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Badano LP, Tomaselli M, Muraru D, Galloo X, Li CHP, Ajmone Marsan N. Advances in the Assessment of Patients With Tricuspid Regurgitation: A State-of-the-Art Review on the Echocardiographic Evaluation Before and After Tricuspid Valve Interventions. J Am Soc Echocardiogr 2024; 37:1083-1102. [PMID: 39029717 DOI: 10.1016/j.echo.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 05/24/2024] [Accepted: 07/09/2024] [Indexed: 07/21/2024]
Abstract
Tricuspid regurgitation (TR) can have a significant impact on the health and mortality of a patient. Unfortunately, many patients with advanced right-sided heart failure are not referred for isolated tricuspid valve (TV) surgery in a timely manner. This delayed referral has resulted in a high in-hospital mortality rate and significant undertreatment. Fortunately, transcatheter TV intervention (TTVI) has emerged as a safe and effective alternative to surgery, successfully reducing TR severity and improving patients' quality of life. Current guidelines emphasize the importance of assessing TR severity and its impact on the right heart chambers for selecting the appropriate intervention. However, the echocardiographic assessment of both right chambers and TV anatomy, along with TR severity, poses specific challenges, leading to the underestimation of TR severity. Recently, three-dimensional echocardiography has become crucial to enhance the characterization of TR severity. Moreover, it is essential to evaluate residual TR after TTVI to gauge the intervention's success and predict the patient's prognosis. This review provides a thorough evaluation of the echocardiographic parameters used to assess TR severity before and after TTVI. It presents a critical analysis of the accuracy and reliability of these parameters, highlighting their strengths and limitations to establish standardized diagnostic criteria and treatment protocols for TR, which will inform clinical decision-making and improve patient outcomes.
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Affiliation(s)
- Luigi P Badano
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, MIlan, Italy
| | - Michele Tomaselli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, MIlan, Italy
| | - Xavier Galloo
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, University Hospital Brussels, Brussels, Belgium
| | - Chi Hion Pedro Li
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, Barcelona, Spain
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Ke Y, Hua L, Pang S, Wang Q, Zhang Z, Liu J, Huang H. A New Era in High-Risk Tricuspid Valve Reoperation. CJC Open 2024; 6:1227-1230. [PMID: 39525341 PMCID: PMC11544280 DOI: 10.1016/j.cjco.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 06/25/2024] [Indexed: 11/16/2024] Open
Affiliation(s)
- Yingjie Ke
- Cardiac Surgical Department, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial People’s Hospital’s Nanhai Hospital, The Second People’s Hospital of Nanhai District Foshan City, Foshan, Guangdong, China
| | - Linbin Hua
- Cardiac Surgical Department, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Shanwen Pang
- Cardiac Surgical Department, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Qiuji Wang
- Cardiac Surgical Department, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Zhaolong Zhang
- Cardiac Surgical Department, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Jian Liu
- Cardiac Surgical Department, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Huanlei Huang
- Cardiac Surgical Department, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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Mao Y, Ma Y, Zhai M, Li L, Jin P, Liu Y, Yang J. Preliminary Study of a Degenerated Tricuspid Bioprosthetic Valve Implanted via Transcatheter Valve-in-Valve Implantation Guided by 3-Dimensional Printing. CJC Open 2024; 6:978-988. [PMID: 39211748 PMCID: PMC11357757 DOI: 10.1016/j.cjco.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/30/2023] [Indexed: 09/04/2024] Open
Abstract
Background The procedures of transcatheter tricuspid valve-in-valve (TTViV) replacement are challenging, and the clinical outcomes are still unclear. Our goal was to report the short- and mid-term clinical outcomes of patients who underwent a TTViV implantation guided by 3-dimensional (3D) printing. Methods A retrospective analysis was performed on 6 patients who had TTViV implantation from May 2021 to March 2022. The median age was 51 years (range: 18-71 years), and 50.0% of the patients were male. Imaging assessments and 3D printing were performed on all 6 patients before the procedures. The perioperative data were evaluated, and the patients were followed up. Results Among the 6 patients, the etiologies of conditions affecting the tricuspid valves at baseline varied widely, including 1 case of Ebstein anomaly, 2 cases of infective endocarditis, 1 case of ventricular septal defect, and 2 cases of rheumatic heart disease. TTViV implantation was successfully performed in all 6 patients via the femoral vein approach; postoperative tricuspid regurgitation disappeared immediately, and the hemodynamic results were satisfactory. During the follow-up, all patients had significant improvement in symptoms and functional status. Conclusions TTViV implantation for the treatment of degenerated tricuspid bioprostheses should be considered safe and effective. Multimodal imaging and 3D printing may provide effective guidance for conducting the procedure. Clinical Trial Registration ClinicalTrials.gov Protocol Registration System (NCT02917980).
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Affiliation(s)
- Yu Mao
- Department of Cardiovascular Surgery, Xijing Hospital, Xi’an, China
| | - Yanyan Ma
- Department of Cardiovascular Surgery, Xijing Hospital, Xi’an, China
| | - Mengen Zhai
- Department of Cardiovascular Surgery, Xijing Hospital, Xi’an, China
| | - Lanlan Li
- Department of Cardiovascular Surgery, Xijing Hospital, Xi’an, China
| | - Ping Jin
- Department of Cardiovascular Surgery, Xijing Hospital, Xi’an, China
| | - Yang Liu
- Department of Cardiovascular Surgery, Xijing Hospital, Xi’an, China
| | - Jian Yang
- Department of Cardiovascular Surgery, Xijing Hospital, Xi’an, China
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Shabbir MA, Yadav P, Tiwari N, Velagapudi P. Transcatheter Tricuspid Valve Replacement: Case Selection, Technical Considerations, and Procedural Planning. US CARDIOLOGY REVIEW 2023; 17:e11. [PMID: 39559523 PMCID: PMC11571394 DOI: 10.15420/usc.2023.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/12/2023] [Indexed: 11/20/2024] Open
Abstract
Tricuspid regurgitation (TR) is a highly prevalent valve disorder in the US, with prevalence increasing with age. Without treatment, severe TR carries a poor prognosis. Tricuspid valve (TV) surgery is recommended for patients with severe TR undergoing left-sided valve surgery. Transcatheter TV repair or transcatheter TV replacement are potential options for patients who are not surgical candidates. A few small studies have demonstrated the feasibility and efficacy of transcatheter TV repair in patients with severe symptomatic TR. Careful patient selection by assessing tricuspid valve anatomy, right ventricular and pulmonary hemodynamics, candidacy for anticoagulation, comorbid conditions, and frailty is key to procedural success. Transcatheter TV repair can be performed via the transjugular or transfemoral access, and requires a large-caliber sheath (up to 45 Fr) and delivery system, particularly with dilated tricuspid annulus due to right ventricular enlargement. Multimodality imaging is essential for diagnosing TR severity, defining valve anatomy, and comprehensive functional assessment of the tricuspid valve, right atrium, and right ventricle. Several prosthetic valves, including the EVOQUE system, NaviGate system, Intrepid valve, and Cardiovalve, are currently being investigated in clinical trials.
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Affiliation(s)
| | - Pradeep Yadav
- Division of Cardiovascular Medicine, Piedmont HospitalAtlanta, GA
| | - Nidhish Tiwari
- Division of Cardiovascular Medicine, University of Nebraska Medical CenterOmaha, NE
| | - Poonam Velagapudi
- Division of Cardiovascular Medicine, University of Nebraska Medical CenterOmaha, NE
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Transcatheter Tricuspid Valve-in-Valve Replacement Using a J-Valve System for a Failed Tricuspid Bioprosthesis. Case Rep Cardiol 2022; 2022:7353522. [PMID: 35813080 PMCID: PMC9259371 DOI: 10.1155/2022/7353522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Redo operation for failed tricuspid bioprosthetic valves is associated with high morbidity and mortality. Transcatheter tricuspid valve-in-valve implantation has become an acceptable option for high-risk patients with a failed tricuspid bioprosthesis. We present a case of successful tricuspid valve-in-valve implantation using a J-valve in a failed tricuspid bioprosthesis position. Case Summary. A 48-year-old male, who had a failed tricuspid bioprosthesis, presented with right-side heart failure, right-to-left shunting at the atrial level, severe dyspnea, cyanosis, peripheral edema, hepatauxe, and ascites. After the interdisciplinary assessment, we successfully performed transcatheter tricuspid valve-in-valve implantation with the J-valve system. At 34-month postoperative follow-up, the patient had no symptoms of heart failure and the echocardiogram showed good valve position and well hemodynamic status. Conclusions This case demonstrated that the J-valve system may be a new option for high-risk patients with a failed tricuspid bioprosthetic valve.
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Jiang W, Long XM, Wei KQ, Li SC, Zhang Z, He BF, Li H. Application effect of thoracoscopic tricuspid valvuloplasty in geriatric patients with tricuspid valve disease. World J Clin Cases 2022; 10:4810-4817. [PMID: 35801058 PMCID: PMC9198848 DOI: 10.12998/wjcc.v10.i15.4810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/28/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Thoracoscopic-assisted technology can ensure that doctors can implement minimally invasive treatment through the right intercostal incision or small incision of the lower sternum. This approach not only can achieve a cardiac correction effect equivalent to that of a thoracotomy but also has the benefit of a clear surgical field ensuring the safety of surgical treatment.
AIM To investigate the effect of thoracoscopic tricuspid valvuloplasty in patients with tricuspid valve disease.
METHODS A total of 41 patients with tricuspid valve disease underwent traditional thoracotomy treatment between January 2018 and June 2020. Forty-one patients with tricuspid valve disease who underwent thoracoscopic tricuspid valvuloplasty treatment between July 2020 and June 2021 in our hospital were selected as controls for our retrospective analysis. The study group underwent thoracoscopic tricuspid valvuloplasty, while traditional thoracotomy was performed in the control group. The operation conditions (the duration of extracorporeal circulation, aorta blocking, endotracheal intubation, and surgery), inflammatory response-related indices (C-reactive protein and white blood cell count) before and after surgery, parameters related to myocardial injury (myocardial troponin T, creatine kinase isoenzyme, creatine kinase, and lactate dehydrogenase), and the incidence of adverse events in the two groups was counted.
RESULTS The duration of extracorporeal circulation (109.35 ± 50.31 min), aortic occlusion (94.26 ± 59.61 min), endotracheal intubation (12.59 ± 3.54 h), and hospital stay (5.29 ± 2.34 d) in the study group were shorter than those in the control group (114.91 ± 46.98 min, 101.37 ± 61.44 min, 13.11 ± 4.01 h, 7.09 ± 3.11 d, respectively). The difference in hospital stay between the two groups was statistically significant (P < 0.05). Serum C-reactive protein level (4.69 ± 1.35 mg/L) and white blood cell count (6.21 ± 1.97 × 109/L) in the study group were found to be not significantly different than those in the control group (5.01 ± 1.18 mg/L, 5.98 ± 2.01 × 109/L, respectively; P > 0.05). Myocardial troponin T (0.04 ± 0.02 ng/mL), creatine kinase isoenzyme (4.02 ± 1.11 mg/mL), creatine kinase (91.35 ± 10.44 U/L), and lactate dehydrogenase (179.81 ± 60.04 U/L) in the study group were also not statistically significant different than those in the control group (0.05 ± 0.03 ng/mL, 3.97 ± 1.05 mg/mL, 89.69 ± 13.05 U/L, 186.35 ± 56.96 U/L; P > 0.05). After the operation, serum C-reactive protein level (7.89 ± 1.73 mg/L) and white blood cell count (10.76 ± 2.35 × 109/L) in the study group were significantly lower than those in the control group (9.96 ± 2.04 mg/L, 14.84 ± 3.07 × 109/L, respectively) (P < 0.05). In addition, myocardial troponin T (0.89 ± 0.32 ng/mL), creatine kinase isoenzyme (26.96 ± 4.95 mg/mL), creatine kinase (608.32 ± 202.33 U/L), and lactate dehydrogenase (282.56 ± 101.34 U/L) in the study group were lower than those in the control group (2.61 ± 0.69 ng/mL, 34.37 ± 6.87 mg/mL, 689.94 ± 214.64 U/L, 369.15 ± 114.46 U/L) (P < 0.05). The incidence of adverse events in the study group (4.88%) was lower than that in the control group (19.51%) (P < 0.05).
CONCLUSION Thoracoscopic tricuspid valvuloplasty can achieve good results in treating patients with tricuspid valve disease, reduce the risk of adverse events, and promote the rapid recovery of patients.
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Affiliation(s)
- Wei Jiang
- Department of Cardiothoracic and Vascular Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Xiao-Mao Long
- Department of Cardiothoracic and Vascular Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Ke-Quan Wei
- Department of Cardiothoracic and Vascular Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Si-Cong Li
- Department of Cardiothoracic and Vascular Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Ze Zhang
- Department of Cardiothoracic and Vascular Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Bang-Fu He
- Department of Cardiothoracic and Vascular Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Hui Li
- Department of Cardiothoracic and Vascular Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Chen S, Dershowitz L, George I. Transcatheter valve implantation for degenerated tricuspid bioprosthesis and failed tricuspid ring. Ann Cardiothorac Surg 2021; 10:651-657. [PMID: 34733692 DOI: 10.21037/acs-2021-tviv-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/29/2021] [Indexed: 11/06/2022]
Abstract
Background Transcatheter tricuspid valve-in-valve (TViV) and valve in-ring (TViR) implantation have become a viable therapy for a failed tricuspid bioprosthesis. Here we report short (thirty days) and long (one-year) term clinical outcomes of ten patients who underwent TViV at our institution. Methods The electronic databases of New York Presbyterian Columbia Medical Center were retrospectively reviewed for cases of transcatheter tricuspid valve replacement (TViV or TViR). Between 2012 and 2019, data from ten patients who underwent TViV were collected. The primary safety outcome was procedure-related adverse events, including clinically evident cardiac perforation, new pericardial effusion and sustained ventricular arrhythmia. The primary efficacy endpoint was defined as successful valve deployment with total (paravalvular or intravalvular) tricuspid regurgitation (TR) estimated as mild or less. Results are descriptive in nature. Results A total of ten patients who underwent TViV were included in the study. Of them, 40% presented with isolated tricuspid bioprosthetic stenosis (TS), 20% with isolated TR and 40% with mixed TS and TR. All patients were treated with the SAPIEN valve (first generation, XT, or Sapien 3). The TViV procedure was successful in all patients, and no immediate post-replacement paravalvular leak (PVL) or intra-procedural complications were reported. The primary safety and efficacy endpoints were met in all patients. At thirty-days, all patients were alive and reported significant improvements in symptoms and functional status. Conclusions Transcatheter tricuspid valve implantation is a safe and effective therapy for degenerative tricuspid bioprosthesis.
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Affiliation(s)
- Shmuel Chen
- Division of Cardiac, Thoracic & Vascular Surgery, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Lyle Dershowitz
- Division of Cardiac, Thoracic & Vascular Surgery, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Isaac George
- Division of Cardiac, Thoracic & Vascular Surgery, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
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Lake P, Kuhn EW, Mauri V, Macherey S, Kaliba J, Baldus S, Frerker C, Schmidt T. Transcatheter valve-in-valve-in-valve replacement in tricuspid position in a patient with pre-existing permanent dual-chamber pacemaker. Clin Res Cardiol 2021; 110:2010-2014. [PMID: 33909128 PMCID: PMC8639564 DOI: 10.1007/s00392-021-01842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
Graphic abstract
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Affiliation(s)
- Philipp Lake
- Department of Internal Medicine III, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Elmar W Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Victor Mauri
- Department of Internal Medicine III, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Sascha Macherey
- Department of Internal Medicine III, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | | | - Stephan Baldus
- Department of Internal Medicine III, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Christian Frerker
- Department of Internal Medicine II, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany
| | - Tobias Schmidt
- Department of Internal Medicine II, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany
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Karahalios B, Breinholt JP, Little SH, Huie Lin C. Intentional bioprosthetic tricuspid valve fracture to facilitate transcatheter valve-in-valve deployment. Catheter Cardiovasc Interv 2021; 97:361-364. [PMID: 32141679 DOI: 10.1002/ccd.28837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 01/25/2020] [Accepted: 02/25/2020] [Indexed: 11/07/2022]
Abstract
While transcatheter valve-in-valve (ViV) implantation may reduce the number of lifetime surgical reinterventions in some patients with congenital heart disease, in other patients the bioprosthetic valve ring can lead to patient-prosthesis mismatch due to reduction of internal diameter if a transcatheter valve is implanted. A 49-year-old woman with multiple prior cardiac surgeries presented with heart failure due to bioprosthetic tricuspid valve stenosis. Initial predilation valvuloplasty suggested conventional ViV implant would produce patient-prosthesis mismatch, therefore, we intentionally fractured the bioprosthetic valve ring to facilitate optimal hemodynamics with implantation of a 29 mm transcatheter valve.
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Affiliation(s)
| | | | - Stephen H Little
- Houston Methodist Debakey Heart and Vascular Center, Houston, Texas, USA
| | - C Huie Lin
- Houston Methodist Debakey Heart and Vascular Center, Houston, Texas, USA
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Kadri AN, Menon V, Sammour YM, Gajulapalli RD, Meenakshisundaram C, Nusairat L, Mohananey D, Hernandez AV, Navia J, Krishnaswamy A, Griffin B, Rodriguez L, Harb SC, Kapadia S. Outcomes of patients with severe tricuspid regurgitation and congestive heart failure. Heart 2019; 105:1813-1817. [DOI: 10.1136/heartjnl-2019-315004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/23/2019] [Accepted: 07/11/2019] [Indexed: 11/04/2022] Open
Abstract
ObjectivesA substantial number of patients with severe tricuspid regurgitation (TR) and congestive heart failure (CHF) are medically managed without undergoing corrective surgery. We sought to assess the characteristics and outcomes of CHF patients who underwent tricuspid valve surgery (TVS), compared with those who did not.MethodsRetrospective observational study involving 2556 consecutive patients with severe TR from the Cleveland Clinic Echocardiographic Database. Cardiac transplant patients or those without CHF were excluded. Survival difference between patients who were medically managed versus those who underwent TVS was compared using Kaplan-Meier survival curves. Multivariate analysis was performed to identify variables associated with poor outcomes.ResultsAmong a total of 534 patients with severe TR and CHF, only 55 (10.3%) patients underwent TVS. Among the non-surgical patients (n=479), 30% (n=143) had an identifiable indication for TVS. At 38 months, patients who underwent TVS had better survival than those who were medically managed (62% vs 35%; p<0.001). On multivariate analysis, advancing age (HR: 1.23; 95% CI 1.12 to 1.35 per 10-year increase in age), moderate (HR: 1.39; 95% CI 1.01 to 1.90) and severe (HR: 2; 95% CI 1.40 to 2.80) right ventricular dysfunction were associated with higher mortality. TVS was associated with lower mortality (HR: 0.44; 95% CI 0.27 to 0.71).ConclusionAlthough corrective TVS is associated with better outcomes in patients with severe TR and CHF, a substantial number of them continue to be medically managed. However, since the reasons for patients not being referred to surgery could not be ascertained, further randomised studies are needed to validate our findings before clinicians can consider surgical referral for these patients.
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Comparison between Three-Dimensional Echocardiography and Computed Tomography for Comprehensive Tricuspid Annulus and Valve Assessment in Severe Tricuspid Regurgitation: Implications for Tricuspid Regurgitation Grading and Transcatheter Therapies. J Am Soc Echocardiogr 2018; 31:1190-1202.e3. [DOI: 10.1016/j.echo.2018.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Indexed: 12/12/2022]
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