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Ueyama HA, Licitra G, Gleason PT, Behbahani-Nejad O, Modi R, Rajagopal D, Byku I, Xie JX, Greenbaum AB, Paone G, Keeling WB, Grubb KJ, Hanzel GS, Devireddy CM, Block PC, Babaliaros VC. Impact of Tricuspid Regurgitation on Outcomes After Transcatheter Mitral Valve Replacement. Am J Cardiol 2024; 220:84-91. [PMID: 38604492 DOI: 10.1016/j.amjcard.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/27/2024] [Accepted: 03/30/2024] [Indexed: 04/13/2024]
Abstract
Development of functional tricuspid regurgitation (TR) because of chronic mitral disease and subsequent heart failure is common. However, the effect of TR on clinical outcomes after transcatheter mitral valve replacement (TMVR) remains unclear. We aimed to evaluate the impact of baseline TR on outcomes after TMVR. This was a single-center, retrospective analysis of patients who received valve-in-valve or valve-in-ring TMVR between 2012 and 2022. Patients were categorized into none/mild TR and moderate/severe TR based on baseline echocardiography. The primary outcome was 3 years all-cause death and the secondary outcomes were in-hospital events. Of the 135 patients who underwent TMVR, 64 (47%) exhibited none/mild TR at baseline, whereas 71 (53%) demonstrated moderate/severe TR. There were no significant differences in in-hospital events between the groups. At 3 years, the moderate/severe TR group exhibited a significantly increased risk of all-cause death (adjusted hazard ratio 3.37, 95% confidence interval 1.35 to 8.41, p = 0.009). When patients with baseline moderate/severe TR were stratified by echocardiography at 30 days into improved (36%) and nonimproved (64%) TR groups, although limited by small sample size, there was no significant difference in 3-year all-cause mortality (p = 0.48). In conclusion, this study investigating the impact of baseline TR on clinical outcomes revealed that moderate/severe TR is prevalent in those who underwent TMVR and is an independent predictor of 3-year all-cause mortality. Earlier mitral valve intervention before the development of significant TR may play a pivotal role in improving outcomes after TMVR.
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Affiliation(s)
- Hiroki A Ueyama
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Giancarlo Licitra
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Patrick T Gleason
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Omid Behbahani-Nejad
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Roshan Modi
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Dhiren Rajagopal
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Isida Byku
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Joe X Xie
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Adam B Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Gaetano Paone
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - W Brent Keeling
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Kendra J Grubb
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - George S Hanzel
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Chandan M Devireddy
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Peter C Block
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia.
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2
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Maisano F, Hahn R, Sorajja P, Praz F, Lurz P. Transcatheter treatment of the tricuspid valve: current status and perspectives. Eur Heart J 2024; 45:876-894. [PMID: 38426859 DOI: 10.1093/eurheartj/ehae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/13/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Transcatheter tricuspid valve interventions (TTVI) are emerging as alternatives to surgery in high-risk patients with isolated or concomitant tricuspid regurgitation. The development of new minimally invasive solutions potentially more adapted to this largely undertreated population of patients, has fuelled the interest for the tricuspid valve. Growing evidence and new concepts have contributed to revise obsolete and misleading perceptions around the right side of the heart. New definitions, classifications, and a better understanding of the disease pathophysiology and phenotypes, as well as their associated patient journeys have profoundly and durably changed the landscape of tricuspid disease. A number of registries and a recent randomized controlled pivotal trial provide preliminary guidance for decision-making. TTVI seem to be very safe and effective in selected patients, although clinical benefits beyond improved quality of life remain to be demonstrated. Even if more efforts are needed, increased disease awareness is gaining momentum in the community and supports the establishment of dedicated expert valve centres. This review is summarizing the achievements in the field and provides perspectives for a less invasive management of a no-more-forgotten disease.
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Affiliation(s)
- Francesco Maisano
- Division of Cardiac Surgery and Valve Center, IRCCS Ospedale San Raffaele, Università Vita Salute, Via Olgettina 60, 20132 Milano, Italy
| | - Rebecca Hahn
- Department of Medicine, Columbia University Irving Medical Center, New York, 161 Fort Washington Avenue, 10032 New York, NY, USA
| | - Paul Sorajja
- Minneapolis Heart Institute at Abbott Northwestern Hospital, 920 East 28th Street, Suite 100, 55407 Minneapolis, MN, USA
| | - Fabien Praz
- Bern University Hospital, University of Bern, Anna-Seiler-Haus Freiburgstrasse 20, 3010 Bern, Switzerland
| | - Philipp Lurz
- Department of Cardiology, Universitätsmedizin Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
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Samim D, Dernektsi C, Brugger N, Reineke D, Praz F. Contemporary Approach to Tricuspid Regurgitation: Knowns, Unknowns, and Future Challenges. Can J Cardiol 2024; 40:185-200. [PMID: 38052301 DOI: 10.1016/j.cjca.2023.11.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023] Open
Abstract
Severe tricuspid regurgitation (TR) worsens heart failure and is associated with impaired survival. In daily clinical practice, patients are referred late, and tricuspid valve interventions (surgical or transcatheter) are underutilised, which may lead to irreversible right ventricular damage and increases risk. This article addresses the appropriate timing and modality for an intervention (surgical or transcatheter), and its potential benefits on clinical outcomes. Ongoing randomised controlled trials will provide further insights into the efficacy of transcatheter valve interventions compared with medical treatment.
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Affiliation(s)
- Daryoush Samim
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
| | - Chrisoula Dernektsi
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiac Surgery, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
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4
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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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Vogelhuber J, Tenaka T, Sudo M, Sugiura A, Öztürk C, Kavsur R, Donner A, Nickenig G, Zimmer S, Weber M, Wilde N. Impact of body mass index in patients with tricuspid regurgitation after transcatheter edge-to-edge repair. Clin Res Cardiol 2024; 113:156-167. [PMID: 37792020 PMCID: PMC10808352 DOI: 10.1007/s00392-023-02312-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Obesity and underweight represent classical risk factors for outcome in patients treated for cardiovascular disease. This study describes the impact of different body mass index (BMI) categories on 1-year clinical outcome in patients with tricuspid regurgitation (TR) undergoing transcatheter-edge-to-edge repair (TEER). METHODS We analyzed 211 consecutive patients (age 78.3 ± 7.2 years, 55.5% female, median EuroSCORE II 9.6 ± 6.7) with tricuspid regurgitation undergoing TEER from June 2015 until May 2021. Patients were prospectively enrolled in our single center registry and were retrospectively analyzed. Patients were stratified according to body mass index (BMI) into 4 groups: BMI < 20 kg/m2 (underweight), BMI 20.0 to < 25.0 kg/m2 (normal weight), BMI 25.0 to > 30.0 kg/m2 (overweight) and BMI ≥ 30 kg/m2 (obese). RESULTS Kaplan-Meier survival curves demonstrated inferior survival for underweight and obese patients, but comparable outcomes for normal and overweight patients (global log rank test, p < 0.01). Cardiovascular death was significantly higher in underweight patients compared to the other groups (24.1% vs. 7.0% vs. 6.3% vs. 6.4%; p < 0.01). Over all, there were comparable rates of bleeding, stroke and myocardial infarction. Multivariable Cox regression analysis (adjusted for age, gender, coronary artery disease, chronic obstructive pulmonary disease, tricuspid annular plane systolic excursion, left-ventricular ejection fraction) confirmed underweight (HR 3.88; 95% CI 1.64-7.66; p < 0.01) and obesity (HR 3.24; 95% CI 1.37-9.16; p < 0.01) as independent risk factors for 1-year all-cause mortality. CONCLUSIONS Compared to normal weight and overweight patients, obesity and underweight patients undergoing TEER display significant higher 1-year all-cause mortality.
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Affiliation(s)
- Johanna Vogelhuber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tetsu Tenaka
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Mitsumasa Sudo
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Refik Kavsur
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Anika Donner
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Nihal Wilde
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Wang X, Ma Y, Liu Z, Fan X, Guan G, Pan S, Wang J, Zhang Y. Comparison of outcomes between transcatheter tricuspid valve repair and surgical tricuspid valve replacement or repair in patients with tricuspid insufficiency. J Cardiothorac Surg 2023; 18:170. [PMID: 37120579 PMCID: PMC10148428 DOI: 10.1186/s13019-023-02271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/04/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Tricuspid regurgitation is associated with significant morbidity and mortality, but with limited treatment options. The objective of this study is to compare the demographic characteristics, complications, and outcomes of transcatheter tricuspid valve repair (TTVr) versus surgical tricuspid valve replacement (STVR) or surgical tricuspid valve repair (STVr), using real-world data from the National Inpatient Sample (NIS) database. METHODS AND RESULTS Our study analyzed data from the National Inpatient Sample (NIS) database from 2016 to 2018 and identified 92, 86, and 84 patients with tricuspid insufficiency who underwent STVr, STVR, and TTVr, respectively. The mean ages of patients who received STVr, STVR, and TTVr were 65.03 years, 66.3 years, and 71.09 years, respectively, with TTVr patients significantly older than those who received STVr (P < 0.05). Patients who received STVr or STVR had higher mortality rates (8.7% and 3.5%, respectively) compared to those who received TTVr (1.2%). Patients who underwent STVr or STVR were also more likely to experience perioperative complications, including third-degree atrioventricular block (8.7% STVr vs. 1.2% TTVr, P = 0.329; 38.4% STVR vs. 1.2% TTVr, P < 0.05), respiratory failure (5.4% STVr vs. 1.2% TTVr, P = 0.369; 15.1% STVR vs. 1.2% TTVr, P < 0.05), respiratory complications (6.5% STVr vs. 1.2% TTVr, P = 0.372; 19.8% STVR vs. 1.2% TTVr, P < 0.05), acute kidney injury (40.2% STVr vs. 27.4% TTVr, P = 0.367; 34.9% STVR vs. 27.4% TTVr, P = 0.617), and fluid and electrolyte disorders (44.6% STVr vs. 22.6% TTVr, P = 0.1332; 50% STVR vs. 22.6% TTVr, P < 0.05). In addition, the average cost of care and the average length of hospital stay were higher for patients who underwent STVr or STVR than for those who received TTVr (USD$37995 ± 356008.523 STVr vs. USD$198397 ± 188943.082 TTVr, P < 0.05; USD$470948 ± 614177.568 STVR vs. USD$198397 ± 188943.082 TTVr, P < 0.05; 15.4 ± 15.19 STVr vs. 9.6 ± 10.21 days TTVr, P = 0.267; 24.7 ± 28.81 STVR vs. 9.6 ± 10.21 days TTVr, P < 0.05). CONCLUSION TTVr has shown to have favorable outcomes compared to STVr or STVR, but more research and clinical trials are required to help formulate evidence-based guidelines for the role of catheter-based management in tricuspid valve disease.
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Affiliation(s)
- Xiqiang Wang
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China
| | - Yanpeng Ma
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China
| | - Zhongwei Liu
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China
| | - Xiude Fan
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Gongchang Guan
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China
| | - Shuo Pan
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China.
| | - Junkui Wang
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China.
| | - Yong Zhang
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China.
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7
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Hausleiter J, Stocker TJ, Adamo M, Karam N, Swaans MJ, Praz F. Mitral valve transcatheter edge-to-edge repair. EUROINTERVENTION 2023; 18:957-976. [PMID: 36688459 PMCID: PMC9869401 DOI: 10.4244/eij-d-22-00725] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/04/2022] [Indexed: 01/21/2023]
Abstract
Mitral regurgitation (MR) is the most prevalent valvular heart disease and, when left untreated, results in reduced quality of life, heart failure, and increased mortality. Mitral valve transcatheter edge-to-edge repair (M-TEER) has matured considerably as a non-surgical treatment option since its commercial introduction in Europe in 2008. As a result of major device and interventional improvements, as well as the accumulation of experience by the interventional cardiologists, M-TEER has emerged as an important therapeutic strategy for patients with severe and symptomatic MR in the current European and American guidelines. Herein, we provide a comprehensive up-do-date overview of M-TEER. We define preprocedural patient evaluation and highlight key aspects for decision-making. We describe the currently available M-TEER systems and summarise the evidence for M-TEER in both primary mitral regurgitation (PMR) and secondary mitral regurgitation (SMR). In addition, we provide recommendations for device selection, intraprocedural imaging and guiding, M-TEER optimisation and management of recurrent MR. Finally, we provide information on major unsolved questions and "grey areas" in M-TEER.
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Affiliation(s)
- Jörg Hausleiter
- Department of Cardiology, LMU Klinikum, Ludwig Maximilian University of Munich, Munich, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Thomas J Stocker
- Department of Cardiology, LMU Klinikum, Ludwig Maximilian University of Munich, Munich, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, University of Brescia, Brescia, Italy
| | - Nicole Karam
- Paris Cardiovascular Research Center, INSERM and Cardiology Department, European Hospital Georges Pompidou, University of Paris, Paris, France
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Fabien Praz
- Bern University Hospital, University of Bern, Bern, Switzerland
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Stolz L, Doldi PM, Weckbach LT, Stocker TJ, Braun D, Orban M, Wild MG, Hagl C, Massberg S, Näbauer M, Hausleiter J, Orban M. Right ventricular function in transcatheter mitral and tricuspid valve edge-to-edge repair. Front Cardiovasc Med 2022; 9:993618. [PMID: 36312295 PMCID: PMC9596758 DOI: 10.3389/fcvm.2022.993618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
Since transcatheter edge-to-edge repair (TEER) has become a valuable therapy in the treatment of both, mitral (MR) and tricuspid regurgitation (TR), the question of optimized patient selection has gained growing importance. After years of attributing rather little attention to the right ventricle (RV) and its function in the setting of valvular heart failure, this neglect has recently changed. The present review sought to summarize anatomy and function of the RV in a clinical context and aimed at presenting the current knowledge on how the RV influences outcomes after TEER for atrioventricular regurgitation. The anatomy of the RV is determined by its unique shape, which necessitates to use three-dimensional imaging methods for detailed and comprehensive characterization. Complex parameters such as RV to pulmonary artery coupling (RVPAc) have been developed to combine information of RV function and afterload which is primary determined by the pulmonary vasculature and LV filling pressure. Beyond that, TR, which is closely related to RV function also plays an important role in the setting of TEER. While mitral valve transcatheter edge-to-edge repair (M-TEER) leads to reduction of concomitant TR in some patients, the prognostic value of TR in the setting of M-TEER remains unclear. Overall, this review summarizes the current state of knowledge of the outstanding role of RV function and associated TR in the setting of TEER and outlines the unsolved questions associated with right-sided heart failure.
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Affiliation(s)
- Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,*Correspondence: Lukas Stolz,
| | - Philipp M. Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ludwig T. Weckbach
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Thomas J. Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mirjam G. Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Christian Hagl
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany,Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mathias Orban
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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9
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Prognostic Value of Pulmonary Hypertension, Right Ventricular Function and Tricuspid Regurgitation on Mortality After Transcatheter Mitral Valve Repair: A Systematic Review and Meta-Analysis. Heart Lung Circ 2022; 31:696-704. [PMID: 35058141 DOI: 10.1016/j.hlc.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/15/2021] [Accepted: 11/25/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH), right ventricular (RV) dysfunction, and tricuspid regurgitation (TR) are commonly present in patients with mitral regurgitation (MR) and known to impair prognosis. This systematic review and meta-analysis aimed to determine the prognostic value of PH, RV function, and TR on mortality after transcatheter mitral valve repair (TMVR). METHODS A systematic search was performed to identify studies investigating PH, RV function, or TR in patients who underwent TMVR. Studies were included for pooled analysis if hazard ratios (HR) for all-cause mortality were given. RESULTS A total of 8,672 patients from 21 selected studies were included (PH, 11 studies; RV function, nine studies; TR, 10 studies). Mean follow-up was 2.7±1.6 years. The HRs and 95% CIs for all-cause mortality of PH (dichotomised: HR 1.70, 95% CI 1.00-2.87; per 10 mmHg increase in systolic PAP: HR 1.17, 95% CI 1.07-1.29), RV function (dichotomised: HR 1.86, 95% CI 1.45-2.38; per 5 mm decrease in TAPSE: HR 1.18, 95% CI 0.97-1.43) and TR (HR 1.51, 95% CI 1.28-1.79) indicated a significant association. CONCLUSION Prognosis after TMVR is worse in patients with significant MR when concomitant PH, RV dysfunction, or TR are present. Careful assessment of these parameters should therefore precede clinical decision-making for TMVR. The current results encourage investigation into whether (1) intervention at an earlier stage of MR reduces incidence of PH, RV dysfunction, and TR; and (2) transcatheter treatment of concomitant TR can improve clinical outcome and prognosis for these patients.
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10
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Tricuspid valve: Once disregarded, now acknowledged. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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11
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Chitturi KR, Bhardwaj B, Murtaza G, Karuparthi PR, Faza NN, Goel SS, Reardon MJ, Kleiman NS, Aggarwal K. Clinical impact of tricuspid regurgitation on transcatheter edge-to-edge mitral valve repair for mitral regurgitation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 41:1-9. [DOI: 10.1016/j.carrev.2022.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/31/2021] [Accepted: 01/27/2022] [Indexed: 11/17/2022]
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12
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Lurz P, Unterhuber M, Rommel KP, Kresoja KP, Kister T, Besler C, Fengler K, Sandri M, Daehnert I, Thiele H, Blazek S, von Roeder M. Iatrogenic Atrial Septal Defects Following Transcatheter Mitral Valve Repair and Implications of Interventional Closure. JACC Cardiovasc Interv 2021; 14:2685-2694. [PMID: 34949392 DOI: 10.1016/j.jcin.2021.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/30/2021] [Accepted: 09/21/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The authors investigated whether iatrogenic atrial septal defect (iASD) closure post-transcatheter mitral valve edge-to-edge repair (TMVR) is superior to conservative therapy (CT) and whether outcomes (death/heart failure [HF] hospitalization) differ between patients with and without an iASD post-TMVR. BACKGROUND Transseptal access for TMVR can create an iASD, which is associated with impaired outcomes. Controversially, the creation of an iASD in HF has been linked to improved hemodynamics. METHODS 80 patients with an iASD and relevant left-to-right shunting (Qp:Qs ≥1.3) 30 days following TMVR were randomized to CT or interventional closure of the iASD (MITHRAS [Closure of Iatrogenic Atrial Septal Defect Following Transcatheter Mitral Valve Repair] cohort), and 235 patients without an iASD served as a comparative cohort. RESULTS All patients of the MITHRAS cohort (mean age 77 ± 9 years, 39% women) received their allocated treatment, and follow-up was completed for all MITHRAS and comparative cohort (mean age 77 ± 8 years, 47% women) patients. Twelve months post-TMVR, there was no significant difference in the combined endpoint of death or HF hospitalization within the MITHRAS cohort (iASD closure: 35% vs CT 50%; P = 0.26). The combined endpoint was more frequent among patients within the MITHRAS cohort as opposed to the comparative cohort (43% vs 17%; P < 0.0001), primarily driven by a higher rate of HF hospitalization (34% vs 8%; P = 0.004). CONCLUSIONS In this randomized controlled trial, interventional closure of a relevant iASD 1 month after TMVR did not result in improved clinical outcomes at 12 months post-TMVR. Patients with an iASD are at higher risk for HF hospitalization independent of iASD management and warrant close follow-up. (Closure of Iatrogenic Atrial Septal Defect Following Transcatheter Mitral Valve Repair [MITHRAS]; NCT03024268).
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Affiliation(s)
- Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany.
| | - Matthias Unterhuber
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany. https://twitter.com/m_unterhuber
| | - Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany. https://twitter.com/RommelPhilipp
| | - Karl-Patrik Kresoja
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany. https://twitter.com/KP_Kresoja
| | - Tobias Kister
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany
| | - Christian Besler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany
| | - Karl Fengler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany
| | - Marcus Sandri
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany
| | - Ingo Daehnert
- Department of Pediatric Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany. https://twitter.com/thiele_holger
| | - Stephan Blazek
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany. https://twitter.com/BlazekStephan
| | - Maximilian von Roeder
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany. https://twitter.com/mvonroeder
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Vogelhuber J, Weber M, Nickenig G. Transcatheter Leaflet Strategies for Tricuspid Regurgitation TriClip and CLASP. Interv Cardiol Clin 2021; 11:51-66. [PMID: 34838297 DOI: 10.1016/j.iccl.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since the recognition of the impact of significant tricuspid regurgitation on the clinical course and mortality, intensive efforts have been made in identifying and developing individually suitable and catheter-based therapy strategies to offer those often older and multimorbid patients at high surgical risk safe, feasible, and efficacious treatment options with justifiable risk. Up to now, transcatheter edge-to-edge repair with leaflet approximation devices such as TriClip (Abbott, Santa Clara, CA, USA) and PASCAL Implant System (Edwards Lifesciences, Irvine, CA, USA) have been evaluated best and several clinical trials could prove safety, feasibility, and efficacy of said devices leading to their recent CE mark. However, further randomized controlled trial are pending and necessary to evaluate their impact on clinical course and outcome in comparison to established treatment recommendations.
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Affiliation(s)
- Johanna Vogelhuber
- Heart Centre, Department of Cardiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Marcel Weber
- Heart Centre, Department of Cardiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Georg Nickenig
- Heart Centre, Department of Cardiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
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14
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Kavsur R, Iliadis C, Spieker M, Brachtendorf B, Tiyerili V, Metze C, Horn P, Baldus S, Kelm M, Nickenig G, Pfister R, Westenfeld R, Becher M. Predictors and prognostic relevance of tricuspid alterations in patients undergoing transcatheter edge-to-edge mitral valve repair. EUROINTERVENTION 2021; 17:827-834. [PMID: 33646125 PMCID: PMC9724950 DOI: 10.4244/eij-d-20-01094] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mitral valve repair may lead to alterations of tricuspid regurgitation (TR). AIMS We aimed to investigate alterations, predictors and prognostic relevance of TR evolution in a large-scale multicentre population of patients undergoing transcatheter mitral valve repair (TMVR) via the MitraClip. METHODS In total, we included 531 TMVR patients with at least one available follow-up echocardiography. TR improvement was defined as a TR ≥II at baseline, which showed a decline of at least one TR categorisation. RESULTS Distribution of preprocedural TR severity was TR 0/I 41% (220/531), TR II 39% (209/531) and TR ≥III 19% (102/531), respectively. Follow-up echocardiography was at 308±187 days. TR severity improved to TR 0/I 49% (259/531), TR II 35% (183/531) and TR III 17% (89/531), p=0.003. Out of 311 patients with TR ≥II at baseline, 41% (127/311) showed TR improvement. Atrial fibrillation (AF), residual mitral regurgitation ≥II (rMR) and tricuspid annular diameter (TAD) remained variables which prevented TR improvement (odds ratio 0.49 [0.29-0.84], 0.47 [0.27-0.81] and 0.97 [0.93-0.997], respectively). TR improvement was associated with better event-free survival regarding post-procedural heart failure hospitalisation (HHF) (hazard ratio 0.6 [0.38-0.94]). The main changes of TR severity occurred within 3 months post TMVR (p=0.006), while there were only minor TR changes between 3 and 12 months of follow-up (p=0.813). CONCLUSIONS TR improvement was frequent after TMVR. Predictors preventing TR improvement were AF, post-procedural rMR, and TAD. Furthermore, TR improvement was an early phenomenon occurring primarily within the first three months post TMVR and served as a suitable marker of reduced HHF.
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Affiliation(s)
- Refik Kavsur
- Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Christos Iliadis
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, Cologne, Germany
| | - Maximilian Spieker
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Vedat Tiyerili
- Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Clemens Metze
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, Cologne, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephan Baldus
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, Cologne, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Roman Pfister
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, Cologne, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marc Becher
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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15
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Affiliation(s)
| | - Marcel Weber
- Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, University Hospital Bonn, Bonn, Germany
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16
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Kreusser MM, Hamed S, Weber A, Schmack B, Volz MJ, Geis NA, Grossekettler L, Pleger ST, Ruhparwar A, Katus HA, Raake PW. MitraClip implantation followed by insertion of a left ventricular assist device in patients with advanced heart failure. ESC Heart Fail 2020; 7:3891-3900. [PMID: 33107214 PMCID: PMC7754960 DOI: 10.1002/ehf2.12982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/29/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022] Open
Abstract
Aims Mitral valve regurgitation (MR) is common in patients with advanced heart failure (HF). Percutaneous mitral valve repair (PMVR) via MitraClip (MC) has emerged as a feasible treatment strategy for these high‐risk patients. However, as HF often further progresses, there is a frequent need for left ventricular assist device (LVAD) implantation in these patients. We aimed to investigate whether prior MC implantation affects the subsequent LVAD implantation and outcome. Methods and results Thirty‐seven patients with advanced HF and significant MR who underwent LVAD implantation were retrospectively analysed. Follow‐up data were collected at 1 year after LVAD implantation. Primary endpoint was all‐cause mortality. Secondary endpoint included peri‐operative parameters and clinical development depicted as New York Heart Association (NYHA) class and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level. Seventeen patients initially received a MC device (MC group), resulting in a significant reduction in MR grade. After MC, NYHA class and INTERMACS level further worsened, leading to subsequent LVAD implantation after a median time of 475 days in the MC group. At LVAD implantation, overall characteristics were comparable with those of the patients undergoing LVAD implantation without prior MC placement (no‐MC group). Procedural data revealed a higher incidence of right ventricular (RV) failure needing mechanical RV assistance and a longer need for nitric oxide ventilation in the MC group after LVAD implantation. One‐year survival was slightly better in the no‐MC group compared with the MC group [41% (n = 7/17) vs. 65% (n = 13/20); P = 0.15], albeit event‐free survival was comparable between both groups, MC and no‐MC. Conclusions LVAD implantation after MC is feasible and safe. However, in patients with advanced HF and severe MR, PMVR may only delay a needed LVAD implantation and thereby lead to poorer peri‐operative RV function and impaired outcome. Arguably, these patients might benefit from the timely management of advanced HF by the means of early LVAD implantation or heart transplantation.
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Affiliation(s)
- Michael M Kreusser
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Sonja Hamed
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Andreas Weber
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Bastian Schmack
- Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.,Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre Essen, University of Duisburg-Essen, Hufelandstrasse 55, Essen, 45147, Germany
| | - Martin J Volz
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Nicolas A Geis
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Leonie Grossekettler
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Sven T Pleger
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.,Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre Essen, University of Duisburg-Essen, Hufelandstrasse 55, Essen, 45147, Germany
| | - Hugo A Katus
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Philip W Raake
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
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17
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Ludwig S, Kalbacher D, Schofer N, Schäfer A, Koell B, Seiffert M, Schirmer J, Schäfer U, Westermann D, Reichenspurner H, Blankenberg S, Lubos E, Conradi L. Early results of a real-world series with two transapical transcatheter mitral valve replacement devices. Clin Res Cardiol 2020; 110:411-420. [PMID: 33074368 PMCID: PMC7907022 DOI: 10.1007/s00392-020-01757-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/02/2020] [Indexed: 12/17/2022]
Abstract
Aims Transcatheter mitral valve replacement (TMVR) with dedicated devices promises to fill the treatment gap between open-heart surgery and edge-to-edge repair for patients with severe mitral regurgitation (MR). We herein present a single-centre experience of a TMVR series with two transapical devices. Methods and results A total of 11 patients were treated with the Tendyne™ (N = 7) or the Tiara™ TMVR systems (N = 4) from 2016 to 2020 either as compassionate-use procedures or as commercial implants. Clinical and echocardiographic data were collected at baseline, discharge and follow-up and are presented in accordance with the Mitral Valve Academic Research Consortium (MVARC) definitions. The study cohort [age 77 years (73, 84); 27.3% male] presented with primary (N = 4), secondary (N = 5) or mixed (N = 2) MR etiology. Patients were symptomatic (all NYHA III/IV) and at high surgical risk [logEuroSCORE II 8.1% (4.0, 17.4)]. Rates of impaired RV function (72.7%), severe pulmonary hypertension (27.3%), moderate or severe tricuspid regurgitation (63.6%) and prior aortic valve replacement (63.6%) were high. Severe mitral annulus calcification was present in two patients. Technical success was achieved in all patients. In 90.9% (N = 10) MR was completely eliminated (i.e. no or trace MR). Procedural and 30-day mortality were 0.0%. At follow-up NYHA class was I/II in the majority of patients. Overall mortality after 3 and 6 months was 10.0% and 22.2%. Conclusions TMVR was performed successfully in these selected patients with complete elimination of MR in the majority of patients. Short-term mortality was low and most patients experienced persisting functional improvement. Graphic abstract ![]()
Electronic supplementary material The online version of this article (10.1007/s00392-020-01757-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany. .,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany.
| | - D Kalbacher
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany
| | - N Schofer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - A Schäfer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - B Koell
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - M Seiffert
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany
| | - J Schirmer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - U Schäfer
- Marienkrankenhaus Hamburg, Department of Cardiology, Angiology and Intensive Care, Hamburg, Germany
| | - D Westermann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany
| | - H Reichenspurner
- Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany.,Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - S Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany
| | - E Lubos
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - L Conradi
- Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany.,Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
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18
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Raman J, Cochrane A. Fix Tricuspid Regurgitation Before It Gets Worse! Heart Lung Circ 2020; 29:1425-1426. [PMID: 33040857 DOI: 10.1016/j.hlc.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jaishankar Raman
- Austin & St Vincent's Hospitals, Melbourne University, Melbourne, Vic, Australia; Deakin University, Geelong & Melbourne, Vic, Australia; Oregon Health and Science University, Portland, OR, USA; University of Illinois at Urbana-Champaign, Champaign, IL, USA.
| | - Andrew Cochrane
- Department of Cardiothoracic Surgery, Monash Medical Centre, Melbourne, Vic, Australia; Department of Surgery, Monash University, Melbourne, Vic, Australia
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19
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Bartko PE, Arfsten H, Heitzinger G, Pavo N, Winter MP, Toma A, Strunk G, Hengstenberg C, Hülsmann M, Goliasch G. Natural history of bivalvular functional regurgitation. Eur Heart J Cardiovasc Imaging 2020; 20:565-573. [PMID: 30508183 DOI: 10.1093/ehjci/jey178] [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: 08/22/2018] [Accepted: 10/29/2018] [Indexed: 01/07/2023] Open
Abstract
AIMS Bivalvular functional regurgitation (BVFR) defined as concomitant mitral and tricuspid insufficiency has not been described or systematically assessed before. Therefore, this study sought to define incidence, impact and natural history of BVFR in heart failure with reduced ejection fraction (HFrEF) to provide the foundation for risk assessment and directions for potential treatment strategies. METHODS AND RESULTS We enrolled 1021 consecutive patients with HFrEF under guideline-directed medical therapy and performed comprehensive echocardiographic and neurohumoral profiling. All-cause mortality during a 5 years of follow-up served as the primary endpoint. Thirty percent of patients suffered from moderate or severe BVFR. Long-term mortality increased with the presence and severity of functional regurgitation (FR) with severe BVFR representing the highest risk-subset (P < 0.001). Severe BVFR patients were more symptomatic and displayed an adverse remodelling and neurohumoral activation pattern (all P < 0.05). Severe BVFR was associated with excess mortality independently of clinical [adjusted hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.39-1.84; P < 0.001] and echocardiographic (adjusted HR 1.31, 95% CI 1.11-1.54; P = 0.001) confounders, guideline-directed medical therapy (adjusted HR 1.55, 95% CI 1.35-1.79; P < 0.001) and neurohumoral activation (adjusted HR 1.31, 95% CI 1.07-1.59; P = 0.009). Moderate BVFR (n = 99) comprised equal baseline characteristics and similar risk as isolated severe FR (HR 0.95, 95% CI 0.69-1.30; P = 0.73). CONCLUSION This long-term outcome study shows the multi-faceted nature of FR and defines BVFR as an important clinical entity associated with impaired functional class, adverse cardiac remodelling, and excess risk of mortality. Moderate BVFR conveys similar risk as isolated severe FR reflecting the deleterious impact of the global regurgitant load on the failing heart and the need of an integrated understanding for risk-assessment.
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Affiliation(s)
- Philipp E Bartko
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A Vienna, Austria
| | - Henrike Arfsten
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A Vienna, Austria
| | - Gregor Heitzinger
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A Vienna, Austria
| | - Noemi Pavo
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A Vienna, Austria
| | - Max-Paul Winter
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A Vienna, Austria
| | - Aurel Toma
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A Vienna, Austria
| | - Guido Strunk
- FH Campus Vienna and Complexity Research, Favoritenstraße 226, A Vienna, Austria
| | - Christian Hengstenberg
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A Vienna, Austria
| | - Martin Hülsmann
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A Vienna, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A Vienna, Austria
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20
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Ben-Shoshan J, Overtchook P, Buithieu J, Mousavi N, Martucci G, Spaziano M, de Varennes B, Lachapelle K, Brophy J, Modine T, Baumbach A, Maisano F, Prendergast B, Tamburino C, Windecker S, Piazza N. Predictors of Outcomes Following Transcatheter Edge-to-Edge Mitral Valve Repair. JACC Cardiovasc Interv 2020; 13:1733-1748. [DOI: 10.1016/j.jcin.2020.03.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 01/20/2023]
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22
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Godino C, Munafò A, Sisinni A, Margonato A, Saia F, Montorfano M, Agricola E, Alfieri O, Colombo A, Senni M. MitraClip Treatment of Secondary Mitral Regurgitation in Heart Failure with Reduced Ejection Fraction: Lessons and Implications from Trials and Registries. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2020. [DOI: 10.1080/24748706.2020.1753899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Cosmo Godino
- Cardiothoracic Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Munafò
- Cardiothoracic Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Sisinni
- Cardiothoracic Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Margonato
- Cardiothoracic Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Saia
- Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Matteo Montorfano
- Cardiothoracic Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Cardiothoracic Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio Alfieri
- Cardiothoracic Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Michele Senni
- Cardiology Division, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
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23
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Post-procedural tricuspid regurgitation predicts long-term survival in patients undergoing percutaneous mitral valve repair. J Cardiol 2019; 74:524-531. [DOI: 10.1016/j.jjcc.2019.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/06/2019] [Accepted: 05/13/2019] [Indexed: 12/28/2022]
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24
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Nickenig G, Weber M, Lurz P, von Bardeleben RS, Sitges M, Sorajja P, Hausleiter J, Denti P, Trochu JN, Näbauer M, Dahou A, Hahn RT. Transcatheter edge-to-edge repair for reduction of tricuspid regurgitation: 6-month outcomes of the TRILUMINATE single-arm study. Lancet 2019; 394:2002-2011. [PMID: 31708188 DOI: 10.1016/s0140-6736(19)32600-5] [Citation(s) in RCA: 244] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/09/2019] [Accepted: 09/16/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Tricuspid regurgitation is a prevalent disease associated with high morbidity and mortality, with few treatment options. The aim of the TRILUMINATE trial is to evaluate the safety and effectiveness of TriClip, a minimally invasive transcatheter tricuspid valve repair system, for reducing tricuspid regurgitation. METHODS The TRILUMINATE trial is a prospective, multicentre, single-arm study in 21 sites in Europe and the USA. Patients with moderate or greater triscuspid regurgitation, New York Heart Association class II or higher, and who were adequately treated per applicable standards were eligible for enrolment. Patients were excluded if they had systolic pulmonary artery pressure of more than 60 mm Hg, a previous tricuspid valve procedure, or a cardiovascular implantable electronic device that would inhibit TriClip placement. Participants were treated using a clip-based edge-to-edge repair technique with the TriClip tricuspid valve repair system. Tricuspid regurgitation was graded using a five-class grading scheme (mild, moderate, severe, massive, and torrential) that expanded on the standard American Society of Echocardiography grading scheme. The primary efficacy endpoint was a reduction in tricuspid regurgitation severity by at least one grade at 30 days post procedure, with a performance goal of 35%, analysed in all patients who had an attempted tricuspid valve repair procedure upon femoral vein puncture. The primary safety endpoint was a composite of major adverse events at 6 months, with a performance goal of 39%. Patients were excluded from the primary safety analysis if they did not reach 6-month follow-up and did not have a major adverse event during previous follow-ups. The trial has completed enrolment and follow-up is ongoing; it is registered with ClinicalTrials.gov, number NCT03227757. FINDINGS Between Aug 1, 2017, and Nov 29, 2018, 85 patients (mean age 77·8 years [SD 7·9]; 56 [66%] women) were enrolled and underwent successful TriClip implantation. Tricuspid regurgitation severity was reduced by at least one grade at 30 days in 71 (86%) of 83 patients who had available echocardiogram data and imaging. The one-sided lower 97·5% confidence limit was 76%, which was greater than the prespecified performance goal of 35% (p<0·0001). One patient withdrew before 6-month follow-up without having had a major adverse event and was excluded from analysis of the primary safety endpoint. At 6 months, three (4%) of 84 patients experienced a major adverse event, which was less than the prespecified performance goal of 39% (p<0·0001). Single leaflet attachment occurred in five (7%) of 72 patients. No periprocedural deaths, conversions to surgery, device embolisations, myocardial infarctions, or strokes occurred. At 6 months, all-cause mortality had occurred in four (5%) of 84 patients. INTERPRETATION The TriClip system appears to be safe and effective at reducing tricuspid regurgitation by at least one grade. This reduction could translate to significant clinical improvement at 6 months post procedure. FUNDING Abbott.
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Affiliation(s)
| | - Marcel Weber
- Heart Center, University Hospital, Bonn, Germany
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | - Marta Sitges
- Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Barcelona, Spain
| | - Paul Sorajja
- Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Jörg Hausleiter
- Medizinische Klinik I der Ludwig-Maximilians Universität München, Munich, Germany
| | | | | | - Michael Näbauer
- Medizinische Klinik I der Ludwig-Maximilians Universität München, Munich, Germany
| | | | - Rebecca T Hahn
- The Cardiovascular Research Foundation, New York, NY, USA; New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
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Kriechbaum SD, Boeder NF, Gaede L, Arnold M, Vigelius-Rauch U, Roth P, Sander M, Böning A, Bayer M, Elsässer A, Möllmann H, Hamm CW, Nef HM. Mitral valve leaflet repair with the new PASCAL system: early real-world data from a German multicentre experience. Clin Res Cardiol 2019; 109:549-559. [PMID: 31451915 DOI: 10.1007/s00392-019-01538-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/02/2019] [Indexed: 12/16/2022]
Abstract
AIMS To examine the clinical experience and practical use of the PASCAL transcatheter valve repair system (Edwards Lifesciences, Irvine, CA, USA) and to report some of the first clinical results. METHODS AND RESULTS A total of 18 consecutive patients with severe, symptomatic mitral regurgitation (MR) were included in this German multicentre registry. All patients underwent clinical, echocardiographic, and laboratory assessment prior to the PASCAL procedure and before hospital discharge. MR was classified as functional in 6 patients, degenerative in 2, and combined in 10. All except one received a single PASCAL implant. The preprocedural severe MR present in all patients was reduced: grade 0 in 4 (22.2%), grade I in 11 (61.1%), grade II in 3 (16.7%). The v-wave was significantly reduced from 31.7 ± 9.5 to 18 ± 7.7 mmHg (p < 0.001). Independent leaflet capture, performed in 4 (22.2%) of the patients, wide clasps, and the 10-mm central spacer are features of the PASCAL device to optimize mitral leaflet repair. There were no periprocedural complications. CONCLUSION PASCAL is a safe and effective mitral valve repair device for the treatment of severe MR. Device-specific features allow valve repair tailored to the individual anatomy of the underlying mitral pathology in each patient.
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Affiliation(s)
- Steffen D Kriechbaum
- Department of Cardiology and Angiology, Medical Clinic I, Universitätsklinikum Gießen and Marburg, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany.
| | - Niklas F Boeder
- Department of Cardiology and Angiology, Medical Clinic I, Universitätsklinikum Gießen and Marburg, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Luise Gaede
- Medical Clinic 2, University Hospital of Erlangen, Giessen, Germany
| | - Martin Arnold
- Medical Clinic 2, University Hospital of Erlangen, Giessen, Germany
| | | | - Peter Roth
- Department of Adult and Paediatric Cardiovascular Surgery, University of Giessen, Giessen, Germany
| | - Michael Sander
- Department of Anaesthesiology, University of Giessen, Giessen, Germany
| | - Andreas Böning
- Department of Adult and Paediatric Cardiovascular Surgery, University of Giessen, Giessen, Germany
| | - Matthias Bayer
- Department of Cardiology and Angiology, Medical Clinic I, Universitätsklinikum Gießen and Marburg, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Albrecht Elsässer
- Department of Cardiology, University of Oldenburg, Oldenburg, Germany
| | - Helge Möllmann
- Medical Clinic I, Department of Cardiology, St-Johannes-Hospital, Dortmund, Germany
| | - Christian W Hamm
- Department of Cardiology and Angiology, Medical Clinic I, Universitätsklinikum Gießen and Marburg, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Holger M Nef
- Department of Cardiology and Angiology, Medical Clinic I, Universitätsklinikum Gießen and Marburg, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
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Nickenig G, Weber M. Another Piece in the Tricuspid Puzzle. JACC Cardiovasc Interv 2019; 12:1435-1437. [DOI: 10.1016/j.jcin.2019.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/19/2019] [Indexed: 11/30/2022]
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27
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Xu A, Jin J, Li X, Xiao J, Zhu P, Gong W, Liu Y, Yu Y, Wang C, Zhang C, Hameed I, Salemi A, Hernandez-Vaquero D, Rajab TK, Nappi F, Shen J, Chen B. Mitral valve restenosis after closed mitral commissurotomy: case discussion. J Thorac Dis 2019; 11:3659-3671. [PMID: 31559074 DOI: 10.21037/jtd.2019.08.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Anyi Xu
- Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 318000, China
| | - Jiang Jin
- Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 318000, China
| | - Xiaodong Li
- Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 318000, China
| | - Jian Xiao
- Changzheng Hospital Affiliated to Shanghai Secondary Military Medical University, Shanghai 200000, China
| | - Peng Zhu
- South Hospital of Southern Medical University, Guangzhou 510000, China
| | - Wenhui Gong
- The First Affiliated Hospital of Anhui Medical University, Hefei 230031, China
| | - Yue Liu
- The First Affiliated Hospital of Harbin Medical University, Harbin 150000, China
| | - Yuetian Yu
- Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200000, China
| | | | - Chengxin Zhang
- First Affiliated Hospital of Anhui Medical University, Hefei 230000, China
| | - Irbaz Hameed
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Arash Salemi
- Department of Cardiothoracic Surgery, RWJ/Barnabas Health, Rutgers University, NJ, USA
| | | | | | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Jianfei Shen
- Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 318000, China
| | - Baofu Chen
- Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 318000, China
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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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29
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6-Month Outcomes of Tricuspid Valve Reconstruction for Patients With Severe Tricuspid Regurgitation. J Am Coll Cardiol 2019; 73:1905-1915. [DOI: 10.1016/j.jacc.2019.01.062] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/14/2019] [Accepted: 01/21/2019] [Indexed: 01/08/2023]
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Transcatheter Tricuspid and Mitral Valve Edge-to-Edge Repair: The Double Double Orifice. CASE 2018; 2:164-173. [PMID: 30370377 PMCID: PMC6200677 DOI: 10.1016/j.case.2018.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Tricuspid regurgitation with mitral valve disease is associated with poor outcomes. Transcatheter edge-to-edge repair of the tricuspid valve can be done successfully. Intraprocedural echocardiography is essential for transcatheter tricuspid therapies.
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31
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Alkhouli M, Berzingi C, Kowatli A, Alqahtani F, Badhwar V. Comparative early outcomes of tricuspid Valve repair versus replacement for secondary tricuspid regurgitation. Open Heart 2018; 5:e000878. [PMID: 30228911 PMCID: PMC6135435 DOI: 10.1136/openhrt-2018-000878] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/18/2018] [Accepted: 08/14/2018] [Indexed: 01/21/2023] Open
Abstract
Background Comparative outcome data on tricuspid valve repair (TVr) versus tricuspid valve replacement (TVR) for severe secondary tricuspid regurgitation (TR) are limited. Methods We used a national inpatient sample to assess in-hospital morbidity and mortality, length of stay and cost in patients with severe secondary TR undergoing isolated TVr versus TVR. Results A total of 1364 patients (national estimate=6757) underwent isolated tricuspid valve surgery during the study period, of whom 569 (41.7%) had TVr and 795 (58.3%) had TVR. There was no difference in the prevalence of major morbidities between the two groups, except for liver disease and hepatic cirrhosis, which were more common in the TVR group. Before propensity matching, in-hospital mortality was similar between patients who underwent isolated TVr and TVR (8.1% vs 10.8%, p=0.093), but the incidence of postoperative morbidities differed: TVR was associated with higher rates of permanent pacemaker implantation and blood transfusion, while TVr was associated with more acute kidney injury. After rigorous propensity score matching, TVR was associated with significantly higher rates of in-hospital death (12% vs 6.9%, p=0.009) and permanent pacemaker implantation (33.7% vs 11.2%, p<0.001). Postoperative morbidities and length of stay, however, were not different between the two groups. Nonetheless, cost of hospitalisation was 16% higher in the TVr group. Conclusions In patients undergoing isolated surgery for secondary TR, TVR is associated with higher in-hospital mortality and need for permanent pacemaker compared with TVr. Further studies are needed to understand the impact of the type of surgery on the short-term and long-term mortality in this complex undertreated population.
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Affiliation(s)
- Mohamad Alkhouli
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
| | - Chalak Berzingi
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
| | - Amer Kowatli
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
| | - Fahad Alqahtani
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
| | - Vinay Badhwar
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
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Invasive hemodynamics and cardiac biomarkers to predict outcomes after percutaneous edge-to-edge mitral valve repair in patients with severe heart failure. Clin Res Cardiol 2018; 108:375-387. [PMID: 30191296 DOI: 10.1007/s00392-018-1365-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/30/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Percutaneous mitral valve repair (PMVR) via MitraClip implantation is a therapeutic option for high-risk or non-surgical candidates with severe mitral regurgitation (MR) and advanced stages of heart failure (HF). However, these patients have a high mortality despite PMVR, and predictors for outcomes are not well established. Here, we evaluated invasive hemodynamics, echocardiography parameters, and biomarkers to predict outcomes after PMVR in severe HF patients. METHODS Patients with reduced ejection fraction (EF) and severe and moderate-to-severe MR undergoing PMVR at our centre between September 2009 and January 2016 were analysed retrospectively. Inclusion criteria were: left ventricular EF < 45%, preoperative right heart catheterization, successful MitraClip deployment ("technical success"), and follow-up for at least 1 year after the procedure. Data from preoperative right heart catheterization, echocardiography, and biomarkers were assessed. Primary endpoint was all-cause mortality at 1 year after PMVR. We performed univariate and multivariate Cox regression analyses and generated a risk score to predict outcomes. RESULTS Of 174 patients with PMVR and severe HF, 79.9% had functional MR. Mean EF was 25% (17.2; 30.7) and advanced New York Heart Association functional class was prevalent (class II: 13%; class III: 70%; and class IV: 17%). The cumulative incidences of all-cause death were 6.9% and 17.8% at 30 days and 1 year, respectively. In the Cox multivariate model, high-sensitive troponin T [hsTnT; hazard ratio (HR) 1.01; confidence interval (CI) 1.01-1.02; p < 0.0001] and mixed venous O2-saturation (HR 0.92; CI 0.89-0.96; p < 0.0001) were found to significantly and independently predict outcomes. A simple risk score including these two parameters was sufficient to discriminate between low- and high-risk patients (HR 7.22; CI 3.4-15.5; p < 0.001). CONCLUSION In a cohort of patients with severe HF undergoing PMVR, patients with elevated hsTnT and reduced mixed venous O2-saturation carried the worst prognosis. A simple risk score including these two parameters may improve patient selection and outcomes after PMVR.
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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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Amano M, Izumi C, Taniguchi T, Morimoto T, Miyake M, Nishimura S, Kitai T, Kato T, Kadota K, Ando K, Furukawa Y, Inada T, Inoko M, Ishii K, Sakaguchi G, Yamazaki F, Koyama T, Komiya T, Yamanaka K, Nishiwaki N, Kanemitsu N, Saga T, Ogawa T, Nakayama S, Tsuneyoshi H, Iwakura A, Shiraga K, Hanyu M, Ohno N, Fukumoto A, Yamada T, Nishizawa J, Esaki J, Minatoya K, Nakagawa Y, Kimura T. Impact of concomitant tricuspid regurgitation on long-term outcomes in severe aortic stenosis. Eur Heart J Cardiovasc Imaging 2018; 20:353-360. [DOI: 10.1093/ehjci/jey105] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/16/2018] [Accepted: 07/04/2018] [Indexed: 02/07/2023] Open
Affiliation(s)
- Masashi Amano
- Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, Japan
| | - Chisato Izumi
- Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, Japan
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Makoto Miyake
- Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, Japan
| | - Shunsuke Nishimura
- Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, Japan
| | - Takeshi Kitai
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyusyu, Japan
| | - Yutaka Furukawa
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tsukasa Inada
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Moriaki Inoko
- Cardiovascular Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Katsuhisa Ishii
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Fumio Yamazaki
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kazuo Yamanaka
- Department of Cardiovascular Surgery, Tenri Hospital, Tenri, Japan
| | - Noboru Nishiwaki
- Department of Cardiovascular Surgery, Kindai University Nara Hospital, Ikoma, Japan
| | - Naoki Kanemitsu
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Toshihiko Saga
- Department of Cardiovascular Surgery, Kindai University Hospital, Osakasayama, Japan
| | - Tatsuya Ogawa
- Department of Cardiovascular Surgery, Kishiwada City Hospital, Kishiwada, Japan
| | - Shogo Nakayama
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Hiroshi Tsuneyoshi
- Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Atsushi Iwakura
- Department of Cardiovascular Surgery, Japan Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Kotaro Shiraga
- Department of Cardiovascular Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, Cardiovascular Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Atsushi Fukumoto
- Department of Cardiovascular Surgery, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Tomoyuki Yamada
- Department of Cardiovascular Surgery, Shiga Medical Center for Adults, Moriyama, Japan
| | - Junichiro Nishizawa
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Jiro Esaki
- Department of Cardiovascular Surgery, Otsu Red Cross Hospital, Otsu, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Atrioventricular valve disease: challenges and achievements in percutaneous treatment. Clin Res Cardiol 2018; 107:88-93. [DOI: 10.1007/s00392-018-1303-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/13/2018] [Indexed: 01/20/2023]
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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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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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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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Lauten A, Figulla HR, Unbehaun A, Fam N, Schofer J, Doenst T, Hausleiter J, Franz M, Jung C, Dreger H, Leistner D, Alushi B, Stundl A, Landmesser U, Falk V, Stangl K, Laule M. Interventional Treatment of Severe Tricuspid Regurgitation. Circ Cardiovasc Interv 2018; 11:e006061. [DOI: 10.1161/circinterventions.117.006061] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/18/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Alexander Lauten
- From the Charité – Universitätsmedizin Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., V.F.); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., A.U., V.F.); Friedrich-Schiller-Universitaet Jena, Germany (H.R.F., T.D., M.F.); Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (A.S.); German Heart Center Berlin (A.U., V.F.); Division of Cardiology, St. Michaels Hospital, Toronto, Canada (N.F.)
| | - Hans R. Figulla
- From the Charité – Universitätsmedizin Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., V.F.); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., A.U., V.F.); Friedrich-Schiller-Universitaet Jena, Germany (H.R.F., T.D., M.F.); Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (A.S.); German Heart Center Berlin (A.U., V.F.); Division of Cardiology, St. Michaels Hospital, Toronto, Canada (N.F.)
| | - Axel Unbehaun
- From the Charité – Universitätsmedizin Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., V.F.); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., A.U., V.F.); Friedrich-Schiller-Universitaet Jena, Germany (H.R.F., T.D., M.F.); Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (A.S.); German Heart Center Berlin (A.U., V.F.); Division of Cardiology, St. Michaels Hospital, Toronto, Canada (N.F.)
| | - Neil Fam
- From the Charité – Universitätsmedizin Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., V.F.); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., A.U., V.F.); Friedrich-Schiller-Universitaet Jena, Germany (H.R.F., T.D., M.F.); Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (A.S.); German Heart Center Berlin (A.U., V.F.); Division of Cardiology, St. Michaels Hospital, Toronto, Canada (N.F.)
| | - Joachim Schofer
- From the Charité – Universitätsmedizin Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., V.F.); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., A.U., V.F.); Friedrich-Schiller-Universitaet Jena, Germany (H.R.F., T.D., M.F.); Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (A.S.); German Heart Center Berlin (A.U., V.F.); Division of Cardiology, St. Michaels Hospital, Toronto, Canada (N.F.)
| | - Torsten Doenst
- From the Charité – Universitätsmedizin Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., V.F.); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., A.U., V.F.); Friedrich-Schiller-Universitaet Jena, Germany (H.R.F., T.D., M.F.); Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (A.S.); German Heart Center Berlin (A.U., V.F.); Division of Cardiology, St. Michaels Hospital, Toronto, Canada (N.F.)
| | - Joerg Hausleiter
- From the Charité – Universitätsmedizin Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., V.F.); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., A.U., V.F.); Friedrich-Schiller-Universitaet Jena, Germany (H.R.F., T.D., M.F.); Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (A.S.); German Heart Center Berlin (A.U., V.F.); Division of Cardiology, St. Michaels Hospital, Toronto, Canada (N.F.)
| | - Marcus Franz
- From the Charité – Universitätsmedizin Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., V.F.); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., A.U., V.F.); Friedrich-Schiller-Universitaet Jena, Germany (H.R.F., T.D., M.F.); Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (A.S.); German Heart Center Berlin (A.U., V.F.); Division of Cardiology, St. Michaels Hospital, Toronto, Canada (N.F.)
| | - Christian Jung
- From the Charité – Universitätsmedizin Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., V.F.); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., A.U., V.F.); Friedrich-Schiller-Universitaet Jena, Germany (H.R.F., T.D., M.F.); Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (A.S.); German Heart Center Berlin (A.U., V.F.); Division of Cardiology, St. Michaels Hospital, Toronto, Canada (N.F.)
| | - Henryk Dreger
- From the Charité – Universitätsmedizin Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., V.F.); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., A.U., V.F.); Friedrich-Schiller-Universitaet Jena, Germany (H.R.F., T.D., M.F.); Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (A.S.); German Heart Center Berlin (A.U., V.F.); Division of Cardiology, St. Michaels Hospital, Toronto, Canada (N.F.)
| | - David Leistner
- From the Charité – Universitätsmedizin Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., V.F.); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., A.U., V.F.); Friedrich-Schiller-Universitaet Jena, Germany (H.R.F., T.D., M.F.); Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (A.S.); German Heart Center Berlin (A.U., V.F.); Division of Cardiology, St. Michaels Hospital, Toronto, Canada (N.F.)
| | - Brunilda Alushi
- From the Charité – Universitätsmedizin Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., V.F.); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., A.U., V.F.); Friedrich-Schiller-Universitaet Jena, Germany (H.R.F., T.D., M.F.); Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (A.S.); German Heart Center Berlin (A.U., V.F.); Division of Cardiology, St. Michaels Hospital, Toronto, Canada (N.F.)
| | - Anja Stundl
- From the Charité – Universitätsmedizin Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., V.F.); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., A.U., V.F.); Friedrich-Schiller-Universitaet Jena, Germany (H.R.F., T.D., M.F.); Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (A.S.); German Heart Center Berlin (A.U., V.F.); Division of Cardiology, St. Michaels Hospital, Toronto, Canada (N.F.)
| | - Ulf Landmesser
- From the Charité – Universitätsmedizin Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., V.F.); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., A.U., V.F.); Friedrich-Schiller-Universitaet Jena, Germany (H.R.F., T.D., M.F.); Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (A.S.); German Heart Center Berlin (A.U., V.F.); Division of Cardiology, St. Michaels Hospital, Toronto, Canada (N.F.)
| | - Volkmar Falk
- From the Charité – Universitätsmedizin Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., V.F.); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., A.U., V.F.); Friedrich-Schiller-Universitaet Jena, Germany (H.R.F., T.D., M.F.); Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (A.S.); German Heart Center Berlin (A.U., V.F.); Division of Cardiology, St. Michaels Hospital, Toronto, Canada (N.F.)
| | - Karl Stangl
- From the Charité – Universitätsmedizin Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., V.F.); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., A.U., V.F.); Friedrich-Schiller-Universitaet Jena, Germany (H.R.F., T.D., M.F.); Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (A.S.); German Heart Center Berlin (A.U., V.F.); Division of Cardiology, St. Michaels Hospital, Toronto, Canada (N.F.)
| | - Michael Laule
- From the Charité – Universitätsmedizin Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., V.F.); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany (A.L., H.D., D.L., B.A., U.L., K.S., M.L., A.U., V.F.); Friedrich-Schiller-Universitaet Jena, Germany (H.R.F., T.D., M.F.); Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (A.S.); German Heart Center Berlin (A.U., V.F.); Division of Cardiology, St. Michaels Hospital, Toronto, Canada (N.F.)
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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: 102] [Impact Index Per Article: 14.6] [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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