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Goyal A, Sulaiman SA, Safi D, Mehta K, Jain H, Jain J, Maheshwari S, Mahalwar G. Transcatheter Edge-to-Edge Repair in Valvular Heart Disease: A Comprehensive Exploration of Equipment, Efficacy, Gender, Racial, and Socioeconomic Disparities, and Future Prospects. Cardiol Rev 2024:00045415-990000000-00292. [PMID: 38970476 DOI: 10.1097/crd.0000000000000742] [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: 07/08/2024]
Abstract
The 2 primary components of valvular heart disease are mitral regurgitation (MR) and tricuspid regurgitation (TR). Transcatheter edge-to-edge repair (TEER) is an advanced, minimally invasive procedure that has recently displayed encouraging outcomes in the treatment of these pathologies. TEER offers a nonsurgical alternative for individuals diagnosed with conditions deemed to be high-risk surgical candidates. Currently, the TEER procedure employs devices such as MitraCLIP and TriCLIP, as well as innovative PASCAL (transcatheter valve repair system used for mitral and tricuspid valve repair) and FORMA (repair system used for tricuspid valve repair) repair systems. In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial enrolling 614 patients to test the efficacy of TEER in MR, a significant reduction in hospitalization due to heart failure was observed at 24 months in the MitraClip + guideline-directed medical therapy (GDMT) group (35.8%) than in the GDMT-alone group (67.9%), HR, 0.53; P < 0.001, lower rate of all-cause mortality at 29.1% compared with 46.1% (P < 0.001), lower risk of cerebrovascular events (P = 0.001), and lower mortality due to cardiovascular events (P < 0.001). In another trial, patients with moderate TR or greater than New York Heart Association Class II or higher underwent TEER using the TriClip for the management of TR. The outcomes were encouraging, with 86% of patients showing a reduction in TR severity of at least one grade. As the technology and research surrounding TEER continue to progress, a more extensive range of patients are expected to qualify for TEER procedures. Our comprehensive review sought to extensively explore the background, equipment used, effectiveness of MR and TR, potential side effects, future prospects, and ongoing trials associated with TEER. We further discuss the existing gender, racial, and socioeconomic disparities in the realm of TEER.
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Affiliation(s)
- Aman Goyal
- From the Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Samia Aziz Sulaiman
- Department of Internal Medicine, School of Medicine, University of Jordan, Amman, Jordan
| | - Darsh Safi
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Kahan Mehta
- Department of Internal Medicine, GMERS Medical College-Vadodara, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India
| | - Hritvik Jain
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS)-Jodhpur, Jodhpur, Rajasthan, India
| | - Jyoti Jain
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS)-Jodhpur, Jodhpur, Rajasthan, India
| | - Surabhi Maheshwari
- Department of Internal Medicine, G.M.E.R.S. Medical College and Hospital, Sola, Gujarat, India
| | - Gauranga Mahalwar
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH
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Passaniti G, Tang GHL, Tanner R, Sharma SK, Kini AS, Lerakis S. Transcatheter Edge-to-Edge Approach to Repair Large Coaptation Gaps: The Zipping Technique. JACC Cardiovasc Interv 2024; 17:1502-1504. [PMID: 38843000 DOI: 10.1016/j.jcin.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Giulia Passaniti
- Division of Cardiology, Mount Sinai Heart Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Centro Alte Specialità e Trapianti, Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy. https://twitter.com/PassanitiGiulia
| | - Gilbert H L Tang
- Division of Cardiology, Mount Sinai Heart Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Cardiovascular Surgery, Mount Sinai Health System, Mount Sinai Heart Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA. https://twitter.com/GilbertTangMD
| | - Richard Tanner
- Division of Cardiology, Mount Sinai Heart Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samin K Sharma
- Division of Cardiology, Mount Sinai Heart Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Annapoorna S Kini
- Division of Cardiology, Mount Sinai Heart Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA. https://twitter.com/DoctorKini
| | - Stamatios Lerakis
- Division of Cardiology, Mount Sinai Heart Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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3
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Decotto S, Iroulart JM, Roveda G, Villanueva E, Aguirre MA, Posadas-Martinez ML, Nucifora E, Pizarro R, Pérez de Arenaza D. Significant tricuspid regurgitation is associated with adverse outcomes in patients with transthyretin amyloid cardiomyopathy. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2024; 5:e388. [PMID: 39015189 PMCID: PMC11247969 DOI: 10.47487/apcyccv.v5i2.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/13/2024] [Indexed: 07/18/2024]
Abstract
Objectives Patients diagnosed with transthyretin amyloid cardiomyopathy (ATTR-CM) often experience poor outcomes due to the development of heart failure (HF). Tricuspid regurgitation (TR) has been found to be correlated with adverse outcomes in patients with HF. This study aims to assess whether the presence of significant TR is associated to adverse cardiac outcomes in patients diagnosed with ATTR-CM. Materials and methods Retrospective study of ATTR-CM patients enrolled in the Institutional Registry of Amyloidosis (NCT01347047). Patients were categorized based on the presence of significant TR (moderate or severe according to current guidelines criteria) or absence of significant TR. All patients were followed up for 2 years to assess the incidence of the composite outcome of death or HF hospitalization. Results A total of 93 ATTR-CM patients were included. The mean age at diagnosis was 82.5 [IQR 75 - 86] years, 86% were male, and the mean left ventricular ejection fraction was 52% [IQR 43 - 60]. Among them, 32.3% (n = 30) patients had significant TR. Patients with significant TR had higher NTpro-BNP values (5308 vs 2454, pg/mL, p = 0.004), and a lower left ventricular ejection fraction (44 vs. 56%, p = 0.0002) compared to patients without significant TR. The incidence of the primary outcome was higher in patients with significant TR (77% vs. 30%, p<0.001). In a multivariate Cox regression analysis, only NTpro-BNP, as a numerical variable (HR 1.00, 95% CI 1.00005-1.0002, p = 0.001), and significant TR (HR 2.23, 95% CI 1.12-4.42, p=0.021) were independently associated with the composite outcome of death or HF hospitalization. Conclusions In patients diagnosed with ATTR-CM, the presence of significant TR was associated with worse outcomes.
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Affiliation(s)
- Santiago Decotto
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.Cardiology DepartmentHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Juan María Iroulart
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.Cardiology DepartmentHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Guido Roveda
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.Cardiology DepartmentHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Eugenia Villanueva
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.Cardiology DepartmentHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - María Adela Aguirre
- Internal Medicine Department. Hospital Italiano de Buenos Aires, Buenos Aires, Argentina;Internal Medicine DepartmentHospital Italiano de Buenos AiresBuenos AiresArgentina
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), Buenos Aires, Argentina.Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB)Buenos AiresArgentina
| | - María Lourdes Posadas-Martinez
- Internal Medicine Department. Hospital Italiano de Buenos Aires, Buenos Aires, Argentina;Internal Medicine DepartmentHospital Italiano de Buenos AiresBuenos AiresArgentina
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), Buenos Aires, Argentina.Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB)Buenos AiresArgentina
| | - Elsa Nucifora
- Hematology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.Hematology DepartmentHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Rodolfo Pizarro
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.Cardiology DepartmentHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Diego Pérez de Arenaza
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.Cardiology DepartmentHospital Italiano de Buenos AiresBuenos AiresArgentina
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4
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McClung JA, Frishman WH, Aronow WS. The Role of Palliative Care in Cardiovascular Disease. Cardiol Rev 2024:00045415-990000000-00182. [PMID: 38169299 DOI: 10.1097/crd.0000000000000634] [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: 01/05/2024]
Abstract
The American Heart Association has recommended that palliative care be integrated into the care of all patients with advanced cardiac illnesses. Notwithstanding, the number of patients receiving specialist palliative intervention worldwide remains extremely small. This review examines the nature of palliative care and what is known about its delivery to patients with cardiac illness. Most of the published literature on the subject concern advanced heart failure; however, some data also exist regarding patients with heart transplantation, pulmonary hypertension, valvular disease, congenital heart disease, indwelling devices, mechanical circulatory support, and advanced coronary disease. In addition, outcome data, certification requirements, workforce challenges, barriers to implementation, and a potential caveat about palliative care will also be examined. Further work is required regarding appropriate means of implementation, quality control, and timing of intervention.
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Affiliation(s)
- John Arthur McClung
- From the Departments of Cardiology and Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
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5
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Farooq MU, Latib A, Jorde UP. Tricuspid Regurgitation in Congestive "End-Organ" Failure: Outline of an Opportunity. Cardiol Rev 2024; 32:18-23. [PMID: 35452428 DOI: 10.1097/crd.0000000000000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tricuspid regurgitation (TR) is a progressive disease that can be addressed only partially by medical therapy. Progression of TR is associated with worsening end-organ function and worse survival, yet tricuspid valve interventions are usually only performed in advanced stages. Recent evidence suggests a pivotal role for TR and pulsatile venous congestion in the pathophysiology of renal and hepatic dysfunction. This critical knowledge has provided the opportunity to optimally define the appropriate timing of transcatheter tricuspid valve interventions, integrating concurrent or impending functional consequences with severity of TR.
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Affiliation(s)
- Muhammed U Farooq
- From the Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
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6
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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.
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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
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7
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Key Echocardiographic Considerations for Tricuspid Valve Transcatheter Edge-to-Edge Repair. J Am Soc Echocardiogr 2023; 36:366-380.e1. [PMID: 36754098 DOI: 10.1016/j.echo.2023.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/21/2023] [Accepted: 01/22/2023] [Indexed: 02/08/2023]
Abstract
Chronic tricuspid regurgitation (TR) results in progressive right ventricular (RV) volume overload, followed by right-sided chamber dilatation, RV systolic dysfunction, and eventual low-output cardiac failure. Severe TR is associated with considerable morbidity and mortality, and yet until recently, patients in the late stage of their disease course had limited treatment options. Cognizant of the high mortality rates associated with surgical intervention, tricuspid valve (TV) transcatheter edge-to-edge repair (TEER) has emerged as a promising solution for patients with severe TR. As has been learned from the transcatheter mitral valve TEER experience, detailed morphological and mechanistic assessment of the TV with transthoracic and transesophageal imaging is essential to optimal patient selection and procedural success. The current review will provide a comprehensive overview of TV anatomy, the updated mechanistic classification of TR, and key echocardiographic considerations in the evaluation, management, and follow-up of patients undergoing TV TEER.
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8
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Sisinni A, Taramasso M, Praz F, Metra M, Agricola E, Margonato A, Fam N, Estevez-Loureiro R, Latib A, Messika-Zeitoun D, Conradi L, von Bardeleben RS, Sorajja P, Hahn RT, Caravita S, Maisano F, Adamo M, Godino C. Concomitant Transcatheter Edge-to-Edge Treatment of Secondary Tricuspid and Mitral Regurgitation: An Expert Opinion. JACC Cardiovasc Interv 2023; 16:127-139. [PMID: 36697147 DOI: 10.1016/j.jcin.2022.11.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/03/2022] [Accepted: 11/01/2022] [Indexed: 01/25/2023]
Abstract
Secondary (functional) tricuspid regurgitation (sTR) is common in patients with mitral regurgitation (MR). Because combined valvular heart disease affects long-term survival, in comparison with isolated MR or tricuspid regurgitation, it is essential to offer patients adequate treatment. Despite considerable experience, no conclusive data are yet available on the prognostic impact of concomitant tricuspid valve surgery at the time of mitral valve surgery. Emerging transcatheter treatments offer the opportunity to treat both conditions (MR and sTR) simultaneously or in a stepwise fashion. This review provides a clinical overview on available data regarding the rationale for treatment of sTR in patients with relevant MR undergoing mitral transcatheter edge-to-edge repair, focusing on clinical and anatomical selection criteria.
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Affiliation(s)
- Antonio Sisinni
- Cardiology Unit, IRCCS Policlinico San Donato, Milan, Italy; Università degli studi di Milano, Milan, Italy. https://twitter.com/antosis_93
| | | | - Fabien Praz
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Marco Metra
- Cardiology Unit, Cardiothoracic Department, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic- Vascular Department, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | - Alberto Margonato
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rodrigo Estevez-Loureiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David Messika-Zeitoun
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Paul Sorajja
- Department of Cardiology, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Rebecca T Hahn
- NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA
| | - Sergio Caravita
- Dyspnea and Pulmonary Hypertension Center, Department of Cardiology, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Milan, Italy; Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy
| | - Francesco Maisano
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology Unit, Cardiothoracic Department, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Cosmo Godino
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy.
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9
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Ben Ali W, Ruf T, Perrin N, Bouhout I, Fam N, Kresoja KP, Lurz P, von Bardeleben RS, Modine T, Ibrahim R. Indications, Limitations, and Development of Tricuspid Valve Interventions in Adults. Can J Cardiol 2022; 38:S66-S78. [PMID: 34464691 DOI: 10.1016/j.cjca.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/19/2021] [Accepted: 08/03/2021] [Indexed: 12/30/2022] Open
Abstract
Tricuspid regurgitation is associated with excessive mortality and poor outcomes regardless of the cause and associated comorbidities. Despite this clear association with mortality, tricuspid valve diseases remain undertreated. Tricuspid valve surgery, either repair or replacement, has shown little detectable survival benefit. Transcatheter tricuspid valve interventions have emerged as a less invasive approach to tricuspid valve diseases. They can be categorised into coaptation devices, annuloplasty devices, transcatheter tricuspid valve replacement, heterotopic caval valve implantation, and tricuspid valve-in-valve. Despite the late referral and the patient's profile, results remain fairly acceptable at least in the short term, with good procedural device success, excellent safety profile, and sustained reduction of tricuspid regurgitation for up to 1 year. Because results are limited to the mid-term, transcatheter tricuspid valve intervention durability will need to be established before broader adoption of these technologies.
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Affiliation(s)
- Walid Ben Ali
- Structural Heart Program and Interventional Cardiology, Université de Montréal, Montréal Heart Institute, Montréal, Québec, Canada; Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France.
| | - Tobias Ruf
- Heart Valve Center Mainz, Universitätsmedizin, Mainz, Germany
| | - Nils Perrin
- Structural Heart Program and Interventional Cardiology, Université de Montréal, Montréal Heart Institute, Montréal, Québec, Canada; Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Ismail Bouhout
- Structural Heart Program and Interventional Cardiology, Université de Montréal, Montréal Heart Institute, Montréal, Québec, Canada
| | - Neil Fam
- Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Philipp Lurz
- Heart Center Leipzig-University Hospital, Leipzig, Germany
| | | | - Thomas Modine
- Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France
| | - Reda Ibrahim
- Structural Heart Program and Interventional Cardiology, Université de Montréal, Montréal Heart Institute, Montréal, Québec, Canada
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10
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Yu PM, Wang YQ, Luo ZR, Tsang RCC, Tronstad O, Shi J, Guo YQ, Jones AYM. Postoperative Pulmonary Complications in Patients With Transcatheter Tricuspid Valve Implantation—Implications for Physiotherapists. Front Cardiovasc Med 2022; 9:904961. [PMID: 35665252 PMCID: PMC9160231 DOI: 10.3389/fcvm.2022.904961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To investigate the incidence of postoperative pulmonary complications (PPCs) and short-term recovery after transcatheter tricuspid valve implantation (TTVI). Methods A total of 17 patients diagnosed with severe tricuspid regurgitation who received a LuX-valve TTVI were included in this study. Spirometry lung function, maximal inspiratory pressure (MIP), and 6-min walk test distance (6MWD) were recorded. Prior to surgery, patients were stratified into high or low pulmonary risk groups based on published predefined criteria. A physiotherapist provided all patients with education on thoracic expansion exercises, effective cough and an inspiratory muscle training protocol at 50% of MIP for 3 days preoperatively. All patients received standard post-operative physiotherapy intervention including positioning, thoracic expansion exercises, secretion removal techniques and mobilization. Patients were assessed for PPCs as defined by the Melbourne-Group Score-version 2. Clinical characteristics and hospital stay, cost, functional capacity, and Kansas City Cardiomyopathy Questionnaire (KCCQ) heart failure score were recorded at admission, 1-week, and 30-days post-op. Results The mean (SD) age of the 17 patients was 68.4 (8.0) years and 15 (88%) were female. Pre-surgical assessment identified 8 patients (47%) at high risk of PPCs. A total of 9 patients (53%) developed PPCs between the 1st and 3rd day post-surgery, and 7 of these 9 patients were amongst the 8 predicted as “high risk” prior to surgery. One patient died before the 30 day follow up. Pre-operative pulmonary risk assessment score, diabetes mellitus, a low baseline MIP and 6MWD were associated with a high incidence of PPCs. Compared to those without PPCs, patients with PPCs had longer ICU and hospital stay, and higher hospitalization cost. At 30 days post-surgery, patients without PPCs maintained higher MIP and 6MWD compared to those with PPCs, but there were no significant between-group differences in other lung function parameters nor KCCQ. Conclusion This is the first study to report the incidence of PPCs post TTVI. Despite a 3-day prehabilitation protocol and standard post-operative physiotherapy, PPCs were common among patients after TTVI and significantly impacted on hospital and short-term recovery and outcomes. In the majority of patients, PPCs could be accurately predicted before surgery. A comprehensive prehabilitation program should be considered for patients prior to TTVI. Clinical Trial Registration [www.ClinicalTrials.gov], identifier [ChiCTR2000039671].
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Affiliation(s)
- Peng-Ming Yu
- Rehabilitation Medicine Center, Sichuan University West China Hospital, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, China
| | - Yu-Qiang Wang
- Department of Cardiovascular Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Ze-Ruxing Luo
- Rehabilitation Medicine Center, Sichuan University West China Hospital, Chengdu, China
| | - Raymond C. C. Tsang
- Department of Physiotherapy, MacLehose Medical Rehabilitation Centre, Hong Kong, Hong Kong SAR, China
| | - Oystein Tronstad
- Department of Physiotherapy, The Prince Charles Hospital, Queensland, QLD, Australia
- Critical Care Research Group, The Prince Charles Hospital, Queensland, QLD, Australia
| | - Jun Shi
- Department of Cardiovascular Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Ying-Qiang Guo
- Department of Cardiovascular Surgery, Sichuan University West China Hospital, Chengdu, China
- *Correspondence: Ying-Qiang Guo,
| | - Alice Y. M. Jones
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, QLD, Australia
- Alice Y. M. Jones,
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11
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Krikken JA, van den Heuvel AFM, Willemsen HM, Voors AA, Lipsic E. Transcatheter edge-to-edge repair of tricuspid regurgitation in the Netherlands: state of the art and future perspectives. Neth Heart J 2022; 30:393-399. [PMID: 35352275 PMCID: PMC9402843 DOI: 10.1007/s12471-022-01673-z] [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] [Accepted: 01/28/2022] [Indexed: 12/28/2022] Open
Abstract
Despite the high prevalence and adverse clinical outcomes of severe tricuspid regurgitation (TR), conventional treatment options, surgical or pharmacological, are limited. Surgery is associated with a high peri-operative risk and medical treatment has not clearly resulted in clinical improvements. Therefore, there is a high unmet need to reduce morbidity and mortality in patients with severe TR. During recent years, several transcatheter solutions have been studied. This review focuses on the transcatheter edge-to-edge repair of TR (TTVR) with respect to patient selection, the procedure, pre- and peri-procedural echocardiographic assessments and clinical outcomes. Furthermore, we highlight the current status of TTVR in the Netherlands and provide data from our initial experience at the University Medical Centre Groningen.
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Affiliation(s)
- Jan A Krikken
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - Ad F M van den Heuvel
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - H Marco Willemsen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik Lipsic
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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12
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Fam N, Ali F, Hassanin M, Ong G. Transcatheter tricuspid valve repair with the modified TriClip/MitraClip G4 system. EUROINTERVENTION 2021; 17:e441-e442. [PMID: 33433390 PMCID: PMC9724951 DOI: 10.4244/eij-d-20-01295] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Neil Fam
- Division of Cardiology, St Michael's Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada
| | - Faeez Ali
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Magdi Hassanin
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Geraldine Ong
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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13
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Simard TJ, Eleid MF. Transcatheter Tricuspid Valve Intervention: Current Perspective. US CARDIOLOGY REVIEW 2021. [DOI: 10.15420/usc.2020.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Tricuspid regurgitation (TR) adversely impacts both quality of life and long-term survival, which generates interest in therapeutic approaches to mitigate these effects. Historically, therapeutic options for TR were limited to surgical approaches, which are often complicated by significant morbidity and mortality in elderly patients with multiple comorbidities. This gap in therapeutic options led to the rapid evolution of transcatheter tricuspid valve intervention (TTVI), with a wide variety of approaches pursued and early results suggesting that TTVI improves clinical outcomes. Numerous strategies, including edge-to-edge repair, annular reduction, spacers, caval valve implantation, and transcatheter tricuspid valve replacement form the basis of TTVI today. In this review, the authors discuss the current state of each approach.
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Affiliation(s)
- Trevor J Simard
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN
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14
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Left-Sided Venous Access: A Technique to Simplify and Improve Success of Tricuspid Valve Clip Repair. JACC Cardiovasc Interv 2021; 14:581-582. [PMID: 33454296 DOI: 10.1016/j.jcin.2020.11.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 11/23/2022]
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15
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Ali FM, Ong G, Edwards J, Connelly KA, Fam NP. Comparison of transcatheter tricuspid valve repair using the MitraClip NTR and XTR systems. Int J Cardiol 2020; 327:156-162. [PMID: 33301831 DOI: 10.1016/j.ijcard.2020.11.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/19/2020] [Accepted: 11/30/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Transcatheter tricuspid leaflet repair (TTVr) using the MitraClip is a promising option for patients with severe tricuspid regurgitation (TR) and heart failure. However, no comparative studies of the NTR and XTR systems have been reported. OBJECTIVES The aim of this study was to assess the relative efficacy, safety, and clinical outcomes of patients with severe TR treated with the MitraClip NTR and XTR systems. METHODS Forty consecutive patients with severe TR underwent TTVr. The primary outcome was procedural success, with NYHA functional class, TR grade and major adverse cardiac and cerebrovascular events (MACCE) assessed at 30-day follow-up. RESULTS The majority of patients had functional TR and a greater proportion of XTR patients had torrential TR with larger coaptation gaps. Procedural success was achieved in 70% vs 80% in the NTR and XTR cohorts. Single leaflet device attachment was equal in both groups (5%). At 30-day follow-up, 70% vs 85% of NTR and XTR patients were in NYHA Class I/II. The mean reduction in TR grade was greater in the XTR group (1.5 ± 0.3 vs 2.3 ± 0.4, p-0.012). In patients with torrential TR at baseline, 55% in the XTR group achieved TR ≤ 2+ compared to none in the NTR group (p < 0.001). CONCLUSIONS In this first study comparing the MitraClip NTR and XTR systems for TTVr, we found both to be safe and effective, while the XTR system allowed treatment of larger coaptation gaps, greater mean reduction in TR grade, with more effective reduction of torrential TR.
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Affiliation(s)
- Faeez M Ali
- St. Michael's Hospital, University of Toronto, Canada
| | - Geraldine Ong
- St. Michael's Hospital, University of Toronto, Canada
| | | | | | - Neil P Fam
- St. Michael's Hospital, University of Toronto, Canada.
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Caneiro-Queija B, Estévez-Loureiro R, Calvo-Iglesias F, Baz-Alonso JA, Abu-Assi E, Íñiguez-Romo A. Tratamiento percutáneo combinado de la insuficiencia mitral y tricuspídea con sistema MitraClip: primera experiencia en España. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2020.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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17
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Kücken T, Tamm S, Haase-Fielitz A, Edlinger CR, Neuss M, Bannehr M, Butter C. Visualisation of the tricuspid valve using a new 3D echocardiographic scoring system. Open Heart 2020; 7:openhrt-2020-001363. [PMID: 32994355 PMCID: PMC7526282 DOI: 10.1136/openhrt-2020-001363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/10/2020] [Indexed: 11/06/2022] Open
Abstract
With rising focus on interventional treatment of the tricuspid valve (TV), the need for good echocardiographic imaging increases. Aim of this study was to develop a scoring system describing how accurate three dimensional (3D) echocardiographic imaging of TV and its anatomical structures is.
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Affiliation(s)
- Tanja Kücken
- Cardiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Brandenburg, Germany
| | - Sarah Tamm
- Cardiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Brandenburg, Germany
| | - Anja Haase-Fielitz
- Cardiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Brandenburg, Germany
| | | | - Michael Neuss
- Cardiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Brandenburg, Germany
| | - Marwin Bannehr
- Cardiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Brandenburg, Germany
| | - Christian Butter
- Cardiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Brandenburg, Germany
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18
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Muntané-Carol G, Alperi A, Faroux L, Bédard E, Philippon F, Rodés-Cabau J. Transcatheter Tricuspid Valve Intervention: Coaptation Devices. Front Cardiovasc Med 2020; 7:139. [PMID: 32903754 PMCID: PMC7438895 DOI: 10.3389/fcvm.2020.00139] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/30/2020] [Indexed: 11/13/2022] Open
Abstract
Transcatheter tricuspid valve intervention (TTVI) has recently emerged as an alternative for the treatment of severe tricuspid regurgitation (TR). Multiple percutaneous devices have been developed in the last decade with promising early results. Among them, the coaptation devices are designed to reduce TR severity by valve leaflet plication or occupying the regurgitant orifice with a spacer. To date, the MitraClip/TriClip devices (Abbott, Santa Clara, CA, USA), the PASCAL system (Edwards Lifesciencies, Irvine, CA, USA), and the FORMA device (Edwards Lifesciencies, Irvine, CA, USA) have been used as coaptation devices for treating severe TR. The present document aimed to review the clinical evidence on coaptation devices in the field of TTVI, describing its design characteristics, main procedural steps, and early and mid-term outcomes.
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Affiliation(s)
| | - Alberto Alperi
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Elisabeth Bédard
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - François Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
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Caneiro-Queija B, Estévez-Loureiro R, Calvo-Iglesias F, Baz-Alonso JA, Abu-Assi E, Íñiguez-Romo A. Combined transcatheter mitral and tricuspid repair with MitraClip: first experience in Spain. ACTA ACUST UNITED AC 2020; 73:1073-1074. [PMID: 32739143 DOI: 10.1016/j.rec.2020.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/11/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - José A Baz-Alonso
- Departamento de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Emad Abu-Assi
- Departamento de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Andrés Íñiguez-Romo
- Departamento de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
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20
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Karam N, Mehr M, Taramasso M, Besler C, Ruf T, Connelly KA, Weber M, Yzeiraj E, Schiavi D, Mangieri A, Vaskelyte L, Alessandrini H, Deuschl F, Brugger N, Ahmad H, Ho E, Biasco L, Orban M, Deseive S, Braun D, Gavazzoni M, Rommel KP, Pozzoli A, Frerker C, Näbauer M, Massberg S, Pedrazzini G, Tang GHL, Windecker S, Schäfer U, Kuck KH, Sievert H, Denti P, Latib A, Schofer J, Nickenig G, Fam N, von Bardeleben RS, Lurz P, Maisano F, Hausleiter J. Value of Echocardiographic Right Ventricular and Pulmonary Pressure Assessment in Predicting Transcatheter Tricuspid Repair Outcome. JACC Cardiovasc Interv 2020; 13:1251-1261. [PMID: 32360260 DOI: 10.1016/j.jcin.2020.02.028] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/10/2020] [Accepted: 02/19/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to assess the value of echocardiographic right ventricular (RV) and systolic pulmonary artery pressure (sPAP) assessment in predicting transcatheter tricuspid edge-to-edge valve repair (TTVR) outcome. BACKGROUND RV dysfunction and pulmonary hypertension are associated with poor prognosis and are systematically sought during tricuspid regurgitation evaluation. The value of echocardiographic assessment in predicting TTVR outcome is unknown. METHODS Data were taken from the TriValve (Transcatheter Tricuspid Valve Therapies) registry, which includes patients undergoing TTVR at 14 European and North American centers. The primary outcome was 1-year survival free from hospitalization for heart failure, and secondary outcomes were 1-year survival and absence of hospital admission for heart failure at 1 year. RESULTS Overall, 249 patients underwent TTVR between June 2015 and 2018 (mean tricuspid annular plane systolic excursion [TAPSE] 15.8 ± 15.3 mm, mean sPAP 43.6 ± 16.0 mm Hg). Tricuspid regurgitation grade ≥3+ was found in 96.8% of patients at baseline and 29.4% at final follow-up; 95.6% were in New York Heart Association functional class III or IV initially, compared with 34.3% at follow-up (p < 0.05). Final New York Heart Association functional class did not differ among TAPSE and sPAP quartiles, even when both low TAPSE and high sPAP were present. Rates of 1-year survival and survival free from hospitalization for heart failure were 83.9% and 78.7%, respectively, without significant differences according to baseline echocardiographic RV characteristics (TAPSE, fractional area change, and end-diastolic area) and sPAP (p > 0.05 for all). CONCLUSIONS TTVR provides clinical improvement, with 1-year survival free from hospital readmission >75% in patients with severe tricuspid regurgitation. Conventional echocardiographic parameters used to assess RV function and sPAP did not predict clinical outcome after TTVR.
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Affiliation(s)
- Nicole Karam
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; European Hospital Georges Pompidou, Cardiology Department, Université de Paris, PARCC, INSERM, Paris, France
| | - Michael Mehr
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | | | - Tobias Ruf
- Mainz University Hospital, University of Mainz, Mainz, Germany
| | - Kim A Connelly
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marcel Weber
- Bonn University Hospital, University of Bonn, Bonn, Germany
| | | | - Davide Schiavi
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Antonio Mangieri
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | | | | | - Florian Deuschl
- University Heart Center Hamburg, University of Hamburg, Hamburg, Germany
| | | | - Hasan Ahmad
- Westchester Medical Center, Valhalla, New York
| | - Edwin Ho
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Mara Gavazzoni
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | | | - Alberto Pozzoli
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | | | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | | | | | | | - Ulrich Schäfer
- University Heart Center Hamburg, University of Hamburg, Hamburg, Germany
| | | | | | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | - Azeem Latib
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy; Department of Cardiology, Montefiore Medical Center, Bronx, New York
| | | | - Georg Nickenig
- Bonn University Hospital, University of Bonn, Bonn, Germany
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Philipp Lurz
- Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease, Munich, Germany.
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21
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Dreger H, Mattig I, Hewing B, Knebel F, Lauten A, Lembcke A, Thoenes M, Roehle R, Stangl V, Landmesser U, Grubitzsch H, Stangl K, Laule M. Treatment of Severe TRIcuspid Regurgitation in Patients with Advanced Heart Failure with CAval Vein Implantation of the Edwards Sapien XT VALve (TRICAVAL): a randomised controlled trial. EUROINTERVENTION 2020; 15:1506-1513. [PMID: 31929100 DOI: 10.4244/eij-d-19-00901] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of our study was to compare the impact of implantation of a balloon-expandable transcatheter valve into the inferior vena cava (CAVI) on exercise capacity with optimal medical therapy (OMT) in patients with severe tricuspid regurgitation (TR) and high surgical risk. METHODS AND RESULTS Twenty-eight patients were randomised to OMT (n=14) or CAVI (n=14). The primary endpoint was maximal oxygen uptake at the three-month follow-up. Secondary endpoints included six-minute walk test, NYHA class, NT-proBNP levels, right heart function, unscheduled heart failure hospitalisation, and quality of life as assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Patients underwent follow-up examinations one, three, six, and twelve months after randomisation. Maximal oxygen uptake did not change significantly in either group after three months and there was no difference between the OMT and CAVI groups (-0.1±1.8 ml∙kg-1∙min-1 vs -1.0±1.6 ml∙kg-1∙min-1, p=0.4995). Compared to baseline, CAVI improved NYHA class, dyspnoea, and quality of life after three months. However, there were no statistically significant differences in the secondary endpoints between the groups. Four periprocedural complications occurred after CAVI, resulting in open heart surgery. Four patients in the OMT group and eight patients (including four after conversion to surgery) in the CAVI group died from right heart failure, sepsis or haemorrhage. CONCLUSIONS CAVI did not result in a superior functional outcome compared to OMT. Due to an unexpectedly high rate of valve dislocations, the study was stopped for safety reasons.
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Affiliation(s)
- Henryk Dreger
- Medizinische Klinik für Kardiologie und Angiologie, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
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22
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Orban M, Rommel KP, Ho EC, Unterhuber M, Pozzoli A, Connelly KA, Deseive S, Besler C, Ong G, Braun D, Edwards J, Miura M, Gülmez G, Stolz L, Gavazzoni M, Zuber M, Orban M, Nabauer M, Maisano F, Thiele H, Massberg S, Taramasso M, Fam NP, Lurz P, Hausleiter J. Transcatheter Edge-to-Edge Tricuspid Repair for Severe Tricuspid Regurgitation Reduces Hospitalizations for Heart Failure. JACC-HEART FAILURE 2020; 8:265-276. [DOI: 10.1016/j.jchf.2019.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/18/2022]
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Combined Tricuspid and Mitral Versus Isolated Mitral Valve Repair for Severe MR and TR. JACC Cardiovasc Interv 2020; 13:543-550. [DOI: 10.1016/j.jcin.2019.10.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/19/2019] [Accepted: 10/08/2019] [Indexed: 11/23/2022]
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Orban M, Orban MW, Braun D, Deseive S, Kupka D, Stocker TJ, Bagaev E, Karam N, Hagl C, Massberg S, Nabauer M, Hausleiter J. Clinical impact of elevated tricuspid valve inflow gradients after transcatheter edge-to-edge tricuspid valve repair. EUROINTERVENTION 2019; 15:e1057-e1064. [PMID: 31498114 DOI: 10.4244/eij-d-19-00237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to compare the outcome of patients with a post-procedural tricuspid valve gradient (TVG) of >3 mmHg vs ≤3 mmHg after transcatheter edge-to-edge tricuspid valve repair (TTVR). METHODS AND RESULTS Between March 2016 and October 2018 we treated 145 patients with severe tricuspid regurgitation (TR) with TTVR by placing 2.2±0.7 clips per patient. Device success (TR reduction ≥1° to at least moderate) was achieved in 125 patients (86.2%). TTVR resulted in an elevated TVG >3 mmHg in 25 (17.2%) patients. Device success (84% vs 86.7%, p=0.9), number of clips implanted (2.3±0.7 vs 2.2±0.7, p=0.33), clinical improvement including NYHA class (III/IV 24% vs 28%, p=0.92) and increase in six-minute walking test at one month (67 m [IQR 5-103 m] vs 56 m [IQR 8-97 m], p=0.93), mortality (HR 1.07, 95% CI: 0.43-2.65, plogrank=0.88) and the combined endpoint mortality and hospitalisation for heart failure at one year (HR 1.07, 95% CI: 0.46-2.48, plogrank=0.88) were similar between patients with a TVG >3 mmHg versus patients with a TVG ≤3 mmHg. CONCLUSIONS A small cohort of patients demonstrated an elevated TVG higher than 3 mmHg at discharge. This elevation had no impact on clinical improvement, mortality or hospitalisation for heart failure.
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Affiliation(s)
- Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
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25
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Mehr M, Taramasso M, Besler C, Ruf T, Connelly KA, Weber M, Yzeiraj E, Schiavi D, Mangieri A, Vaskelyte L, Alessandrini H, Deuschl F, Brugger N, Ahmad H, Biasco L, Orban M, Deseive S, Braun D, Rommel KP, Pozzoli A, Frerker C, Näbauer M, Massberg S, Pedrazzini G, Tang GHL, Windecker S, Schäfer U, Kuck KH, Sievert H, Denti P, Latib A, Schofer J, Nickenig G, Fam N, von Bardeleben RS, Lurz P, Maisano F, Hausleiter J. 1-Year Outcomes After Edge-to-Edge Valve Repair for Symptomatic Tricuspid Regurgitation: Results From the TriValve Registry. JACC Cardiovasc Interv 2019; 12:1451-1461. [PMID: 31395215 DOI: 10.1016/j.jcin.2019.04.019] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/01/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate procedural and 1-year clinical and echocardiographic outcomes of patients treated with tricuspid edge-to-edge repair. BACKGROUND Transcatheter edge-to-edge repair has been successfully performed in selected patients with symptomatic tricuspid regurgitation (TR) and high risk for surgery, but outcome data are sparse. METHODS This analysis of the multicenter international TriValve (Transcatheter Tricuspid Valve Therapies) registry included 249 patients with severe TR treated with edge-to-edge repair in compassionate and/or off-label use. Clinical and echocardiographic outcomes were prospectively collected and retrospectively analyzed. RESULTS In 249 patients (mean age 77 ± 9 years; European System for Cardiac Operative Risk Evaluation II score 6.4% [interquartile range: 3.9% to 13.9%]), a successful procedure with TR reduction to grade ≤2+ was achieved in 77% by placement of 2 ± 1 tricuspid clips. Concomitant treatment of severe TR and mitral regurgitation was performed in 52% of patients. At 1-year follow-up, significant and durable improvements in TR severity (TR ≤2+ in 72% of patients) and New York Heart Association functional class (≤II in 69% of patients) were observed. All-cause mortality was 20%, and the combined rate of mortality and unplanned hospitalization for heart failure was 35%. Predictors of procedural failure included effective regurgitant orifice area, tricuspid coaptation gap, tricuspid tenting area, and absence of central or anteroseptal TR jet location. Predictors of 1-year mortality were procedural failure, worsening kidney function, and absence of sinus rhythm. CONCLUSIONS Transcatheter tricuspid edge-to-edge repair can achieve TR reduction at 1 year, resulting in significant clinical improvement. Predictors of procedural failure and 1-year mortality identified here may help select patients who will benefit most from this therapy.
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Affiliation(s)
- Michael Mehr
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | | | - Tobias Ruf
- Mainz University Hospital, University of Mainz, Mainz, Germany
| | - Kim A Connelly
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marcel Weber
- Bonn University Hospital, University of Bonn, Bonn, Germany
| | | | | | | | | | | | - Florian Deuschl
- University Heart Center Hamburg, University of Hamburg, Hamburg, Germany
| | | | - Hasan Ahmad
- Westchester Medical Center, Valhalla, New York
| | | | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Alberto Pozzoli
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | | | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Gilbert H L Tang
- Westchester Medical Center, Valhalla, New York; Mount Sinai Medical Center, New York, New York
| | | | - Ulrich Schäfer
- University Heart Center Hamburg, University of Hamburg, Hamburg, Germany
| | | | | | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | - Azeem Latib
- San Raffaele University Hospital, Milan, Italy
| | | | - Georg Nickenig
- Bonn University Hospital, University of Bonn, Bonn, Germany
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Philipp Lurz
- Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany.
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Percutaneous interventions for mitral and tricuspid heart valve diseases. Cardiovasc Interv Ther 2019; 35:62-71. [DOI: 10.1007/s12928-019-00610-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 08/03/2019] [Indexed: 12/27/2022]
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27
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Karam N, Braun D, Mehr M, Orban M, Stocker TJ, Deseive S, Orban M, Hagl C, Näbauer M, Massberg S, Hausleiter J. Impact of Transcatheter Tricuspid Valve Repair for Severe Tricuspid Regurgitation on Kidney and Liver Function. JACC Cardiovasc Interv 2019; 12:1413-1420. [DOI: 10.1016/j.jcin.2019.04.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 11/29/2022]
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28
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Schlotter F, Orban M, Rommel KP, Besler C, von Roeder M, Braun D, Unterhuber M, Borger M, Hagl C, Orban M, Nabauer M, Massberg S, Thiele H, Hausleiter J, Lurz P. Aetiology-based clinical scenarios predict outcomes of transcatheter edge-to-edge tricuspid valve repair of functional tricuspid regurgitation. Eur J Heart Fail 2019; 21:1117-1125. [PMID: 31359620 DOI: 10.1002/ejhf.1547] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/09/2019] [Accepted: 06/01/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Florian Schlotter
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mathias Orban
- Klinikum der Universität München, Medizinische Klinik und Poliklinik I, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Christian Besler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Maximilian von Roeder
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Daniel Braun
- Klinikum der Universität München, Medizinische Klinik und Poliklinik I, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Matthias Unterhuber
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Michael Borger
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Christian Hagl
- Klinikum der Universität München, Herzchirurgische Klinik und Poliklinik, Munich, Germany
| | - Martin Orban
- Klinikum der Universität München, Medizinische Klinik und Poliklinik I, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Michael Nabauer
- Klinikum der Universität München, Medizinische Klinik und Poliklinik I, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Steffen Massberg
- Klinikum der Universität München, Medizinische Klinik und Poliklinik I, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Jörg Hausleiter
- Klinikum der Universität München, Medizinische Klinik und Poliklinik I, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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29
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Tabata N, Sinning JM, Kaikita K, Tsujita K, Nickenig G, Werner N. Current status and future perspective of structural heart disease intervention. J Cardiol 2019; 74:1-12. [DOI: 10.1016/j.jjcc.2019.02.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
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30
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Miura M, Maisano F, Zuber M, Gavazzoni M, Cuevas O, Lin SI, Ho EC, Pozzoli A, Taramasso M. Novel transcatheter therapies for treating tricuspid regurgitation. Minerva Cardioangiol 2019; 67:223-233. [DOI: 10.23736/s0026-4725.18.04837-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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31
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Lin SI, Miura M, Maisano F, Zuber M, Gavazzoni M, Ho EC, Pozzoli A, Taramasso M. Transcatheter Edge-to-edge Repair of Severe Tricuspid Regurgitation. US CARDIOLOGY REVIEW 2019. [DOI: 10.15420/usc.2018.20.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Despite the increasing knowledge of the long-term adverse consequence of severe tricuspid regurgitation (TR), most patients with moderate- to-severe TR are still treated conservatively because of the high risk of surgery. Percutaneous procedures have emerged as an attractive alternative treatment. Transcatheter edge-to-edge repair is a validated technique to treat mitral regurgitation. In recent years, the same concept has been applied to patients with TR and prohibitive operative risk. Early trials have shown feasibility and safety. More clinical experiences and long-term results are still being gathered. In this article, we provide an overview of transcatheter edge-to-edge repair and look at the current evidence and clinical results regarding procedure.
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Affiliation(s)
- Shu-I Lin
- Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland; Cardiovascular Center, MacKay Memorial Hospital, Tamsui, Taiwan
| | - Mizuki Miura
- Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland
| | - Francesco Maisano
- Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland
| | - Michel Zuber
- Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland
| | - Mara Gavazzoni
- Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland; Cardiology Department, University of Brescia, Brescia, Italy
| | - Edwin C Ho
- Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland; Division of Cardiology, St Michael’s Hospital, Toronto, Canada
| | - Alberto Pozzoli
- Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland
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32
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Acute and Short-Term Results of Transcatheter Edge-to-Edge Repair for Severe Tricuspid Regurgitation Using the MitraClip XTR System. JACC Cardiovasc Interv 2019; 12:604-605. [DOI: 10.1016/j.jcin.2018.11.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/20/2018] [Indexed: 11/16/2022]
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33
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Stocker TJ, Orban M, Braun D, Scheck F, Weckbach LT, Orban M, Deseive S, Nabauer M, Massberg S, Hausleiter J. Physical Activity and Noninvasive Cardiac Output as Novel Clinical Endpoints After Transcatheter Valve Repair for Severe Tricuspid Regurgitation. JACC Cardiovasc Interv 2018; 11:2127-2129. [DOI: 10.1016/j.jcin.2018.06.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 06/19/2018] [Indexed: 11/16/2022]
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34
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Transcatheter Edge-to-Edge Repair for Severe Tricuspid Regurgitation Using the Triple-Orifice Technique Versus the Bicuspidalization Technique. JACC Cardiovasc Interv 2018; 11:1790-1792. [PMID: 30170957 DOI: 10.1016/j.jcin.2018.05.049] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/29/2018] [Indexed: 11/20/2022]
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35
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Grasso C, Popolo Rubbio A, Braun D, Hausleiter J, Nickenig G. Transcatheter treatment of tricuspid regurgitation (focusing on current technologies). EUROINTERVENTION 2018; 14:AB112-AB120. [DOI: 10.4244/eij-d-18-00520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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36
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Hausleiter J, Braun D, Orban M, Latib A, Lurz P, Boekstegers P, von Bardeleben RS, Kowalski M, Hahn RT, Maisano F, Hagl C, Massberg S, Nabauer M. Patient selection, echocardiographic screening and treatment strategies for interventional tricuspid repair using the edge-to-edge repair technique. EUROINTERVENTION 2018; 14:645-653. [DOI: 10.4244/eij-d-17-01136] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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37
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Braun D, Nabauer M, Orban M, Englmaier A, Rösler D, Hagl C, Massberg S, Hausleiter J. One-year results of transcatheter treatment of severe tricuspid regurgitation using the edge-to-edge repair technique. EUROINTERVENTION 2018; 14:e413-e415. [PMID: 29741485 DOI: 10.4244/eij-d-18-00186] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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38
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Hausleiter J, Braun D. Mitral Meets Tricuspid: Is Severe Tricuspid Regurgitation a Bystander or Is There a Need for Combined Percutaneous Mitral and Tricuspid Valve Repair? JACC Cardiovasc Interv 2018; 11:1152-1153. [PMID: 29929636 DOI: 10.1016/j.jcin.2018.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany.
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
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39
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Lurz P, Besler C, Noack T, Forner AF, Bevilacqua C, Seeburger J, Rommel KP, Blazek S, Hartung P, Zimmer M, Mohr F, Schuler G, Linke A, Ender J, Thiele H. Transcatheter treatment of tricuspid regurgitation using edge-to-edge repair: procedural results, clinical implications and predictors of success. EUROINTERVENTION 2018; 14:e290-e297. [DOI: 10.4244/eij-d-17-01091] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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40
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Besler C, Orban M, Rommel KP, Braun D, Patel M, Hagl C, Borger M, Nabauer M, Massberg S, Thiele H, Hausleiter J, Lurz P. Predictors of Procedural and Clinical Outcomes in Patients With Symptomatic Tricuspid Regurgitation Undergoing Transcatheter Edge-to-Edge Repair. JACC Cardiovasc Interv 2018; 11:1119-1128. [DOI: 10.1016/j.jcin.2018.05.002] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/23/2018] [Accepted: 05/01/2018] [Indexed: 11/28/2022]
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41
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Combined Mitral and Tricuspid Versus Isolated Mitral Valve Transcatheter Edge-to-Edge Repair in Patients With Symptomatic Valve Regurgitation at High Surgical Risk. JACC Cardiovasc Interv 2018; 11:1142-1151. [DOI: 10.1016/j.jcin.2018.04.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/03/2018] [Indexed: 12/13/2022]
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42
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Asmarats L, Puri R, Latib A, Navia JL, Rodés-Cabau J. Transcatheter Tricuspid Valve Interventions. J Am Coll Cardiol 2018; 71:2935-2956. [DOI: 10.1016/j.jacc.2018.04.031] [Citation(s) in RCA: 183] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/29/2018] [Accepted: 04/15/2018] [Indexed: 01/11/2023]
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43
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Kalra A, Uberoi AS, Latib A, Khera S, Little SH, Bhatt DL, Reardon MJ, Kleiman NS, Barker CM. Emerging Transcatheter Options for Tricuspid Regurgitation. Methodist Debakey Cardiovasc J 2018; 13:120-125. [PMID: 29743996 DOI: 10.14797/mdcj-13-3-120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Tricuspid regurgitation (TR) presents as either primary valve pathology or secondary to pulmonary or left-sided heart disease. Severe TR portends a worse prognosis independent of age, right ventricular size and function, severe left ventricular dysfunction, and increased pulmonary arterial pressures. Surgical treatment for TR has mostly been limited to patients undergoing mitral valve repair since those at high surgical risk are not candidates for traditional TR surgery. For these patients, minimally invasive techniques could be of great benefit, yet these techniques have been slow to develop because of the various anatomic and physiological aspects of the tricuspid valve apparatus. Several promising new techniques are currently undergoing clinical investigation, including caval valve implantation, percutaneous tricuspid annuloplasty techniques (Trialign, TriCinch, Cardioband), edge-to-edge repair with the MitraClip system, the FORMA device, and the GATE tricuspid Atrioventricular Valved Stent. Further evaluation of their safety and long-term efficacy is warranted prior to commercial approval and widespread adoption.
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Affiliation(s)
- Ankur Kalra
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS.,WEILL CORNELL MEDICAL COLLEGE, NEW YORK, NEW YORK.,UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER, CASE WESTERN RESERVE UNIVERSITY, CLEVELAND, OHIO
| | - Angad S Uberoi
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Azeem Latib
- EMO-GVM CENTRO CUORE COLUMBUS AND SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY
| | - Sahil Khera
- MASSACHUSETTS GENERAL HOSPITAL, HARVARD MEDICAL SCHOOL, BOSTON, MASSACHUSETTS
| | - Stephen H Little
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS.,WEILL CORNELL MEDICAL COLLEGE, NEW YORK, NEW YORK
| | - Deepak L Bhatt
- BRIGHAM AND WOMEN'S HEART & VASCULAR CENTER, HARVARD MEDICAL SCHOOL, BOSTON, MASSACHUSETTS
| | - Michael J Reardon
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS.,WEILL CORNELL MEDICAL COLLEGE, NEW YORK, NEW YORK
| | - Neal S Kleiman
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS.,WEILL CORNELL MEDICAL COLLEGE, NEW YORK, NEW YORK
| | - Colin M Barker
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS.,WEILL CORNELL MEDICAL COLLEGE, NEW YORK, NEW YORK
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44
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Orban M, Besler C, Braun D, Nabauer M, Zimmer M, Orban M, Noack T, Mehilli J, Hagl C, Seeburger J, Borger M, Linke A, Thiele H, Massberg S, Ender J, Lurz P, Hausleiter J. Six-month outcome after transcatheter edge-to-edge repair of severe tricuspid regurgitation in patients with heart failure. Eur J Heart Fail 2018; 20:1055-1062. [PMID: 29405554 DOI: 10.1002/ejhf.1147] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 11/10/2022] Open
Abstract
AIMS Severe tricuspid regurgitation (TR) is common in patients with right-sided heart failure (HF) and causes substantial morbidity and mortality. Treatment options beyond medical therapy are limited for high-risk patients. Transcatheter edge-to-edge tricuspid valve (TV) repair showed procedural safety and short-term efficacy. Impact on mid-term outcome is unclear. This dual-centre observational study evaluates the mid-term safety, efficacy and clinical outcome after edge-to-edge TV repair for severe TR in patients with HF. METHODS AND RESULTS Overall, 50 patients with right-sided HF and severe TR were treated with the transcatheter edge-to-edge repair technique; 14 patients were treated for isolated TR and 36 patients for combined mitral regurgitation (MR) and TR. At 6-month follow-up (available for 98% of patients), a persistent reduction of at least one echocardiographic TR grade was achieved in 90% of patients and New York Heart Association class improved in 79% of patients. The 6-minute walk distance increased by 44% (+84 m, P < 0.001), the median N-terminal pro-B-type natriuretic peptide decreased by 30% (from 3625 to 2526 pg/mL, P = 0.002), and the quality of life score improved by 16% (decrease of 6 points in the Minnesota Living with Heart Failure Questionnaire score, P = 0.056). The improvements were comparable in patients undergoing isolated TR or combined MR and TR treatment. During follow-up, 8 patients died, 14 were hospitalized for worsening of HF, 2 underwent TV surgery, and 2 received a second TV clip procedure. CONCLUSIONS Transcatheter edge-to-edge TV repair for severe TR is safe and effective in reducing TR. It appears to be associated with improved clinical outcome in the majority of patients.
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Affiliation(s)
- Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Christian Besler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Michael Nabauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Marion Zimmer
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Thilo Noack
- Department of Heart Surgery, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Julinda Mehilli
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Joerg Seeburger
- Department of Heart Surgery, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Michael Borger
- Department of Heart Surgery, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Axel Linke
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Joerg Ender
- Department of Anaesthesiology and Intensive Care Medicine, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
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Abstract
Heart failure (HF) is often associated with different valve diseases, predominantly functional mitral and tricuspid regurgitation. However, the association between HF and aortic stenosis, particularly low-flow low-gradient aortic stenosis, is not infrequent. Severe mitral and tricuspid regurgitations, as well as aortic stenosis, in HF patients worsen prognosis and left ventricular dilatation and induce further reduction in left ventricular ejection fraction. Transcatheter edge-to-edge mitral and tricuspid valve repair and transcatheter aortic valve implantation could be an important therapeutic option with a satisfactory long-term outcome in HF patients with comorbidities and even in patients with severely depressed ejection fraction.
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Affiliation(s)
- Marijana Tadic
- Department of Internal Medicine and Cardiology, Department of Cardiology, Campus Virchow Klinikum (CVK), Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Viale della Resistenza 23, 20036, Meda, Italy
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46
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Del Forno B, Lapenna E, Dalrymple-Hay M, Taramasso M, Castiglioni A, Alfieri O, De Bonis M. Recent advances in managing tricuspid regurgitation. F1000Res 2018; 7:355. [PMID: 29636903 PMCID: PMC5865201 DOI: 10.12688/f1000research.13328.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2018] [Indexed: 11/20/2022] Open
Abstract
Isolated tricuspid valve surgery is usually carried out with very high morbidity and mortality given the complexity of the affected patients. In light of this, trans-catheter tricuspid valve interventions have been emerging as an attractive alternative to surgery over the last few years. Although feasibility has been shown with a number of devices, clinical experience remains preliminary and associated with significant clinical and technical challenges. Here we describe currently available trans-catheter treatment options for severe tricuspid regurgitation implanted in different locations.
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Affiliation(s)
| | | | - Malcom Dalrymple-Hay
- Plymouth Hospitals NHS Trust, Department of Cardiac Surgery, Derriford Hospital, Plymouth, UK
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47
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Ho EC, Fam NP. Transcatheter therapies for tricuspid regurgitation: coaptation augmentation devices. Minerva Cardioangiol 2018; 66:718-728. [PMID: 29546746 DOI: 10.23736/s0026-4725.18.04657-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Advancements in transcatheter technology has increased the number of therapeutic options for patients with tricuspid regurgitation. One category of repair devices attempts to augment leaflet coaptation by either leaflet plication or by functioning as a space occupying device. These include the MitraClip (Abbott, Santa Clara, CA, USA), PASCAL (Edwards Lifesciences, Irvine, CA, USA) and FORMA (Edwards Lifesciences, Irvine, CA, USA) devices. All three have been successfully implanted with promising short-term echocardiographic and clinical outcomes. Improvements in patient selection, device design and procedural technique will lead to more effective tricuspid regurgitation reduction. Further research to assess efficacy, safety and durability of these devices is needed, along with determination of long-term clinical outcomes.
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Affiliation(s)
- Edwin C Ho
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada
| | - Neil P Fam
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada -
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Alqahtani F, Berzingi CO, Aljohani S, Hijazi M, Al-Hallak A, Alkhouli M. Contemporary Trends in the Use and Outcomes of Surgical Treatment of Tricuspid Regurgitation. J Am Heart Assoc 2017; 6:JAHA.117.007597. [PMID: 29273638 PMCID: PMC5779056 DOI: 10.1161/jaha.117.007597] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Tricuspid regurgitation (TR), if untreated, is associated with an adverse impact on long‐term outcomes. In recent years, there has been an increasing enthusiasm about surgical and transcatheter treatment of patients with severe TR. We aim to evaluate the contemporary trends in the use and outcomes of tricuspid valve (TV) surgery for TR using the National Inpatient Sample. Methods and Results Between January 1, 2003 and December 31, 2014, an estimated 45 477 patients underwent TV surgery for TR in the United States, of whom 15% had isolated TV surgery and 85% had TV surgery concomitant with other cardiac surgery. There was a temporal upward trend to treat sicker patients during the study period. Patients who underwent isolated TV repair or replacement had a distinctly different clinical risk profile than those patients who underwent TV surgery simultaneous with other surgery. Isolated TV replacement was associated with high in‐hospital mortality (10.9%) and high rates of permanent pacemaker implantation (34.1%) and acute kidney injury requiring dialysis (5.5%). Similarly, isolated TV repair was also associated with high in‐hospital mortality (8.1%) and significant rates of permanent pacemaker implantation (10.9%) and new dialysis (4.4%). Isolated TV repair and TV replacement were both associated with protracted hospitalizations and substantial cost. Conclusions In contemporary practice, surgical treatment of TR remains underused and is associated with high operative morbidity and mortality, prolonged hospitalizations, and considerable cost.
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Affiliation(s)
- Fahad Alqahtani
- West Virginia University Heart and Vascular Institute, Morgantown, WV
| | - Chalak O Berzingi
- West Virginia University Heart and Vascular Institute, Morgantown, WV
| | - Sami Aljohani
- West Virginia University Heart and Vascular Institute, Morgantown, WV
| | - Mohamad Hijazi
- West Virginia University Heart and Vascular Institute, Morgantown, WV
| | - Ahmad Al-Hallak
- West Virginia University Heart and Vascular Institute, Morgantown, WV
| | - Mohamad Alkhouli
- West Virginia University Heart and Vascular Institute, Morgantown, WV .,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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Abstract
Symptomatic severe tricuspid regurgitation (TR), if untreated, carries a dismal prognosis. These patients are at very high risk for surgical repair or replacement and transcatheter options to treat TR are emerging. More than 300 transcatheter tricuspid repairs with the MitraClip system have been performed worldwide with promising results. The TriClip system, with the MitraClip NT delivered via a dedicated tricuspid steerable guide catheter, is currently under investigation. This article describes the step-by-step technique on using the MitraClip system to perform transcatheter tricuspid repair using echocardiographic and fluoroscopic guidance. The latest data on worldwide experience with tricuspid clipping are also discussed.
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Affiliation(s)
- Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, 1190 Fifth Avenue, GP2W, Box 1028, New York, NY 10029, USA.
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Braun D, Orban M, Nabauer M, Orban M, Gross L, Englmaier A, Rösler D, Mehilli J, Bauer A, Hagl C, Massberg S, Hausleiter J. Transcatheter Treatment of Severe Tricuspid Regurgitation Using the Edge-to-Edge Repair Technique in the Presence and Absence of Pacemaker Leads. JACC Cardiovasc Interv 2017; 10:2014-2016. [DOI: 10.1016/j.jcin.2017.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 07/11/2017] [Indexed: 10/18/2022]
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