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Kaneyuki D, Jordan AM, Rosen JL, Macmillan TR, Morris RJ, Tchantchaleishvili V. Isolated Tricuspid Valve Surgery for Functional Tricuspid Regurgitation. Thorac Cardiovasc Surg 2024. [PMID: 38580322 DOI: 10.1055/a-2300-6791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
BACKGROUND Severe tricuspid regurgitation (TR) adversely affects long-term survival; however, isolated tricuspid valve (TV) surgery has been rarely performed due to high operative mortality. In addition, the previous literature included heterogeneous TR etiologies. Therefore, we aimed to elucidate early and long-term outcomes of isolated TV surgery for functional TR. METHODS An electronic search was performed to identify all relevant studies. Baseline characteristics, perioperative variables, and clinical outcomes were extracted and pooled for meta-analysis. RESULTS This meta-analysis included seven studies. Pooled analyses showed that 68% (35, 89) of patients had preoperative atrial fibrillation or flutter, and 58% (11, 94) had a history of left-sided valve surgery. Seventy-three percent (65, 80) of patients had at least one physical exam finding of right-sided heart failure, and 57% (44, 69) were in New York Heart Association class III or IV. TV replacement was more common than repair. In TV replacement, bioprosthetic valve (39%, 13, 74) was more common than mechanical prosthesis (22%, 18, 26). The early mortality rate was 7%. Twenty percent of patients required a permanent pacemaker postoperatively. The overall 1- and 5-year survival rates were 84.5 and 69.1%, respectively. CONCLUSION More than half of the patients who underwent isolated TV surgery for functional TR had undergone left-sided valve surgery and had significant heart failure symptoms at the time of surgery. Further studies on the surgical indication for concomitant TV surgery at the time of left-sided valve surgery and the appropriate timing of surgery for isolated functional TR are needed to improve survival.
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Affiliation(s)
- Daisuke Kaneyuki
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Andrew M Jordan
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Jake L Rosen
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Thomas Reese Macmillan
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Rohinton J Morris
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Vakhtang Tchantchaleishvili
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
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Park I, Chung S, Cho YH, Sung K, Kim WS, Song K, Ahn JH, Jeon CS, Park PW, Jeong DS. Outcomes of Concomitant Maze Procedure in Tricuspid Repair for Severe Tricuspid Regurgitation. J Korean Med Sci 2024; 39:e143. [PMID: 38651225 PMCID: PMC11035715 DOI: 10.3346/jkms.2024.39.e143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND We aimed to analyze the impact of concomitant Maze procedure on the clinical and rhythm outcomes, and echocardiographic parameters in tricuspid repair for patients with severe tricuspid regurgitation (TR) and persistent atrial fibrillation (AF). METHODS Patients who had severe TR and persistent AF and underwent tricuspid valve (TV) repair were included in the study. Both primary TR and secondary TR were included in the current study. The study population was stratified according to Maze procedure. The primary outcome was major adverse cardiovascular and cerebrovascular event (MACCE) at 15 years post-surgery. Propensity-score matching analyses was performed to adjust baseline differences. RESULTS Three hundred seventy-one patients who underwent tricuspid repair for severe TR and persistent AF from 1994 to 2021 were included, and 198 patients (53.4%) underwent concomitant Maze procedure. The maze group showed 10-year sinus rhythm (SR) restoration rate of 55%. In the matched cohort, the maze group showed a lower cumulative incidence of cardiac death (4.6% vs. 14.4%, P = 0.131), readmission for heart failure (8.1% vs. 22.2%, P = 0.073), and MACCE (21.1% vs. 42.1%, P = 0.029) at 15 years compared to the non-maze group. Left atrial (LA) diameter significantly decreased in the maze group at 5 years (53.3 vs. 59.6 mm, P < 0.001) after surgery compared to preoperative level, and there was a significant difference in the change of LA diameter over time between the two groups (P = 0.013). CONCLUSION The Maze procedure during TV repair in patients with severe TR and persistent AF showed acceptable SR rates and lower MACCE rates compared to those without the procedure, while also promoting LA reverse remodeling.
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Affiliation(s)
- Ilkun Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suryeun Chung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungsub Song
- Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Joong Hyun Ahn
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang Seok Jeon
- Department of Thoracic and Cardiovascular Surgery, Incheon Sejong Hospital, Incheon, Korea
| | - Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Incheon Sejong Hospital, Incheon, Korea
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Zhu QM, Berry N. Tricuspid Regurgitation: Disease State and Advances in Percutaneous Therapy. Eur Cardiol 2023; 18:e55. [PMID: 37860699 PMCID: PMC10583156 DOI: 10.15420/ecr.2023.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/31/2023] [Indexed: 10/21/2023] Open
Abstract
Tricuspid regurgitation (TR) is a relatively common finding. There has been growing recognition of the morbidity and adverse prognosis of severe TR, which affects 1.6 million people in the US. However, symptomatic TR remains undertreated despite emerging therapeutic modalities. In this review, the pathophysiological and epidemiological features of TR are examined and the diagnosis, natural history, and clinical presentation are discussed. An overview of TR therapy is provided, including medical and surgical treatments, as well as novel percutaneous approaches. The currently available studies on percutaneous therapy demonstrate promise for transcatheter valve repair and replacement with favourable clinical outcomes and short-term durability. However, further study is needed.
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Affiliation(s)
- Qiuyu Martin Zhu
- Kaiser Permanente Mid-Atlantic States Internal Medicine Residency Program Gaithersburg, MD, US
| | - Natalia Berry
- Mid-Atlantic Permanente Medical Group McLean, VA, US
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Akintoye E, Wang TKM, Nakhla M, Ali AH, Fava AM, Akyuz K, Popovic ZB, Pettersson GB, Gillinov AM, Xu B, Griffin BP, Desai MY. Quantitative Echocardiographic Assessment and Optimal Criteria for Early Intervention in Asymptomatic Tricuspid Regurgitation. JACC Cardiovasc Imaging 2023; 16:13-24. [PMID: 36274042 DOI: 10.1016/j.jcmg.2022.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/11/2022] [Accepted: 08/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Significant tricuspid regurgitation (TR) is associated with poor outcome and high operative mortality resulting from late presentation. Yet, the optimal timing for intervention is unknown. OBJECTIVES The purpose of this study was to evaluate the prognostic value of echocardiographic parameters to inform early intervention in asymptomatic TR. METHODS Using the Cleveland Clinic echocardiography database 2004 to 2018, the authors identified a consecutive cohort of asymptomatic patients with moderate to severe (3+) or severe (4+) TR. Quantitative TR and right heart parameters were retrospectively determined, and their prognostic utility for all-cause mortality was assessed. RESULTS In 325 asymptomatic patients (mean age: 67.9 years; 79.4% female) with at least 3+ TR, there were 132 deaths (40.6%), with a median survival time of 9.9 years (95% CI: 7.9-12.7 years). By contrast, the median survival time in an age- and sex-matched cohort of symptomatic TR patients was 4.4 years (95% CI: 2.8-5.9 years). Among all the echocardiographic parameters evaluated, right ventricle free wall strain (RVFWS) and tricuspid regurgitant volume (RVol) were the strongest predictors of mortality in asymptomatic TR. The optimal discriminatory thresholds for these parameters were RVFWS <-19% and RVol >45 mL. The 5-year survival rates by number of risk factors (RF) were 93% (95% CI: 86%-96%), 65% (95% CI: 55%-74%), and 38% (95% CI: 26%-49%) for no RF, 1 RF, and both RFs, respectively. Compared with symptomatic TR, mortality was lower for asymptomatic TR with no RF (HR: 0.10; 95% CI: 0.04-0.29) or 1 RF (HR: 0.29; 95% CI: 0.14-0.58), but similar for asymptomatic TR with both RFs (HR: 1.11; 95% CI: 0.56-2.19). CONCLUSIONS RVFWS and RVol are key prognostic markers that can be serially monitored to inform optimal timing of intervention for severe asymptomatic TR.
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Affiliation(s)
- Emmanuel Akintoye
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio, USA
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio, USA
| | - Michael Nakhla
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio, USA
| | - Adel Hajj Ali
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio, USA
| | - Agostina M Fava
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio, USA
| | - Kevser Akyuz
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio, USA
| | - Zoran B Popovic
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio, USA
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio, USA
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio, USA
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio, USA
| | - Milind Y Desai
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio, USA.
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Wang TKM, Akintoye E. Atrial Functional Tricuspid Regurgitation: Do We Blame the AF, Right Atrium, or Both? JACC Cardiovasc Imaging 2022; 16:588-590. [PMID: 36752438 DOI: 10.1016/j.jcmg.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Emmanuel Akintoye
- Section of Cardiovascular Imaging, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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