1
|
Badano LP, Tomaselli M, Muraru D, Galloo X, Li CHP, Ajmone Marsan N. Advances in the Assessment of Patients With Tricuspid Regurgitation: A State-of-the-Art Review on the Echocardiographic Evaluation Before and After Tricuspid Valve Interventions. J Am Soc Echocardiogr 2024:S0894-7317(24)00356-0. [PMID: 39029717 DOI: 10.1016/j.echo.2024.07.008] [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: 02/11/2024] [Revised: 05/24/2024] [Accepted: 07/09/2024] [Indexed: 07/21/2024]
Abstract
Tricuspid regurgitation (TR) can have a significant impact on the health and mortality of a patient. Unfortunately, many patients with advanced right-sided heart failure are not referred for isolated tricuspid valve (TV) surgery in a timely manner. This delayed referral has resulted in a high in-hospital mortality rate and significant undertreatment. Fortunately, transcatheter TV intervention (TTVI) has emerged as a safe and effective alternative to surgery, successfully reducing TR severity and improving patients' quality of life. Current guidelines emphasize the importance of assessing TR severity and its impact on the right heart chambers for selecting the appropriate intervention. However, the echocardiographic assessment of both right chambers and TV anatomy, along with TR severity, poses specific challenges, leading to the underestimation of TR severity. Recently, three-dimensional echocardiography has become crucial to enhance the characterization of TR severity. Moreover, it is essential to evaluate residual TR after TTVI to gauge the intervention's success and predict the patient's prognosis. This review provides a thorough evaluation of the echocardiographic parameters used to assess TR severity before and after TTVI. It presents a critical analysis of the accuracy and reliability of these parameters, highlighting their strengths and limitations to establish standardized diagnostic criteria and treatment protocols for TR, which will inform clinical decision-making and improve patient outcomes.
Collapse
Affiliation(s)
- Luigi P Badano
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, MIlan, Italy
| | - Michele Tomaselli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, MIlan, Italy
| | - Xavier Galloo
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, University Hospital Brussels, Brussels, Belgium
| | - Chi Hion Pedro Li
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, Barcelona, Spain
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
2
|
Willemen Y, Møller JE, Nejjari M, Linde JJ, Vejlstrup NG, von Bardeleben RS, Latib A, Modine T, De Backer O. Multimodality imaging for intraprocedural guidance of a transcatheter tricuspid valve replacement. Eur Heart J Cardiovasc Imaging 2024; 25:888-891. [PMID: 38626921 DOI: 10.1093/ehjci/jeae101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 06/29/2024] Open
Affiliation(s)
- Yannick Willemen
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
| | - Jacob E Møller
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
| | | | - Jesper J Linde
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
| | - Niels G Vejlstrup
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
| | | | - Azeem Latib
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
| |
Collapse
|
3
|
Tang GHL, Zaid S, Hahn RT, Aggarwal V, Alkhouli M, Aman E, Berti S, Chandrashekhar YS, Chadderdon SM, D'Agostino A, Fam NP, Ho EC, Kliger C, Kodali SK, Krishnamoorthy P, Latib A, Lerakis S, Lim DS, Mahadevan VS, Nair DG, Narula J, O'Gara PT, Packer DL, Praz F, Rogers JH, Ruf TF, Sanchez CE, Sharma A, Singh GD, van Mieghem NM, Vannan MA, Yadav PK, Ya'Qoub L, Zahr FE, von Bardeleben RS. Structural Heart Imaging Using 3-Dimensional Intracardiac Echocardiography: JACC Cardiovascular Imaging Position Statement. JACC Cardiovasc Imaging 2024:S1936-878X(24)00202-X. [PMID: 38970594 DOI: 10.1016/j.jcmg.2024.05.012] [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: 04/02/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 07/08/2024]
Abstract
3-dimensional (3D) intracardiac echocardiography (ICE) is emerging as a promising complement and potential alternative to transesophageal echocardiography for imaging guidance in structural heart interventions. To establish standardized practices, our multidisciplinary expert position statement serves as a comprehensive guide for the appropriate indications and utilization of 3D-ICE in various structural heart procedures. The paper covers essential aspects such as the fundamentals of 3D-ICE imaging, basic views, and workflow recommendations specifically tailored for ICE-guided structural heart procedures, such as transeptal puncture, device closure of intracardiac structures, and transcatheter mitral and tricuspid valve interventions. Current challenges, future directions, and training requirements to ensure operator proficiency are also discussed, thereby promoting the safety and efficacy of this innovative imaging modality to support expanding its future clinical applications.
Collapse
Affiliation(s)
| | - Syed Zaid
- Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York, USA
| | - Vratika Aggarwal
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Edris Aman
- University of California, Davis Medical Center, Sacramento, California, USA
| | - Sergio Berti
- G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Y S Chandrashekhar
- Minneapolis Veterans Affairs Medical Center, University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | - Neil P Fam
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Edwin C Ho
- Montefiore Medical Center, Bronx, New York, USA
| | - Chad Kliger
- Lenox Hill Hospital, New York, New York, USA
| | - Susheel K Kodali
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Azeem Latib
- Montefiore Medical Center, Bronx, New York, USA
| | | | - D Scott Lim
- University of Virginia, Charlottesville, Virginia, USA
| | - Vaikom S Mahadevan
- University of Massachusetts Chan School of Medicine, Worchester, Massachusetts, USA
| | - Devi G Nair
- St. Bernard's Heart and Vascular Center, Jonesboro, Arkansas, USA
| | - Jagat Narula
- University of Texas Health Houston, Houston, Texas, USA
| | | | | | - Fabien Praz
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jason H Rogers
- University of California, Davis Medical Center, Sacramento, California, USA
| | | | | | - Alok Sharma
- Minneapolis Veterans Affairs Medical Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gagan D Singh
- University of California, Davis Medical Center, Sacramento, California, USA
| | | | | | | | - Lina Ya'Qoub
- University of California, San Francisco Medical Center, San Francisco, California, USA
| | - Firas E Zahr
- Oregon Health and Science University, Portland, Oregon, USA
| | | |
Collapse
|
4
|
Madhavan MV, Agarwal V, Hahn RT. Transcatheter Therapy for the Tricuspid Valve: A Focused Review of Edge-to-Edge Repair and Orthotopic Valve Replacement. Curr Cardiol Rep 2024; 26:459-474. [PMID: 38884853 PMCID: PMC11199311 DOI: 10.1007/s11886-024-02051-4] [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] [Accepted: 03/20/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE OF REVIEW Patients with severe tricuspid regurgitation (TR) are at risk for significant morbidity and mortality. Transcatheter tricuspid valve interventions (TTVI) may offer patients less invasive treatment alternatives to surgery. This review evaluates the most common class of device currently used worldwide to treat TR, tricuspid transcatheter edge-to-edge repair (T-TEER) and orthotopic transcatheter tricuspid valve replacement (TTVR), both of which are now approved in the USA and Europe. RECENT FINDINGS The first pivotal randomized clinical trial, TRILUMINATE, demonstrated that T-TEER can safely reduce TR and is associated with improved health status outcomes. However, results of this trial have raised questions about whether this device can provide sufficient TR reduction to impact clinical outcomes. Orthotopic TTVR has recently gained attention with initial data suggesting near-complete TR elimination. The current review examines the technical features and anatomic limitations of the most commonly used devices for T-TEER and orthotopic TTVR, discusses the current clinical data for these devices, and offers a theoretical construct for device selection.
Collapse
Affiliation(s)
- Mahesh V Madhavan
- NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Vratika Agarwal
- NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA
| | - Rebecca T Hahn
- NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA.
- Cardiovascular Research Foundation, New York, NY, USA.
| |
Collapse
|
5
|
Liu Y, Li W, Zhou D, Zhang Y, Pan W, Chen S, Shi J, Chen H, Kong D, Ge Z, Guo K, Shu X, Pan C, Ge J. Step-by-step transesophageal echocardiographic guidance for transjugular transcatheter tricuspid valve replacement with a radial force-independent bioprosthesis. Quant Imaging Med Surg 2024; 14:1061-1069. [PMID: 38223060 PMCID: PMC10784097 DOI: 10.21037/qims-23-218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 11/09/2023] [Indexed: 01/16/2024]
Abstract
The prohibitive risk of isolated tricuspid valve (TV) surgery encouraged rapid development of a transcatheter solution for tricuspid regurgitation (TR). The favorable results of these devices informed recent guidelines to recommend considering transcatheter treatment of symptomatic secondary severe TR in inoperable patients. Transcatheter TV repair systems usually reduce TR through leaflet approximation and direct annuloplasty. Orthotopic transcatheter TV replacement (TTVR) devices generally rely on radial force and tricuspid leaflet engagement for implantation and stability. The LuX-Valve is a novel radial force-independent orthotopic TTVR device that is operated through the trans-atrial approach. Its radial force-independency is achieved through an interventricular septal anchor tab (septal insertion) and two leaflet graspers (leaflet engagement). Such a unique design makes the intraprocedural imaging different from that of other currently available TTVR systems. The latest generation of this device, the LuX-Valve Plus, comes with a newly designed delivery system through the transjugular approach, which makes the intraprocedural monitoring and adjustment of the device even more complex for successful implantation. However, its unique imaging needs for intra-procedural guidance and post-operative evaluation have not been described before. Therefore, we aimed to elaborate the key steps of transesophageal echocardiography (TEE) to guide this novel procedure. Herein, the primary 2-dimensional (2D) and 3-dimensional (3D) echocardiographic work planes are proposed and the critical steps are emphasized for better communication between imagers and interventionists. The suitability of 2D and 3D echocardiography to guide this procedure is also discussed to increase the flexibility of choice during the implantation.
Collapse
Affiliation(s)
- Yu Liu
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Li
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Daxin Zhou
- Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuan Zhang
- Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenzhi Pan
- Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shasha Chen
- Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Shi
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Haiyan Chen
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Dehong Kong
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Zhenyi Ge
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Kefang Guo
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cuizhen Pan
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Junbo Ge
- Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
6
|
Seligman H, Vora AN, Haroian NQ, Puri R, Heng EL, Smith RD, Latib A, Makkar R, Sorajja P, Leon MB, Ahmad Y. The Current Landscape of Transcatheter Tricuspid Valve Intervention. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101201. [PMID: 39131057 PMCID: PMC11307702 DOI: 10.1016/j.jscai.2023.101201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 08/13/2024]
Abstract
Tricuspid regurgitation (TR) is common, and its prevalence increases with age. It was previously estimated that there are 1.6 million patients in the United States with moderate or worse TR, and more contemporary data suggest the age-adjusted prevalence of TR is 0.55%. Increasing TR severity is associated with an adverse prognosis independent of the pulmonary artery pressure and the degree of right heart failure. In heart failure with reduced ejection fraction, survival is significantly worsened when moderate or severe TR is present. The mainstay of therapy has traditionally been surgery, but outcomes are poor. There has been increasing attention on the potential role of transcatheter interventions for TR. Numerous platforms are in developmental evolution, which broadly fall into 3 categories: valve replacement, valve repair (subdivided into annular, leaflet, and chordal platforms), and caval valve implantation. In this review, we examine all these strategies and devices, including guidance on how to appropriately select patients who can benefit from intervention.
Collapse
Affiliation(s)
- Henry Seligman
- Department of Cardiology, Harefield Hospital, Guys and St Thomas’ Foundation Trust, Uxbridge, London, United Kingdom
| | - Amit N. Vora
- Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Noah Q. Haroian
- Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ee Ling Heng
- Department of Cardiology, Harefield Hospital, Guys and St Thomas’ Foundation Trust, Uxbridge, London, United Kingdom
| | - Robert D. Smith
- Department of Cardiology, Harefield Hospital, Guys and St Thomas’ Foundation Trust, Uxbridge, London, United Kingdom
| | - Azeem Latib
- Department of Interventional Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Martin B. Leon
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
- Cardiovascular Research Foundation, New York, New York
| | - Yousif Ahmad
- Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| |
Collapse
|