOI: 10.1016/j.jcin.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/22/2024] [Accepted: 02/13/2024] [Indexed: 04/12/2024]
Abstract
Severe tricuspid regurgitation (TR) is a progressive condition associated with substantial morbidity, poor quality of life, and increased mortality. Patients with TR commonly have coexisting conditions including congestive heart failure, pulmonary hypertension, chronic lung disease, atrial fibrillation, and cardiovascular implantable electronic devices, which can increase the complexity of medical and surgical TR management. As such, the optimal timing of referral for isolated tricuspid valve (TV) intervention is undefined, and TV surgery has been associated with elevated risk of morbidity and mortality. More recently, an unprecedented growth in TR treatment options, namely the development of a wide range of transcatheter TV interventions (TTVI) is stimulating increased interest and referral for TV intervention across the entire medical community. However, there are no stepwise algorithms for the optimal management of symptomatic severe TR before TTVI. This article reviews the contemporary assessment and management of TR with addition of a medical framework to optimize TR before referral for TTVI.
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Affiliation(s)
- Garrett A Welle
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. https://twitter.com/GarrettWelleMD
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA. https://twitter.com/hahn_rt
| | - Joann Lindenfeld
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Charles J Davidson
- Division of Cardiology, Northwestern University Medical Center, Chicago, Illinois, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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3
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Hagemeyer D, Merdad A, Sierra LV, Ruberti A, Kargoli F, Bouchat M, Boiago M, Moschovitis A, Deva DP, Stolz L, Ong G, Peterson MD, Piazza N, Taramasso M, Dumonteil N, Modine T, Latib A, Praz F, Hausleiter J, Fam NP. Clinical Characteristics and Outcomes of Patients Screened for Transcatheter Tricuspid Valve Replacement: The TriACT Registry. JACC Cardiovasc Interv 2024; 17:552-560. [PMID: 38418058 DOI: 10.1016/j.jcin.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND Transcatheter tricuspid valve replacement (TTVR) abolishes tricuspid regurgitation (TR) and has emerged as a definitive treatment for TR. OBJECTIVES The purpose of this multicenter, observational study was to determine the clinical characteristics and short-term outcomes of patients with TR screened for TTVR. METHODS Patients underwent TTVR screening at 7 centers on a compassionate-use basis. The primary endpoints were NYHA functional class and TR grade at 30-day follow-up. Secondary endpoints included all-cause mortality, heart failure hospitalization, technical success, and reasons for TTVR screening failure. RESULTS A total of 149 patients (median age 79 years [Q1-Q3: 72-84 years], 54% women) underwent TTVR screening. The TTVR screening failure rate was 74%, mainly related to large tricuspid annular diameter. Patients undergoing TTVR (n = 38) had significant functional improvements (NYHA functional class I or II from 21% to 68%; P < 0.001), with TR ≤1+ in 97% at 30-day follow-up (P < 0.001 from baseline). Technical success was achieved in 91%, with no intraprocedural mortality or conversion to surgery. At 30-day follow-up, mortality was 8%, heart failure hospitalization 5%, major bleeding 18%, and reintervention 9%. Patients who failed screening for TTVR and subsequently underwent "bailout" transcatheter edge-to-edge repair (n = 26) had favorable outcomes (NYHA functional class I or II from 27% to 58%; P < 0.001), with TR ≤1+ in 43% at 30-day follow-up (P < 0.001 from baseline). CONCLUSIONS This first real-world report of TTVR screening demonstrated a high screening failure rate, mainly related to large tricuspid annular diameter. Patients undergoing TTVR had superior TR reduction and symptom alleviation compared with bailout tricuspid transcatheter edge-to-edge repair, at the cost of greater procedural complications.
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Affiliation(s)
- Daniel Hagemeyer
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anas Merdad
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Laura Villegas Sierra
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Andrea Ruberti
- Division of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Faraj Kargoli
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Marine Bouchat
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France
| | - Mauro Boiago
- Groupe Cardio-Vasculaire lnterventionnel, Cinique Pasteur, Toulouse, France
| | | | - Djeven P Deva
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Geraldine Ong
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mark D Peterson
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nicolo Piazza
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Nicolas Dumonteil
- Groupe Cardio-Vasculaire lnterventionnel, Cinique Pasteur, Toulouse, France
| | - Thomas Modine
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Fabien Praz
- Division of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Neil P Fam
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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Sala A, Hahn RT, Kodali SK, Mack MJ, Maisano F. Tricuspid Valve Regurgitation: Current Understanding and Novel Treatment Options. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101041. [PMID: 39132395 PMCID: PMC11307688 DOI: 10.1016/j.jscai.2023.101041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/08/2023] [Accepted: 05/03/2023] [Indexed: 08/13/2024]
Abstract
Managing patients with severe symptomatic tricuspid regurgitation (TR) remains extremely challenging, with a lack of consensus on when and how to treat it. Tricuspid valve pathology has been disregarded for a very long time because of the established belief that treating left-sided heart diseases would lead to the resolution or significant improvement of TR. Initially considered benign, severe TR has been found to be a strong predictor of prognosis. Despite the increasing prevalence and the disabling nature of this disease, the great majority of patients with clinically significant TR have seldom been considered for structural interventions. Numerous surgical and transcatheter treatment options are now available; however, optimal timing and procedural selection remain crucial aspects influencing outcomes. According to recent evidence in the literature, early referral is associated with good short and long-term outcomes, and various predictors of favorable outcomes following either surgical or transcatheter treatment have been identified. Evaluation by a multidisciplinary heart team with expertise in tricuspid valve disease is of paramount importance to identify adequate treatment for every patient.
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Affiliation(s)
- Alessandra Sala
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Rebecca T. Hahn
- Department of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Susheel K. Kodali
- Department of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Michael J. Mack
- Department of Cardiac Surgery, Baylor Scott & White Health, Plano, Texas
| | - Francesco Maisano
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
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Caneiro-Queija B, Estévez-Loureiro R, Piñón-Esteban M, Barreiro-Pérez M, Baz-Alonso JA, Íñiguez-Romo A. Transfemoral transcatheter tricuspid valve replacement with the Cardiovalve system. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:270-272. [PMID: 36228959 DOI: 10.1016/j.rec.2022.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/19/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Berenice Caneiro-Queija
- Departamento de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | | | - Miguel Piñón-Esteban
- Departamento de Cirugía Cardiaca, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Manuel Barreiro-Pérez
- Departamento de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - José A Baz-Alonso
- Departamento de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Andrés Íñiguez-Romo
- Departamento de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
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6
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Transcatheter Tricuspid Valve Replacement: Illustrative Case Reports and Review of State-of-Art. J Clin Med 2023; 12:jcm12041371. [PMID: 36835907 PMCID: PMC9967402 DOI: 10.3390/jcm12041371] [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: 01/27/2023] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Tricuspid regurgitation (TR) is one of the most common heart valve diseases, associated a with poor prognosis since significant TR is associated with an increased mortality risk compared to no TR or mild regurgitation. Surgery is the standard treatment for TR, although it is associated with high morbidity, mortality, and prolonged hospitalization, particularly in tricuspid reoperation after left-sided surgery. Thus, several innovative percutaneous transcatheter approaches for repair and replacement of the tricuspid valve have gathered significant momentum and have undergone extensive clinical development in recent years, with favorable clinical outcomes in terms of mortality and rehospitalization during the first year of follow-up. We present three clinical cases of transcatheter tricuspid valve replacement in an orthotopic position with two different innovative systems along with a review of the state-of-the-art of this emergent topic.
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7
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Barker CM, Goel K. Transcatheter Tricuspid Interventions: Past, Present, and Future. Methodist Debakey Cardiovasc J 2023; 19:57-66. [PMID: 37213880 PMCID: PMC10198234 DOI: 10.14797/mdcvj.1250] [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: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/23/2023] Open
Abstract
Tricuspid regurgitation (TR) etiologies include primary valve pathology or secondary (functional) regurgitation from increased hemodynamic pressure or volume on the right side of the heart. Patients with severe TR have a worse prognosis independent of all other variables. Surgical treatment for TR has mostly been limited to patients undergoing concomitant left-sided cardiac surgery. The results and durability of surgical repair or replacement are not well defined. For patients with significant and symptomatic TR, transcatheter techniques would be beneficial, but these techniques and devices have been slow to develop. Much of the delay is a result of neglect and challenges in defining the symptoms associated with TR. In addition, the anatomic and physiological aspects of the tricuspid valve apparatus present unique challenges. Several devices and techniques are in various phases of clinical investigation. This review highlights the current landscape of transcatheter tricuspid interventions and future opportunities. It is imminent that these therapies become commercially available and widely adopted to have a significant positive impact on millions of patients that have been neglected.
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Affiliation(s)
- Colin M. Barker
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, US
| | - Kashish Goel
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, US
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8
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Transcatheter tricuspid valve intervention: to repair or to replace? Curr Opin Cardiol 2022; 37:495-501. [PMID: 36094538 DOI: 10.1097/hco.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The burden of tricuspid regurgitation (TR) is high in the aging population, almost 4% in the age group over 75 have moderate or more TR. This carries a poor prognosis and an increased incidence of mortality, prolonged hospitalization, and rehospitalization in symptomatic patients with severe TR is observed. Percutaneous tricuspid valve intervention has emerged as a viable therapeutic option, with an increasingly large toolbox of both tricuspid repair and replacement devices. The optimal strategy, timing and patient selection for transcatheter intervention are yet to be determined. This review focuses on the current strengths and limitations of transcatheter tricuspid repair vs. replacement, drawing on lessons learned from surgery. RECENT FINDINGS Early outcome studies have been published in the last 2 years for many of the new percutaneous tricuspid valve devices. We have summarized these results and compared them to surgical tricuspid valve repair and replacement. We found that surgical data shows a tendency to better outcome with tricuspid valve repair compared to replacement. For transcatheter interventions studies comparing repair and replacement are lacking but both interventions show good procedural success rates and are efficient in reducing the grade of tricuspid regurgitation. SUMMARY Transcatheter tricuspid valve interventions offer a safe and effective alternative to tricuspid surgery or medical therapy. The decision between valve replacement and repair should be based on patient anatomy, operator experience and device availability until head-to-head comparison of different devices are available.
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9
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Jain P, Mohammed AN, Fischer C, Aljure O. Current and Investigational Transcatheter Mitral Valve Replacement Systems: A Narrative Review for the Cardiac Anesthesiologist. J Cardiothorac Vasc Anesth 2022; 36:4108-4128. [PMID: 35915003 DOI: 10.1053/j.jvca.2022.05.019] [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: 12/22/2021] [Revised: 04/21/2022] [Accepted: 05/13/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Pankaj Jain
- Department of Anesthesiology University of Miami Miller School of Medicine, Miami, FL.
| | - Asif Neil Mohammed
- Department of Anesthesiology University of Miami Miller School of Medicine, Miami, FL
| | - Charles Fischer
- Department of Anesthesiology University of Miami Miller School of Medicine, Miami, FL
| | - Oscar Aljure
- Department of Anesthesiology University of Miami Miller School of Medicine, Miami, FL
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10
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Alperi A, Almendárez M, Álvarez R, Moris C, Leon V, Silva I, Hernández-Vaquero D, Pascual I, Avanzas P. Transcatheter tricuspid valve interventions: Current status and future perspectives. Front Cardiovasc Med 2022; 9:994502. [PMID: 36187002 PMCID: PMC9518720 DOI: 10.3389/fcvm.2022.994502] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
The development of transcatheter therapies to treat valvular heart diseases has changed the rules of the game, particularly in the case of aortic stenosis and mitral regurgitation. In the last years, the tricuspid valve has also been the focus of these percutaneous techniques for several reasons: (1) tricuspid regurgitation is a frequent disease associated with poor clinical outcomes in spite of medical treatment, leading to end-stage right ventricular heart failure, (2) surgical tricuspid valve repair or replacement has been the treatment of choice for patients with tricuspid valve disease, but high mortality rates for isolated surgical tricuspid valve intervention have been reported in the literature, and (3) most patients with tricuspid pathology are ultimately denied cardiac surgery because of their comorbidity burden. Thus, in this context the development of less invasive catheter-based therapies would be of high clinical relevance. The present review provides an overview regarding the framework of chronic tricuspid regurgitation transcatheter therapeutic options, summarizes the transcatheter systems under clinical use or clinical evaluation with their technical features, and describes the updated current evidence in this challenging and evolving field.
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Affiliation(s)
- Alberto Alperi
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Marcel Almendárez
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Rut Álvarez
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Cesar Moris
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Victor Leon
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Iria Silva
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Daniel Hernández-Vaquero
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
- Isaac Pascual
| | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
- *Correspondence: Pablo Avanzas ;
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11
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Reemplazo percutáneo de la válvula tricúspide por vía femoral con el sistema Cardiovalve. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Russo G, Taramasso M, Pedicino D, Gennari M, Gavazzoni M, Pozzoli A, Muraru D, Badano LP, Metra M, Maisano F. Challenges and future perspectives of transcatheter tricuspid valve interventions: adopt old strategies or adapt to new opportunities? Eur J Heart Fail 2021; 24:442-454. [PMID: 34894039 DOI: 10.1002/ejhf.2398] [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: 07/17/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 01/08/2023] Open
Abstract
Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease and is associated with an increased risk of cardiovascular events and death at long-term follow-up. Functional TR accounts for over 90% of TR and is mainly due to annular or right ventricular dilatation. Most often, TR is observed in patients with left-sided valvular heart disease (with or without previous surgical correction) and pulmonary hypertension. Isolated TR is less frequent, though burdened by high surgical mortality. This, together with an incomplete understanding of the disease, has brought to a significant undertreatment in spite of the growing evidence of the impact of severe TR on mortality. Moreover, uncertainties about the appropriate timing for intervention and the predictors of procedural success have contributed to limit TR treatment. Transcatheter tricuspid valve replacement or repair interventions represent novel and less invasive alternatives to surgery and have shown early promising results. The purpose of this review is to provide a complete and updated overview of TR pathology with a special focus on current percutaneous treatment options, future challenges and directions.
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Affiliation(s)
- Giulio Russo
- Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Daniela Pedicino
- Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Mara Gavazzoni
- IRCCS, Instituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, Milan, Italy
| | - Alberto Pozzoli
- Heart Surgery Unit, Cardiocentro Ticino, Lugano, Switzerland
| | - Denisa Muraru
- IRCCS, Instituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, Milan, Italy
| | - Luigi P Badano
- IRCCS, Instituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, Milan, Italy
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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