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Ender JK, Ackermann M. Recent Developments in Catheter-based Cardiac Procedures. Anesthesiol Clin 2025; 43:229-242. [PMID: 40348541 DOI: 10.1016/j.anclin.2025.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2025]
Abstract
Since the first transcatheter aortic valve implantation in 2002, catheter-based cardiac procedures have increased significantly. This review provides an overview of CE approved devices, updated guidelines, and the key clinical findings for TAVR as well as for AV Valve interventions. Recent studies compare balloon-expanding and self-expanding valves, highlighting differences in prosthesis mismatch and paravalvular leaks. Long-term trials confirm TAVR's efficacy, especially in low-risk patients. Challenges include paravalvular regurgitation, vascular complications, and coronary obstruction, with innovations like the BASILICA procedure addressing risks. Local anesthesia in TAVR shows benefits over general anesthesia. As TAVR expands to younger patients, optimizing management pathways and addressing complications remain critical for improved outcomes.
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Affiliation(s)
- Joerg Karl Ender
- Department of Anesthesiology and Intensive Care Medicine, Hearcenter, University Leipzig, Leipzig, Germany.
| | - Michael Ackermann
- Versace and Partners Anaesthesiologists, Building 4, First Floor, Ashlea Gardens Office Parkc/o Garstfontein and Matroosberg Street, Ashlea Gardens, 0081 Pretoria, South Africa
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2
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Fatehi Hassanabad A, Kim A, Svystonyuk D, Bisleri G, Adams C, Kent WDT. Minimally Invasive Tricuspid Valve Surgery: An Alternative Surgical Approach in the Era of Transcatheter Interventions. Cardiol Rev 2025:00045415-990000000-00495. [PMID: 40366146 DOI: 10.1097/crd.0000000000000951] [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] [Indexed: 05/15/2025]
Abstract
There has been significant growth in minimally invasive valve surgery over the past 2 decades, with novel approaches including video-assisted minithoracotomy, totally endoscopic, and robotic assisted. Outcomes of these techniques suggest that they can improve patient-reported outcomes, enhance mobility, reduce blood loss, and facilitate earlier discharge and return to work. Minimally invasive tricuspid valve surgery now provides surgeons and patients with an alternative option for treating tricuspid valve disease. These operations can be conducted safely and yield favorable outcomes with carefully selected patients. Herein, we provide a comprehensive overview of minimally invasive tricuspid valve surgery, including a summary of the current literature on minithoracotomy valve repair or replacement, beating heart, redo, and multiple-valve surgery. Finally, we contextualize how minimally invasive tricuspid valve surgery can play an important role in the era of emerging transcatheter strategies.
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Affiliation(s)
- Ali Fatehi Hassanabad
- From the Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Angela Kim
- Division of Vascular Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Daniyil Svystonyuk
- From the Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Gianluigi Bisleri
- Section of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Corey Adams
- From the Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - William D T Kent
- From the Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
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3
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Metra M, Tomasoni D, Adamo M, Anker SD, Bayes-Genis A, von Bardeleben RS, Böhm M, Donal E, Filippatos GS, Maisano F, Ponikowski P, Savarese G, Praz F, Butler J. Evidence Generation and Implementation of Transcatheter Interventions for Atrioventricular Valvular Heart Disease in Heart Failure: Current Status and Future Directions. Circulation 2025; 151:1342-1363. [PMID: 40324027 DOI: 10.1161/circulationaha.124.070411] [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] [Indexed: 05/07/2025]
Abstract
Mitral regurgitation and tricuspid regurgitation are the most common valvular heart diseases in patients with heart failure and have independent prognostic value. Transcatheter interventions are now available for the treatment of valvular heart disease, and their efficacy and safety have been tested in randomized controlled trials. However, evidence is still limited and sometimes inconclusive because several aspects of these trials limit their interpretation or consistency. These include heterogeneity in the pathogenesis and clinical characteristics of patients, the dynamic nature of secondary atrioventricular valve disease severity, the role of heart failure medications and devices, dependency on procedural results and operators' skills, smaller number of patients enrolled and the power to detect differences in trials, and limitations to use patients' reported outcomes with unblinded study protocols. These specific aspects of trials in patients with atrioventricular valve disease are reviewed in this article with a focus on possible solutions to generate further evidence for the efficacy and safety for transcatheter treatments of atrioventricular valve disease in patients with heart failure.
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Affiliation(s)
- Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (M.M., D.T., M.A.)
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (M.M., D.T., M.A.)
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden (D.T., G.S.)
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (M.M., D.T., M.A.)
| | - Stefan D Anker
- Department of Cardiology (CVK) of German Heart Center Charité, German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Germany (S.D.A.)
| | - Antoni Bayes-Genis
- Institut del Cor, Hospital Universitari Germans Trias I Pujol, Barcelona, Spain (A.B.-G.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV; Departamento de Medicina, Universitat Autònoma de Barcelona), Barcelona, Spain (A.B.-G.)
| | - Ralph Stephan von Bardeleben
- Department of Cardiology and Heart Valve Center, Universitätsmedizin Johannes Gutenberg-University, Mainz, Germany (R.S.v.B.)
| | - Michael Böhm
- Department of Internal Medicine Clinic III, Saarland University Hospital, Homburg/Saar, Germany (M.B.)
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, France (E.D.)
| | - Gerasimos S Filippatos
- Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (G.S.F.)
| | - Francesco Maisano
- Valve Center IRCCS Ospedale San Raffaele, Cardiac Surgery, University Vita Salute, Milan, Italy (F.M.)
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University Poland (P.P.)
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland (P.P.)
| | - Gianluigi Savarese
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden (D.T., G.S.)
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland (F.P.)
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX (J.B.)
- Department of Medicine, University of Mississippi Medical Center, Jackson (J.B.)
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4
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Stolz L, Davidson C, Rudolph V, Hausleiter J. Residual tricuspid regurgitation after tricuspid valve interventions: What do we know? Eur J Heart Fail 2025. [PMID: 40325498 DOI: 10.1002/ejhf.3675] [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: 01/04/2025] [Revised: 03/02/2025] [Accepted: 04/08/2025] [Indexed: 05/07/2025] Open
Affiliation(s)
- Lukas Stolz
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Charles Davidson
- Northwestern University Feinberg School of Medicine, Bluhm Cardiovascular Institute, Chicago, IL, USA
| | - Volker Rudolph
- General and Interventional Cardiology/Angiology, Heart and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Medical Faculty OWL, Bad Oeynhausen, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
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5
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Sugiura A, Dreyfus J, Bombace S, Ivannikova M, Bartkowiak J, Haussig S, Schneider LM, Kassar M, Horn P, Taramasso M, Iliadis C, Osawa I, Goto T, Weber M, Tanaka T, Zimmer S, Obadia JF, Habib G, Bazire B, Iung B, Bohbot Y, Tribouilloy C, Donal E, Nejjari M, Riant E, Le Tourneau T, Lavie-Badie Y, Coisne A, Modine T, Lim P, Doguet F, Selton-Suty C, Baldus S, Kelm M, Praz F, Rottbauer W, Hans-Peter Linke A, Hahn R, Volker R, Messika-Zeitoun D, Lurz P, Nickenig G. Transcatheter Edge-to-Edge Repair in Patients With Primary Tricuspid Regurgitation. JACC Cardiovasc Interv 2025; 18:1289-1299. [DOI: 10.1016/j.jcin.2025.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2025]
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Kobayashi T, Matsue Y, Fujimoto Y, Maeda D, Kida K, Kitai T, Kagiyama N, Yamaguchi T, Okumura T, Mizuno A, Oishi S, Inuzuka Y, Akiyama E, Suzuki S, Yamamoto M, Tamura Y, Minamino T. Prevalence and Prognostic Implications of Changes in Tricuspid Regurgitation Severity in Acute Heart Failure. J Card Fail 2025; 31:781-788. [PMID: 39226988 DOI: 10.1016/j.cardfail.2024.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/18/2024] [Accepted: 08/20/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Tricuspid regurgitation (TR), prevalent in acute heart failure (AHF), has a poor prognosis; however, the dynamics of TR severity during hospitalization and its prognostic implications remain unclear. We investigated TR dynamism during hospitalization and its prognostic impact in AHF. METHODS AND RESULTS This is a post hoc analysis of a prospective multicenter study of patients with AHF who underwent echocardiographic TR severity evaluation at admission and before discharge. The primary end point was a combined of 1-year all-cause mortality and HF rehospitalization after discharge. Among 1079 participants, TR severity changed dynamically, with 60.3% of those with moderate TR and 29.6% of those with severe TR at admission being diagnosed as no or mild TR at discharge. In 3 groups stratified by changes in TR severity, the persistent TR groups had a higher incidence of the primary end point than the resolution and absence groups. In adjusted analyses, the persistent group (hazard ratio, 1.37; 95% confidence interval, 1.04-1.80), but not the resolution group (hazard ratio, 1.07; 95% confidence interval, 0.79-1.44), had a higher primary end point incidence than the absence group. CONCLUSIONS TR severity at admission in patients with AHF can change dynamically and is associated with subsequent prognosis. Significant TR that remains even after decongestive therapy might be a target for further treatment in hospitalized patients with AHF.
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Affiliation(s)
- Tetsuya Kobayashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Cardiology, Tokyo Bay Medical Center, Urayasu, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Yudai Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Daichi Maeda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Keisuke Kida
- Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Nobuyuki Kagiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tetsuo Yamaguchi
- Department of Cardiology, Cardiovascular Center, Toranomon Hospital, Tokyo, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Shogo Oishi
- Department of Cardiology, Mahoshi Hospital, Kobe, Japan
| | - Yasutaka Inuzuka
- Department of Cardiology, Shiga Medical Center for Adults, Moriyama, Japan
| | - Eiichi Akiyama
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Satoshi Suzuki
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Masayoshi Yamamoto
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuichi Tamura
- Department of Cardiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan
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Naik H, Price MJ, Kapadia S, Whisenant BK, Tadros P, Makkar R, Asgar AW, Fam N, Tang GHL, Mehta SR, Byrne T, Singh G, Panaich SS, Peterman K, Trusty PM, Hamid N, Hahn RT, Adams DH, Sorajja P. Tricuspid Transcatheter Edge-to-Edge Repair in Patients With Transvalvular CIED Leads: The TRILUMINATE Pivotal Trial. JACC Clin Electrophysiol 2025; 11:1012-1020. [PMID: 39903153 DOI: 10.1016/j.jacep.2025.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Revised: 01/08/2025] [Accepted: 01/13/2025] [Indexed: 02/06/2025]
Abstract
BACKGROUND Patients with tricuspid regurgitation (TR) frequently have transvalvular cardiac implantable electronic device (CIEDs). OBJECTIVES The aim of this study was to determine the safety and efficacy of tricuspid transcatheter edge-to-edge repair in patients with transvalvular CIED leads. METHODS The TRILUMINATE (Trial to Evaluate Cardiovascular Outcomes in Patients Treated With the Tricuspid Valve Repair System) Pivotal Trial (NCT03904147) is an international randomized, controlled trial in symptomatic subjects with severe TR. Subjects with CIED leads were screened by an eligibility committee prior to inclusion into the randomized or single-arm cohorts. Safety events were adjudicated by an independent review committee. All echocardiograms were analyzed by an independent core laboratory. RESULTS A total of 98 subjects (of 469) with attempted TriClip procedures had transvalvular CIED leads. CIED+ subjects were older (age 80.2 ± 8.6 years vs 78.2 ± 7.6 years; P = 0.02), with a higher prevalence of renal disease (46.9% vs 31.5%; P = 0.004) and lower health status (Kansas City Cardiomyopathy Questionnaire overall summary score 51.9 ± 21.0 vs 55.0 ± 23.1) at baseline compared with CIED- subjects. Slightly fewer clips were implanted in CIED+ subjects (mean 1.9) than in CIED- subjects (mean 2.2) (P = 0.0018). Procedural times were significantly shorter in CIED+ subjects (132.9 ± 63.3 minutes vs 155.9 ± 71.9 minutes; P = 0.0043) although greater in those with lead-induced TR (149.5 ± 87.5 minutes). Major adverse events (1.0% vs 1.1%) and major bleeding (3.1% vs 3.0%) were infrequent in CIED+ and CIED- subjects. At 30 days, TR reduction to moderate or less was similar in CIED+ and CIED- subjects (88% vs 87%) and was sustained out to 1 year in the majority of subjects (81% vs 84%). Compared with baseline, Kansas City Cardiomyopathy Questionnaire overall summary score significantly improved through 1 year in CIED+ subjects (18.7 ± 22.6; P < 0.0001) and CIED- subjects (16.8 ± 22.6; P < 0.0001). Heart failure symptoms were reduced in both groups at 30 days, with 85% of CIED+ subjects and 87% of CIED- subjects in NYHA functional class I or II. There were no differences in mortality, heart failure hospitalization, and need for tricuspid valve surgery or intervention between groups. No lead revisions, removals, or replacements were reported through follow-up. CONCLUSIONS Tricuspid transcatheter edge-to-edge repair with the TriClip system was safe and effective in selected CIED+ subjects and did not affect CIED function. CIED+ subjects experienced similar TR reduction and quality-of-life improvements as CIED- subjects. Future work should define the treatable scope of patients with transvalvular CIED leads. (TRILUMINATE Pivotal Trial; NCT03904147).
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Affiliation(s)
- Hursh Naik
- Arizona Cardiovascular Research Center, Phoenix, Arizona, USA.
| | | | | | | | - Peter Tadros
- Kansas University Medical Center, Kansas City, Kansas, USA
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Neil Fam
- St. Micheal's Hospital, Toronto, Ontario, Canada
| | | | - Shamir R Mehta
- Hamilton Health Science Centre, Hamilton, Ontario, Canada
| | - Timothy Byrne
- Phoenix Cardiovascular Research Group, Phoenix, Arizona, USA
| | - Gagan Singh
- University of California, Davis Medical Center, Sacramento, California, USA
| | | | | | | | - Nadira Hamid
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Rebecca T Hahn
- NewYork-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | | | - Paul Sorajja
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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8
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Addetia K, Henry M, Smith H, Yamat M, Kim G, Jain R, Wali E, Lee L, Marzlin N, Abutaleb A, Crouch J, Weiss ES, Ota T, Salerno C, Li H, Husain AA, Jeevanandam V, Lang RM. Mechanisms of Cardiac Implantable Electronic Device Interference With the Tricuspid Valve Apparatus. Am J Cardiol 2025; 250:30-37. [PMID: 40280194 DOI: 10.1016/j.amjcard.2025.04.016] [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: 01/31/2025] [Revised: 04/02/2025] [Accepted: 04/13/2025] [Indexed: 04/29/2025]
Abstract
Cardiac implantable electronic devices (CIEDs) have been implicated in the development of tricuspid valve (TV) dysfunction. However, the mechanisms of dysfunction are not well characterized. We sought to define the prevalence, location and mechanisms of CIED-TV interference based on direct inspection of gross pathologic specimens from consecutive patients with CIEDs who had undergone orthotopic heart transplantation (OHT). CIED-interference was classified by location (septal, posterior or anterior trigone of the RV), portion of TV apparatus involved (leaflet(s) only, sub-tricuspid apparatus (STA) only or a combination of both leaflet and STA) and type of interference (adherence, trapping or both). Sixty-two cases of CIED-TV interference were identified (5 leaflet, 30 STA and 27 leaflet and STA). The majority of patients had nonischemic cardiomyopathy (81%) and leads in situ for <10 years (77%). Most CIED-TV interference involved either the posterior (n = 23, 37%), septal (n = 15, 24%) or posteroseptal regions of the RV (n = 16, 26%). Interference with the anterior leaflet or anterior STA was rare. STA interference consisted of lead trapping behind the papillary muscles or chordae alone (n = 6), lead adherence with trapping (n = 21) and lead adherence alone (n = 3). Combination STA and leaflet interference consisted of adherence and trapping (n = 20) and adherence without trapping (n = 7). In conclusion, CIED-TV interference occurs most frequently with the STA in the posterior and septal regions of the RV. These findings have the potential to instruct imagers on how to evaluate for CIED-TV interference in an era where, elucidating the mechanism of TV dysfunction and considering options for repair is gaining momentum.
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Affiliation(s)
- Karima Addetia
- Department of Medicine, Section of Cardiology, University of Chicago Heart and Vascular Center, Chicago, Illinois.
| | - Michael Henry
- Department of Medicine, Section of Cardiology, University of Chicago Heart and Vascular Center, Chicago, Illinois
| | - Heather Smith
- Department of Medicine, Section of Cardiology, University of Chicago Heart and Vascular Center, Chicago, Illinois
| | - Megan Yamat
- Department of Medicine, Section of Cardiology, University of Chicago Heart and Vascular Center, Chicago, Illinois
| | - Gene Kim
- Department of Medicine, Section of Cardiology, University of Chicago Heart and Vascular Center, Chicago, Illinois
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Eisha Wali
- Department of Medicine, Section of Cardiology, University of Chicago Heart and Vascular Center, Chicago, Illinois
| | - Linda Lee
- Department of Medicine, Section of Cardiology, University of Chicago Heart and Vascular Center, Chicago, Illinois
| | - Nathan Marzlin
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - AbdulRahman Abutaleb
- Department of Medicine, Section of Cardiology, University of Chicago Heart and Vascular Center, Chicago, Illinois
| | - Jonathan Crouch
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Eric S Weiss
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Takeyoshi Ota
- Department of Medicine, Section of Cardiology, University of Chicago Heart and Vascular Center, Chicago, Illinois
| | - Christopher Salerno
- Department of Medicine, Section of Cardiology, University of Chicago Heart and Vascular Center, Chicago, Illinois
| | - Huihua Li
- Department of Medicine, Section of Cardiology, University of Chicago Heart and Vascular Center, Chicago, Illinois
| | - Aliya A Husain
- Department of Medicine, Section of Cardiology, University of Chicago Heart and Vascular Center, Chicago, Illinois
| | - Valluvan Jeevanandam
- Department of Medicine, Section of Cardiology, University of Chicago Heart and Vascular Center, Chicago, Illinois
| | - Roberto M Lang
- Department of Medicine, Section of Cardiology, University of Chicago Heart and Vascular Center, Chicago, Illinois
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9
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Zhang X, Pommert NS, Meier D, Sellers SL, Seoudy H, Müller OJ, Frank D, Attmann T, Berndt R, Warnecke G, Puehler T, Lutter G. Transcatheter tricuspid valve replacement: will it prevail? Front Cardiovasc Med 2025; 12:1562658. [PMID: 40308273 PMCID: PMC12040945 DOI: 10.3389/fcvm.2025.1562658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2025] [Accepted: 03/19/2025] [Indexed: 05/02/2025] Open
Abstract
Severe tricuspid regurgitation (TR) is a prevalent and challenging condition associated with poor survival outcomes and significant morbidity. Medical therapy alone often fails to provide adequate symptom relief, and stand-alone surgical intervention is linked to high mortality rates, making it a less favorable option unless combined with left-sided valve surgery. The advent of transcatheter tricuspid interventions has provided new therapeutic possibilities, particularly for high-risk patients who are ineligible for conventional surgery. However, many patients are still unsuited for transcatheter tricuspid repair or have only limited benefits from such procedures. In this context, Transcatheter tricuspid valve replacement (TTVR) has rapidly emerged as a promising alternative, offering the potential for more effective treatment outcomes. This review explores the latest advancements in TTVR devices, highlights key clinical findings, and discusses the challenges and limitations of this evolving strategy. Additionally, we address patient selection criteria, procedural outcomes, and future directions in the field, emphasizing the potential of TTVR to transform the management of severe TR.
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Affiliation(s)
- Xiling Zhang
- Department of Cardiac Surgery, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Nina Sophie Pommert
- Department of Cardiac Surgery, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital Schleswig-Holstein (UKSH), Luebeck, Germany
| | - David Meier
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stephanie L. Sellers
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Hatim Seoudy
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of Cardiology and Angiology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Oliver J. Müller
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of Cardiology and Angiology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Derk Frank
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of Cardiology and Angiology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Tim Attmann
- Department of Cardiac Surgery, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Rouven Berndt
- Department of Vascular Surgery, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Thomas Puehler
- Department of Cardiac Surgery, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital Schleswig-Holstein (UKSH), Luebeck, Germany
| | - Georg Lutter
- Department of Cardiac Surgery, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
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10
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Fram G, Alrayes H, Lai LKL, Dawdy J, Zweig B, Parikh S, Song T, Pantelic M, Alter J, Gonzalez PE, O’Neill B, Frisoli T, Villablanca P, Lee J. Fluoroscopy-Guided Intracardiac Echocardiography Navigation: A Novel Landmark-Based Imaging Technique for Transcatheter Tricuspid Valve Replacement. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2025; 4:102613. [PMID: 40308230 PMCID: PMC12038275 DOI: 10.1016/j.jscai.2025.102613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Revised: 01/20/2025] [Accepted: 01/23/2025] [Indexed: 05/02/2025]
Affiliation(s)
- Georgi Fram
- Center for Structural Heart, Henry Ford Hospital, Detroit, Michigan
| | - Hussayn Alrayes
- Center for Structural Heart, Henry Ford Hospital, Detroit, Michigan
| | - Leo Kar Lok Lai
- Center for Structural Heart, Henry Ford Hospital, Detroit, Michigan
| | - John Dawdy
- Center for Structural Heart, Henry Ford Hospital, Detroit, Michigan
| | - Bryan Zweig
- Center for Structural Heart, Henry Ford Hospital, Detroit, Michigan
| | - Sachin Parikh
- Center for Structural Heart, Henry Ford Hospital, Detroit, Michigan
| | - Thomas Song
- Center for Structural Heart, Henry Ford Hospital, Detroit, Michigan
| | - Milan Pantelic
- Center for Structural Heart, Henry Ford Hospital, Detroit, Michigan
| | - James Alter
- Center for Structural Heart, Henry Ford Hospital, Detroit, Michigan
| | | | - Brian O’Neill
- Center for Structural Heart, Henry Ford Hospital, Detroit, Michigan
| | - Tiberio Frisoli
- Center for Structural Heart, Henry Ford Hospital, Detroit, Michigan
| | | | - James Lee
- Center for Structural Heart, Henry Ford Hospital, Detroit, Michigan
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11
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Olds DM, Smith JL, Spertus JA, Dunlay SM, Bocell FD, Wu C, Cohen DJ, Arnold SV. Assessing the Relevance of the Kansas City Cardiomyopathy Questionnaire in Patients With Tricuspid Regurgitation: The Tri-QOL Qualitative Study. Circ Cardiovasc Qual Outcomes 2025; 18:e011245. [PMID: 39895493 DOI: 10.1161/circoutcomes.124.011245] [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: 05/15/2024] [Accepted: 01/14/2025] [Indexed: 02/04/2025]
Abstract
BACKGROUND Validly measuring disease-specific health status is critical in patients with severe tricuspid regurgitation (TR) to quantify the benefit of different interventions. The Kansas City Cardiomyopathy Questionnaire (KCCQ) has been used to assess health status in patients with severe TR, but its content validity in this patient population is unknown, including whether additional questions are needed to supplement the KCCQ. METHODS Twenty participants with symptomatic severe TR from 2 midwestern clinical sites were interviewed in 2023 using a semistructured guide. The interview guide addressed symptoms, physical and social functioning, and quality of life concepts of the KCCQ, as well as other potential TR symptoms not represented in the KCCQ. Interview transcripts were analyzed using inductive and deductive coding and content analysis, with additional participants recruited until thematic saturation occurred. RESULTS Mean age of the participants was 80 (41-89), and 75% were female. Shortness of breath and fatigue were reported by virtually all participants (n=20 and n=19, respectively) and had a marked negative impact on their physical and social functioning and quality of life. Lower limb edema was also reported by 10 participants. Although these concepts are captured by the KCCQ, other symptoms were also reported, including appetite loss (n=8) and upper body edema (n=4), but did not seem to markedly affect participants' function or quality of life. In addition, all participants who experienced these other symptoms reported symptoms that were already captured by the KCCQ. CONCLUSIONS All participants experienced symptoms captured by the KCCQ, and these symptoms had a substantial impact on their physical and social functioning and quality of life. Although some participants reported additional symptoms not assessed by the KCCQ, their incorporation would only marginally improve content validity. Thus, the current KCCQ appears to be appropriate for capturing the disease-specific health status of patients with severe TR.
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Affiliation(s)
- Danielle M Olds
- University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality (D.M.O., J.A.S., S.V.A.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.M.O., J.A.S., S.V.A.)
| | - Jamie L Smith
- University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality (D.M.O., J.A.S., S.V.A.)
- Mayo Clinic, Rochester, MN (J.L.S., S.M.D.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.M.O., J.A.S., S.V.A.)
| | | | - Fraser D Bocell
- US Food and Drug Administration, Silver Spring, MD (F.D.B., C.W.)
| | - Changfu Wu
- US Food and Drug Administration, Silver Spring, MD (F.D.B., C.W.)
| | - David J Cohen
- St. Francis Hospital, Roslyn, NY (D.J.C.)
- Cardiovascular Research Foundation, New York, NY (D.J.C.)
| | - Suzanne V Arnold
- University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality (D.M.O., J.A.S., S.V.A.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.M.O., J.A.S., S.V.A.)
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12
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Sugiura A, Tanaka T, Kavsur R, Öztürk C, Vogelhuber J, Silaschi M, Weber M, Zimmer S, Nickenig G. Tricuspid regurgitation: Innovation, current landscape, and future perspective of transcatheter tricuspid valve interventions. J Cardiol 2025:S0914-5087(25)00084-X. [PMID: 40107448 DOI: 10.1016/j.jjcc.2025.03.009] [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: 08/26/2024] [Revised: 03/07/2025] [Accepted: 03/11/2025] [Indexed: 03/22/2025]
Abstract
Tricuspid regurgitation (TR) is a prevalent cardiovascular disease necessitating innovative treatments. Assessing comorbidities, such as right ventricular dysfunction, is pivotal for the therapeutic strategy. Preprocedural echocardiographic assessments are crucial for achieving optimal TR reduction. Transcatheter interventions have emerged as less invasive therapies. Tricuspid transcatheter edge-to-edge repair is the predominant technology, proven safe and effective in reducing TR. Additionally, transcatheter tricuspid valve replacement and direct annuloplasty technologies have been developed and recognized as attractive alternatives, each with unique advantages. This review discusses the innovation, current landscape, and future perspective of transcatheter tricuspid valve interventions for treating TR.
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Affiliation(s)
- Atsushi Sugiura
- Department of Internal Medicine II, Heart Center Bonn, Bonn, Germany.
| | - Tetsu Tanaka
- Department of Internal Medicine II, Heart Center Bonn, Bonn, Germany
| | - Refik Kavsur
- Department of Internal Medicine II, Heart Center Bonn, Bonn, Germany
| | - Can Öztürk
- Department of Internal Medicine II, Heart Center Bonn, Bonn, Germany
| | | | - Miriam Silaschi
- Department of Cardiac Surgery, Heart Center Bonn, Bonn, Germany
| | - Marcel Weber
- Department of Internal Medicine II, Heart Center Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine II, Heart Center Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, Heart Center Bonn, Bonn, Germany
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13
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Mekary W, Ibrahim R, Lloyd MS, Bhatia NK, Westerman SB, Shah AD, Byku I, Gleason P, Greenbaum A, Babaliaros V, Merchant FM, El-Chami MF. Pacing considerations in patients undergoing transcatheter tricuspid valve replacement: Insights from a tertiary care center. Heart Rhythm 2025:S1547-5271(25)00117-1. [PMID: 40278809 DOI: 10.1016/j.hrthm.2025.02.004] [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: 12/23/2024] [Revised: 01/27/2025] [Accepted: 02/03/2025] [Indexed: 04/26/2025]
Abstract
BACKGROUND Patients requiring transcatheter tricuspid valve replacement (TTVR) often have a preexisting pacemaker lead crossing the tricuspid valve (TV). TTVR could also lead to heart block. OBJECTIVE We aimed to describe pacing considerations in patients referred for TTVR. METHODS We identified patients who underwent TTVR at Emory Healthcare. Clinical characteristics including presence of preexisting pacemaker leads, management of these TV leads at the time of TTVR, and pacing requirements after TTVR were collected. RESULTS Seventy-three patients underwent TTVR; 21 (29%) patients had preexisting permanent pacing systems (19 transvenous leads and 2 leadless pacemakers [LPs]). In 14 patients (73.7%), the transvenous lead was jailed. Five patients (26.3%) underwent lead extraction and implantation of a TV-sparing pacing system (n = 2) or ventricular LP (n = 2), whereas 1 patient did not undergo device reimplantation. After TTVR, 7 of 52 patients had heart block requiring permanent pacing (13%); 4 patients received an LP, 2 patients had a TV-sparing pacemaker implanted, and 1 had a lead implanted across the valve. During an average follow-up of 10.5 months, complications were reported in 3 of 14 patients with jailed leads (21%). Two patients required fractured lead revision. One of the revisions was complicated by infection, which resulted in the patient's death. A patient with a jailed right ventricular lead died suddenly 1 week after discharge. CONCLUSION More than 20% of patients with jailed leads after TTVR have serious complications due to lead malfunctions. TTVR-related heart block was common in our cohort (13%), and its treatment with LP or TV-sparing pacing systems was safe and effective.
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Affiliation(s)
- Wissam Mekary
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Rand Ibrahim
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Michael S Lloyd
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Neal K Bhatia
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Stacy B Westerman
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Anand D Shah
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Isida Byku
- Division of Cardiology, Section of Structural Heart and Valve Disease, Emory University School of Medicine, Atlanta, Georgia
| | - Patrick Gleason
- Division of Cardiology, Section of Structural Heart and Valve Disease, Emory University School of Medicine, Atlanta, Georgia
| | - Adam Greenbaum
- Division of Cardiology, Section of Structural Heart and Valve Disease, Emory University School of Medicine, Atlanta, Georgia
| | - Vasilis Babaliaros
- Division of Cardiology, Section of Structural Heart and Valve Disease, Emory University School of Medicine, Atlanta, Georgia
| | - Faisal M Merchant
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia.
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14
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Evangelista RAA, Pires ALR, Nogueira BV. A chronological history of heart valve prostheses to offer perspectives of their limitations. Front Bioeng Biotechnol 2025; 13:1533421. [PMID: 40028289 PMCID: PMC11868121 DOI: 10.3389/fbioe.2025.1533421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2024] [Accepted: 01/23/2025] [Indexed: 03/05/2025] Open
Abstract
Prosthetic heart valves (PHV) have been studied for around 70 years. They are the best alternative to save the life of patients with cardiac valve diseases. However, current PHVs may still cause significant disadvantages to patients. In general, native heart valves show complex structures and reproducing their functions challenges scientists. Valve repair and replacement are the options to heal heart valve diseases (VHDs), such as stenosis and regurgitation, which show high morbidity and mortality worldwide. Valve repair contributes to the performance of cardiac cycles. However, it fails to restore valve anatomy to its normal condition. On the other hand, replacement is the only alternative to treat valve degeneration. It may do so by mechanical or bioprosthetic valves. Although prostheses may restructure patients' cardiac cycle, both prostheses may show limitations and potential disadvantages, such as mechanical valves causing thrombogenicity or bioprosthetic valves, calcification. Thus, prostheses require constant improvements to remedy these limitations. Although the design of mechanical valve structures has improved, their raw materials cause great disadvantages, and alternatives for this problem remain scarce. Cardiac valve tissue engineering emerged 30 years ago and has improved over time, e.g., xenografts and fabricated heart valves serving as scaffolds for cell seeding. Thus, this review describes cardiac valve substitutes, starting with the history of valvular prosthesis transplants and ending with some perspectives to alleviate the limitations of artificial valves.
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Affiliation(s)
| | - Ana Luiza Resende Pires
- Graduate Program in Biotechnology, Federal University of Espírito Santo. Av. Marechal Campos, Vitória, Brazil
| | - Breno Valentim Nogueira
- Rede Nordeste de Biotecnologia (RENORBIO), Federal University of Espírito Santo (UFES), Vitória, Brazil
- Graduate Program in Biotechnology, Federal University of Espírito Santo. Av. Marechal Campos, Vitória, Brazil
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15
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Di Mauro M, Bonalumi G, Giambuzzi I, Masiero G, Tarantini G. Isolated tricuspid regurgitation: a new entity to face. Prevalence, prognosis and treatment of isolated tricuspid regurgitation. Minerva Cardiol Angiol 2025; 73:38-53. [PMID: 37021626 DOI: 10.23736/s2724-5683.23.06294-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
In recent years the tricuspid is no longer considered the "forgotten valve," but nowadays, specialists focused the treatment of tricuspid regurgitation (TR) especially at the time of left heart valve (LHV) surgery, overlooking the emerging entity of isolated TR. Its incidence appears to be rising along with the higher prevalence of atrial fibrillation (AF), intracardiac devices and intravenous drug users. Hence, the aim of the present review is to summarize the available evidences in terms of natural history, clinical presentation and treatment of isolated TR. Tricuspid regurgitation is commonly classified into primary and secondary etiology. Primary or organic TR is relatively uncommon (10%) and may be due to either acquired or congenital diseases. Conversely, secondary or functional TR, caused by dilatation and flattening of the tricuspid annulus along with increase of leaflet tethering due to the remodeling of the right ventricle (RV) has become in last decade an emerging entity. Secondary TR may be due grade progression after left heart valve surgery, to previous TV surgery failure, RV remodeling or permanent AF. Primary TR causes pure volume overload on initially normal right-sided cardiac chambers. Conversely, RV enlargement is the major finding of secondary TR; RV systolic area, RV spherical index and right atrial area were identified as independent factors correlated with TV tethering height. The RV has less muscle mass than the left ventricle, and RV systolic function is therefore more load sensitive. Thus, pulmonary hypertension results in an early fall in RV ejection fraction and associated RV enlargement. An interesting entity is isolated TR related to AF, whose prevalence is estimated to be 14% in recent studies. It is known to cause dilation of the mitral and tricuspid annulus, together with changes in the dynamic mechanisms that govern the variation in area size during the cardiac cycle; as a matter of fact the relative change in TA area was significantly lower in AF (13.5%) than in sinus rhythm (SR) (33.1%). In isolated TR, medical therapy (MT) is indicated only in patients with secondary TR having also severe RV/LV dysfunction or severe pulmonary hypertension. Diuretics are the main MT in case of isolated TR in the presence of right HF in carefully selected candidates, surgery can be performed safely with good long-term survival and it should be considered early at first stages. In the treatment of isolated TR we had two diametrically opposed approaches so far, such as medical therapy, based almost exclusively on diuretics, and surgical therapy. In this scenario, trans-catheter approach is gaining momentum, including repair or replacement treatment. The former sees the use of devices for direct or indirect annuloplasty, or leaflet approximation. The second consists of orthotopic or heterotopic replacement devices (transcatheter tricuspid valve replacement devices). Evidences from randomized studies and longer follow-up will help clarify the best patient selection and treatment strategies.
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Affiliation(s)
- Michele Di Mauro
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute of Maastricht (CARIM), Maastricht, the Netherlands -
| | - Giorgia Bonalumi
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan, Italy
| | - Ilaria Giambuzzi
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan, Italy
- Department of Clinical and Community Sciences (DISCCO), University of Milan, Milan, Italy
| | - Giulia Masiero
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giuseppe Tarantini
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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16
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Arnold SV, Spertus JA, Gosch K, Dunlay SM, Olds DM, Jones PG, Bocell FD, Wu C, Cohen DJ. Validation of the Kansas City Cardiomyopathy Questionnaire in Patients With Tricuspid Regurgitation. JAMA Cardiol 2025; 10:117-125. [PMID: 39476153 PMCID: PMC11525660 DOI: 10.1001/jamacardio.2024.4266] [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] [Received: 02/10/2024] [Accepted: 09/18/2024] [Indexed: 11/02/2024]
Abstract
Importance Improving patients' health status is a key goal of treating tricuspid regurgitation (TR). The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a heart failure disease-specific health status measure used to capture the health status impact of TR and the benefit of transcatheter tricuspid valve intervention (TTVI), but its validity in this clinical setting is unknown. Objective To evaluate the psychometric properties of the KCCQ in patients with TR. Design, Setting, and Participants Data were pooled from patients with severe TR enrolled in 11 manufacturer-sponsored trials of TTVI. The data were transferred to the US Food and Drug Administration to harmonize and anonymize prior to analysis by an independent center. Data were collected from December 2015 to April 2023, and data analysis was performed from July to October 2023. Main Outcomes and Measures Prespecified analyses included evaluation of internal consistency, reproducibility, responsiveness, construct validity, and predictive validity. Outcomes were determined using Cronbach α, score comparisons, intraclass correlation, Cohen d, Spearman correlations with best available reference measures, and association of scores and changes in scores with risk of subsequent clinical events. Results The study cohort was composed of 2693 patients enrolled in either single-arm (n = 1517) or randomized (n = 1176) investigations of TTVI. Mean (SD) patient age was 78.6 (8.0) years, 1658 of 2693 patients (61.6%) were female, and the mean (SD) baseline KCCQ Overall Summary (KCCQ-OS) score was 50 (23). There was strong internal consistency within individual domains (Cronbach α, .77-.83). Among clinically stable patients between 1 and 6 months, there were small mean changes in KCCQ domain and summary scores (differences of -0.1 to 1.9 points), demonstrating reproducibility. In contrast, domain and summary scores of patients who underwent TTVI showed large improvements at 1 month after treatment (mean changes, 12.1-21.4 points), indicating excellent perceived responsiveness. Construct validity was moderately strong when domains were compared with best available reference measures (Spearman correlations, 0.47-0.69). In both cross-sectional and longitudinal analyses, the KCCQ-OS was associated with clinical events, with lower scores associated with an increased risk of mortality (hazard ratio, 1.34 per 10-point decrement; 95% CI, 1.22-1.47) and heart failure hospitalization (hazard ratio, 1.24 per 10-point decrement; 95% CI, 1.17-1.31). Conclusions and Relevance In this cohort study, the KCCQ had strong psychometric properties in patients with severe TR, including reliability, responsiveness, and validity. These data support use of the KCCQ in patients with severe TR as a measure of their symptoms, function, and quality of life and also for assessing the impact of interventions, such as TTVI, in rigorously controlled trials.
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Affiliation(s)
- Suzanne V. Arnold
- Healthcare Institute for Innovations in Quality, University of Missouri-Kansas City
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - John A. Spertus
- Healthcare Institute for Innovations in Quality, University of Missouri-Kansas City
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Kensey Gosch
- Healthcare Institute for Innovations in Quality, University of Missouri-Kansas City
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | | | - Danielle M. Olds
- Healthcare Institute for Innovations in Quality, University of Missouri-Kansas City
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Philip G. Jones
- Healthcare Institute for Innovations in Quality, University of Missouri-Kansas City
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | | | - Changfu Wu
- US Food and Drug Administration, Silver Spring, Maryland
| | - David J. Cohen
- St Francis Hospital, Roslyn, New York
- Cardiovascular Research Foundation, New York, New York
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17
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Zhao Y, Wei W, Wang Z, Dong Y, Su Z, Guo S. Impact of behavior change theory-based nursing interventions on cardiac function recovery and quality of life among cardiac surgery patients with cardiopulmonary bypass. J Cardiothorac Surg 2025; 20:109. [PMID: 39891309 PMCID: PMC11783950 DOI: 10.1186/s13019-024-03219-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 12/24/2024] [Indexed: 02/03/2025] Open
Abstract
BACKGROUND This study investigates the impact of nursing interventions, guided by behavior change theory, on the recovery of cardiac function and quality of life in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). METHODS A total of 120 patients scheduled for CPB in the Department of Cardiology at our hospital, from February 2021 to May 2023, were enrolled. According to the study protocol, patients were randomly assigned to either a control group (n = 60) or an observation group (n = 60) post-surgery. The control group received routine nursing care, while the observation group received nursing interventions based on behavior change theory, including health education, psychological support, and behavioral incentives. Informed consent was obtained from all patients. General patient data were collected from clinical records. Cardiac function was assessed using echocardiography. The wall motion score index (WMSI) and 6-minute walk distance (6MWD) were evaluated post-care. Serum levels of inflammatory cytokines TNF-α, IL-6, and IL-10 were measured via ELISA. Quality of life was assessed using the WHOQOL-BREF questionnaire, while anxiety and depression levels were evaluated using the HAM-A and HAM-D scales, respectively. RESULTS The baseline clinical characteristics and biochemical data of both groups were comparable (P > 0.05). The observation group showed a significantly higher left ventricular ejection fraction (LVEF) compared to the control group (P < 0.05), while both left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic diameter (LVEDD) were significantly lower (P < 0.05). Additionally, the observation group had a significantly lower WMSI score and a longer 6MWD (P < 0.05). Regarding inflammatory markers, TNF-α and IL-6 levels were significantly reduced in the observation group, while IL-10 levels were significantly elevated compared to the control group (P < 0.05). In terms of quality of life, the observation group reported significantly higher scores in physical health, mental health, social relationships, and environmental factors (P < 0.05). Moreover, anxiety and depression levels were significantly lower in the observation group, as evidenced by reduced HAM-A and HAM-D scores (P < 0.05). CONCLUSION Nursing care guided by behavior change theory significantly improves cardiac function and overall quality of life in patients recovering from cardiac surgery with CPB. This approach enhances LVEF, reduces left intraventricular diameter, lowers inflammatory cytokine levels, and improves mental health and social functioning. These findings underscore the importance of behavior change theory-based nursing interventions in optimizing postoperative recovery.
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Affiliation(s)
- Youwei Zhao
- Department of Cardiac Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Yuhua District, Shijiazhuang, 050000, Hebei, China
| | - Wei Wei
- Department of Cardiac Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Yuhua District, Shijiazhuang, 050000, Hebei, China
| | - Zhiyuan Wang
- Department of Cardiac Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Yuhua District, Shijiazhuang, 050000, Hebei, China
| | - Yanbo Dong
- Department of Cardiac Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Yuhua District, Shijiazhuang, 050000, Hebei, China
| | - Zhenyu Su
- Department of Cardiac Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Yuhua District, Shijiazhuang, 050000, Hebei, China
| | - Shichao Guo
- Department of Cardiac Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Yuhua District, Shijiazhuang, 050000, Hebei, China.
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18
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Li L, Hu Y, Yang Z, Luo Z, Wang J, Wang W, Liu X, Wang Y, Fan Y, Yu P, Zhang Z. Exploring the assessment of post-cardiac valve surgery pulmonary complication risks through the integration of wearable continuous physiological and clinical data. BMC Med Inform Decis Mak 2025; 25:47. [PMID: 39891164 PMCID: PMC11786410 DOI: 10.1186/s12911-025-02875-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 01/17/2025] [Indexed: 02/03/2025] Open
Abstract
BACKGROUND Postoperative pulmonary complications (PPCs) following cardiac valvular surgery are characterized by high morbidity, mortality, and economic cost. This study leverages wearable technology and machine learning algorithms to preoperatively identify high-risk individuals, thereby enhancing clinical decision-making for the mitigation of PPCs. METHODS A prospective study was conducted at the Department of Cardiovascular Surgery of West China Hospital, Sichuan University, from August 2021 to December 2022. We examined 100 cardiac valvular surgery patients, where wearable technology was utilized to collect and analyze nocturnal physiological data at the 24-hour admission, in conjunction with clinical data extraction from the Hospital Information System's electronic records. We systematically evaluated three different input types (physiological, clinical, and both) and five classifiers (XGB, LR, RF, SVM, KNN) to identify the combination with strong predictive performance for PPCs. Feature selection was conducted using Recursive Feature Elimination with Cross-Validated (RFECV) for each model, yielding an optimal feature subset for each, followed by a grid search to tune hyperparameters. Stratified 5-fold cross-validation was used to evaluate the generalization performance. The significance of AUC differences between models was tested using the DeLong test to determine the optimal prognostic model comprehensively. Additionally, univariate logistic regression analysis was conducted on the features of the best-performing model to understand the impact of individual feature on PPCs. RESULTS In this study, 22 patients (22%) developed PPCs. Across classifiers, models combining both physiological and clinical features performed better than physiological or clinical features alone. Specifically, including physiological data in the classification model improved AUC, ACC, F1, and precision by an average of 8.32%, 1.80%, 3.28% and 6.06% compared to using clinical data only. The XGB classifier, utilizing both dataset, achieved the highest performance with an AUC of 0.82 (± 0.08) and identified eight significant features. The DeLong test indicated that the XGB model utilizing the both dataset significantly outperformed the XGB models trained on the physiological or clinical datasets alone. Univariate logistic regression analysis suggested that surgical methods, age, nni_50, and min_ven_in_mean are significantly associated with the occurrence of PPCs. CONCLUSION The integration of continuous wearable physiological and clinical data significantly improves preoperative risk assessment for PPCs, which helps to optimize surgical management and reduce PPCs morbidity and mortality.
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Affiliation(s)
- Lixuan Li
- Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China
| | - Yuekong Hu
- Department of Rehabilitation Medicine, West China Tianfu Hospital, Sichuan University, Chengdu, China
| | | | - Zeruxin Luo
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiachen Wang
- General Hospital of Tibet Military Region, Lhasa, China
| | - Wenqing Wang
- Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China
| | - Xiaoli Liu
- Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China
| | - Yuqiang Wang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Fan
- Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China
| | - Pengming Yu
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Zhengbo Zhang
- Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China.
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19
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Monaco GD, Mincione G, Sticchi A, Reimers B, Colombo A, Mangieri A. Transcatheter Tricuspid Valve Replacement: Current Options and Future Perspectives. Rev Cardiovasc Med 2025; 26:25712. [PMID: 39867193 PMCID: PMC11760540 DOI: 10.31083/rcm25712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 09/30/2024] [Accepted: 10/10/2024] [Indexed: 01/28/2025] Open
Abstract
Tricuspid regurgitation (TR) is a potentially lethal condition and represents a significant clinical challenge both for clinical and interventional cardiologists. Traditionally managed medically and surgically, transcatheter therapies are now an emerging option, especially in patients with prohibitive surgical risk due to age or comorbidities. Transcatheter tricuspid valve replacement (TTVR) is emerging as a potential solution for patients suffering from TR with positive clinical data supporting its use in a wide range of anatomies and clinical settings. However, the adoption of TTVR introduces new challenges, including a scarcity of long-term clinical risks of valve thrombosis, questions regarding the durability of implanted valves, and the potential higher risk for post-procedural pacemaker (PM) implantation.
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Affiliation(s)
- Guido Del Monaco
- Cardiovascular Department IRCCS (Istituto di Ricerca e Cura a Carattere Scientifico) Humanitas Research Hospital, 20089 Rozzano, Milan, Italy
- Department of Biomolecular Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Gianluca Mincione
- Cardiovascular Department IRCCS (Istituto di Ricerca e Cura a Carattere Scientifico) Humanitas Research Hospital, 20089 Rozzano, Milan, Italy
- Department of Biomolecular Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Alessandro Sticchi
- Cardiac Catheterization Laboratory, Azienda Ospedaliero Universitaria Pisana, 56100 Pisa, Italy
- Cardiothoracic and Vascular Department, University of Pisa, 56126 Pisa, Italy
| | - Bernhard Reimers
- Cardiovascular Department IRCCS (Istituto di Ricerca e Cura a Carattere Scientifico) Humanitas Research Hospital, 20089 Rozzano, Milan, Italy
- Department of Biomolecular Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Antonio Colombo
- Cardiovascular Department IRCCS (Istituto di Ricerca e Cura a Carattere Scientifico) Humanitas Research Hospital, 20089 Rozzano, Milan, Italy
- Department of Biomolecular Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Antonio Mangieri
- Cardiovascular Department IRCCS (Istituto di Ricerca e Cura a Carattere Scientifico) Humanitas Research Hospital, 20089 Rozzano, Milan, Italy
- Department of Biomolecular Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
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20
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Goldschmied A, Droppa M, Gawaz M, Geisler T. Transcatheter Tricuspid Valve Replacement Following Tricuspid Edge-To-Edge-Repair. Catheter Cardiovasc Interv 2025; 105:265-269. [PMID: 39623673 PMCID: PMC11694554 DOI: 10.1002/ccd.31317] [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: 10/01/2024] [Revised: 11/18/2024] [Accepted: 11/22/2024] [Indexed: 01/03/2025]
Abstract
Significant tricuspid regurgitation (TR) is seen as a relevant contributor of cardiac morbidity and mortality. Transcatheter tricuspid valve replacement (TTVR) is a novel technique to treat this condition. We present the case of an 82-year-old lady who was admitted for recurrent right heart decompensation despite having undergone treatment with tricuspid edge-to-edge repair (TEER). The patient underwent transfemoral implantation of a 48 mm EVOQUE valve. Since the implanted Clip was not in the central part of the valve, it was pushed toward the valvular anulus by the expanded prothesis. Echocardiography showed a good result with no residual TR. Options for residual TR after T-TEER are very limited. TTVR might be suitable in selected patients with non-central Clip placement.
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Affiliation(s)
- Andreas Goldschmied
- Department of Cardiology and AngiologyUniversity Hospital TübingenOtfried‐Müller‐Straße 10TübingenBaden‐WürttembergGermany
| | - Michal Droppa
- Department of Cardiology and AngiologyUniversity Hospital TübingenOtfried‐Müller‐Straße 10TübingenBaden‐WürttembergGermany
| | - Meinrad Gawaz
- Department of Cardiology and AngiologyUniversity Hospital TübingenOtfried‐Müller‐Straße 10TübingenBaden‐WürttembergGermany
| | - Tobias Geisler
- Department of Cardiology and AngiologyUniversity Hospital TübingenOtfried‐Müller‐Straße 10TübingenBaden‐WürttembergGermany
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21
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Alasnag M. Transcatheter Repair Solutions: Will They Stand the Test of Time? JACC Cardiovasc Interv 2024; 17:2808-2810. [PMID: 39663061 DOI: 10.1016/j.jcin.2024.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 10/21/2024] [Indexed: 12/13/2024]
Affiliation(s)
- Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia.
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22
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Tanaka T, Vogelhuber J, Öztürk C, Silaschi M, Bakhtiary F, Zimmer S, Nickenig G, Weber M, Sugiura A. Eligibility for Transcatheter Tricuspid Valve Interventions in Patients With Tricuspid Regurgitation. JACC Cardiovasc Interv 2024; 17:2732-2744. [PMID: 39663054 DOI: 10.1016/j.jcin.2024.09.019] [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: 03/05/2024] [Revised: 09/07/2024] [Accepted: 09/10/2024] [Indexed: 12/13/2024]
Abstract
BACKGROUND It remains unclear what proportion of patients with tricuspid regurgitation (TR) are suitable candidates for transcatheter tricuspid valve intervention (TTVI) in clinical practice. OBJECTIVES The aim of this study was to ascertain the prevalence of eligibility for tricuspid transcatheter edge-to-edge repair (T-TEER) and transcatheter tricuspid valve replacement (TTVR) devices among patients with TR. METHODS The tricuspid valve anatomy of all consecutive patients with TR who were considered for TTVI in local heart team conferences was retrospectively reviewed. According to current expert consensus, the anatomical feasibility for T-TEER was classified into 3 groups: favorable, feasible, and unfavorable anatomy. Clinical and anatomical eligibility for TTVR was evaluated in patients with cardiac computed tomographic (CCT) images. RESULTS Among 491 patients, 99 (20.2%) and 235 (47.9%) were considered to have favorable and feasible anatomy for T-TEER, respectively. In contrast, 157 patients (32.0%) had unfavorable anatomy for T-TEER. The most common reason for unfavorable anatomy for T-TEER was large coaptation gap width (66.2%), followed by anteroposterior TR jet location (62.4%). Among 327 patients with CCT images, 205 (62.7%) were judged to be clinically or anatomically ineligible for TTVR, mainly because of tricuspid annuli larger than commercially available prosthesis sizes (65.4%). Combined echocardiographic and CCT assessment showed that 23.2% of the patients with TR were ineligible for both T-TEER and TTVR. CONCLUSIONS Of 491 patients requiring TTVI, 32.0% had unfavorable anatomy for T-TEER, and 37.3% of patients with CCT images were eligible for TTVR. Despite the emergence of TTVR devices, 23.2% of patients with TR remained ineligible for both T-TEER and TTVR.
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Affiliation(s)
- Tetsu Tanaka
- Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany.
| | - Johanna Vogelhuber
- Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Can Öztürk
- Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Atsushi Sugiura
- Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
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23
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Furman D, Whisenant B. Transcatheter Tricuspid Valve Clinical Trials: Incomplete Data and FDA-Approved Devices. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2024; 8:100335. [PMID: 39670044 PMCID: PMC11632808 DOI: 10.1016/j.shj.2024.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/19/2024] [Accepted: 05/23/2024] [Indexed: 12/14/2024]
Abstract
Each reviewed trial of transcatheter tricuspid valve intervention demonstrated clinically meaningful improvement in Kansas City Cardiomyopathy Questionnaire (KCCQ)-defined quality of life and favorable right ventricular remodeling. KCCQ correlates with tricuspid regurgitation (TR) reduction, heart failure hospitalization, and mortality. Change in KCCQ is therefore meaningful both as a measure of quality of life and as a surrogate endpoint of the impact of TV interventions. TRILUMINATE, the first randomized trial to evaluate the safety and efficacy of tricuspid edge-to-edge repair, demonstrated clinically important benefits in KCCQ score and favorable right ventricular remodeling, which are appropriate endpoints for this symptomatic population. TRISCEND II, which evaluated the safety and effectiveness of the EVOQUE valve, enrolled patients with more New York Heart Association class III and IV heart failure and lower KCCQ scores than TRILUMINATE. EVOQUE tricuspid valve replacement in TRISCEND II reduced TR to mild or less in 94% of patients compared to 50% of patients treated with TriClip in TRILUMINATE. The higher-risk TRISCEND II population and the near elimination of TR with EVOQUE are consistent with the favorable trend in EVOQUE mortality. Patients with diminished left ventricular systolic function being considered for either of these tricuspid valve interventions should be optimized with guideline directed medical therapy. Significant left-side valve disease should be treated. Patients should be optimally diuresed and excluded with severe pulmonary hypertension. Patients with persistent severe TR and symptoms or right ventricular enlargement should be considered for intervention. Smaller coaptation gaps without significant pacemaker impingement may be well served with transcatheter tricuspid edge-to-edge repair, while larger coaptation gaps and leaflets pinned by right ventricular leads, particularly in patients tolerating oral anticoagulation, may be best served with transcatheter tricuspid valve replacement.
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Affiliation(s)
- Deborah Furman
- Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Brian Whisenant
- Department of Cardiovascular Medicine, Intermountain Medical Center, Murray, UT
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24
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Abushouk A, Layoun H, Harb SC, Miyasaka R, Albert C, Starling RC, Reed GW, Krishnaswamy A, Yun JJ, Kapadia SR, Puri R. Real-World Patient Eligibility and Feasibility of Transcatheter Edge-to-Edge Repair or Replacement Interventions for Tricuspid Regurgitation. J Card Fail 2024; 30:1265-1272. [PMID: 39389736 DOI: 10.1016/j.cardfail.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 07/21/2024] [Accepted: 07/23/2024] [Indexed: 10/12/2024]
Abstract
Novel transcatheter therapies for tricuspid regurgitation (TR) appear promising, yet their applicability to an all-comer TR population remains unclear. We aimed to assess the feasibility of emerging transcatheter tricuspid therapies in a real-world population with greater than or equal to moderate symptomatic TR. A total of 178 patients were referred to our center between January 2019 and December 2021 for greater than or equal to moderate symptomatic TR and were classified into 4 groups: Investigative (patients eligible for enrollment in the Triluminate, Clasp TR, and TRISCEND trials), off-label clipping, surgery, and medical treatment. A total of 10.7% of the population were deemed eligible for investigative therapies, 20.2% and 19.7% of patients were offered off-label clipping and surgery, respectively, and 49.4% received medical treatment. Common reasons for investigative therapy-related ineligibility were unsuitable anatomy (large tricuspid annulus or wide leaflet coaptation gap) and the presence of significant comorbidities. Compared with the other groups, the investigative group was less likely to harbor concomitant ≥moderate mitral regurgitation, greater than or equal to moderate right ventricular dysfunction or severe pulmonary hypertension (P < .05). At 1 year, there remained a significant reduction in TR severity in the investigative group (P < .001) in comparison with the medical treatment group. However, the results were comparable to off-label clipping (P = .60) and inferior to surgery (P =.04). Exploratory analyses failed to show evidence of differences in the rates of all-cause mortality (P =.40) and heart failure hospitalizations (P = .94) between all groups. Current real-world eligibility of TR patients for emerging transcatheter therapies remains limited, underscoring the need for continued innovative efforts to offer device therapies to a broader TR cohort.
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Affiliation(s)
- Abdelrahman Abushouk
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Habib Layoun
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rhonda Miyasaka
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Chonyang Albert
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Randall C Starling
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - James J Yun
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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25
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Hahn RT, Makkar R, Makar M, Davidson C, Puthamana J, Zahr F, Chadderdon S, Fam N, Ong G, Yadav PK, Thourani VH, Vannan MA, Tchétché D, Dumonteil N, Bonfils L, Lepage L, Smith R, Grayburn PA, Webb JG, Moss R, Windecker S, Brugger N, Nabauer M, Hausleiter J, Kodali S. EVOQUE Tricuspid Valve Replacement System: State-of-the-Art Screening and Intraprocedural Guidance. JACC Cardiovasc Interv 2024; 17:2093-2112. [PMID: 39322362 DOI: 10.1016/j.jcin.2024.07.034] [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: 04/25/2024] [Revised: 07/08/2024] [Accepted: 07/21/2024] [Indexed: 09/27/2024]
Abstract
With the recent approval of the transcatheter EVOQUE tricuspid valve replacement system to treat severe, symptomatic tricuspid regurgitation, there is a need to define the appropriate patient population and anatomical considerations for this device. In this consensus document, the authors review these considerations, describe the procedural steps and imaging requirements to ensure technical success, and discuss management of complex intraprocedural circumstances.
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Affiliation(s)
- Rebecca T Hahn
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA.
| | - Raj Makkar
- Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Moody Makar
- Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Charles Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jyothy Puthamana
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Firas Zahr
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Scott Chadderdon
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Neil Fam
- Toronto Heart Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Geraldine Ong
- Toronto Heart Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Pradeep K Yadav
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Vinod H Thourani
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA; Department of Cardiovascular Surgery, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Mani A Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | | | | | | | - Laurent Lepage
- Cardiology Department, Clinique Pasteur, Toulouse, France
| | - Robert Smith
- Baylor Scott and White Research Institute, The Heart Hospital Baylor Plano, Plano, Texas, USA
| | - Paul A Grayburn
- Baylor Scott and White Research Institute, The Heart Hospital Baylor Plano, Plano, Texas, USA
| | - John G Webb
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Moss
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephan Windecker
- Department of Cardiology, University Cardiovascular Center, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, University Cardiovascular Center, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Michael Nabauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Susheel Kodali
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
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26
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Wensel R, Opitz C. Novel interventions on the tricuspid valve: how to consider the pulmonary circulation? Curr Opin Pulm Med 2024; 30:444-450. [PMID: 39114937 DOI: 10.1097/mcp.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
PURPOSE OF REVIEW This review addresses treatment options for moderate to severe tricuspid valve regurgitation and the importance of right ventricular function and the pulmonary circulation. RECENT FINDINGS Several interventional treatment options for severe tricuspid regurgitation have been developed including transcatheter edge-to-edge repair, annuloplasty and valve replacement. So far, transcatheter edge-to-edge repair is most frequently used with procedural success rates of more than 95% and improvements in functional and quality of life parameters for up to 2 years. Right ventricular function as well as pulmonary artery pressure and resistance levels are important outcome predictors. Mean pulmonary artery pressure more than 30 mmHg, transpulmonary gradient more than 17 mmHg and right ventricular to pulmonary artery coupling ratio less than 0.406 indicate poor outcome. SUMMARY Despite the remarkable safety of interventional treatment of severe tricuspid regurgitation right ventricular dysfunction and abnormal pulmonary hemodynamics are important determinants of procedural success and clinical outcome.Complete hemodynamic work-up should be an integral part of prerepair assessment although validated data predicting outcome are limited.
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Affiliation(s)
- Roland Wensel
- Klinik für Innere Medizin - Kardiologie, DRK Kliniken Berlin | Westend, Berlin, Germany
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27
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Xi R, Mumtaz MA, Xu D, Zeng Q. Tricuspid Regurgitation Complicating Heart Failure: A Novel Clinical Entity. Rev Cardiovasc Med 2024; 25:330. [PMID: 39355586 PMCID: PMC11440397 DOI: 10.31083/j.rcm2509330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/05/2024] [Accepted: 05/14/2024] [Indexed: 10/03/2024] Open
Abstract
With the escalating incidence of heart failure, accurate diagnosis is paramount for tailored therapeutic interventions. The tricuspid valve, particularly tricuspid regurgitation, once relegated as the "forgotten valve", has gained prominence due to increasing evidence implicating severe tricuspid valve disease in the prognosis of diverse cardiovascular conditions. This review delineates recent significant advancements in imaging modalities, transcatheter interventions, and epidemiological and pathophysiological insights regarding tricuspid regurgitation complicating heart failure. A comprehensive understanding of these innovative concepts and technologies can significantly improve patient outcomes.
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Affiliation(s)
- Rongyang Xi
- The First School of Clinical Medicine, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, China
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, China
| | - Muhammad Ahsan Mumtaz
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Southern Medical University, 510515 Guangzhou, Guangdong, China
| | - Dingli Xu
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Southern Medical University, 510515 Guangzhou, Guangdong, China
| | - Qingchun Zeng
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Southern Medical University, 510515 Guangzhou, Guangdong, China
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28
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Goyal A, Sulaiman SA, Pancholi V, Jain H, Daoud M, Sohail AH. Celebrating a breakthrough: FDA greenlights TriClip G4 for tricuspid regurgitation: an editorial. Int J Surg 2024; 110:5317-5319. [PMID: 38759689 PMCID: PMC11392211 DOI: 10.1097/js9.0000000000001628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/06/2024] [Indexed: 05/19/2024]
Affiliation(s)
- Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai
| | | | - Vidhi Pancholi
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai
| | - Hritvik Jain
- Department of Internal Medicine, All India Institute of Medical Sciences-Jodhpur, Rajasthan, India
| | - Mohamed Daoud
- Department of Internal Medicine, Bogomolets National Medical University, Kyiv, Ukraine
| | - Amir H. Sohail
- Department of Surgery, University of New Mexico Health Sciences, Albuquerque, New Mexico, USA
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29
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Zahr F, Elmariah S, Vemulapalli S, Kodali SK, Hahn RT, Anderson AS, Eleid MF, Davidson CJ, Sharma RP, O'Neill WW, Bethea B, Thourani VH, Chakravarty T, Gupta A, Makkar RR. Impact of Tricuspid Regurgitation on Outcomes of Transcatheter Aortic Valve Replacement With Balloon-Expandable Valves. JACC Cardiovasc Interv 2024; 17:1916-1931. [PMID: 39197990 DOI: 10.1016/j.jcin.2024.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/15/2024] [Accepted: 07/02/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Tricuspid regurgitation (TR) is highly prevalent in the transcatheter aortic valve replacement (TAVR) population, but clear management guidelines are lacking. OBJECTIVES The aims of this study were to elucidate the prevalence and consequences of severe TR in patients with aortic stenosis undergoing TAVR and to examine the change in TR post-TAVR, including predictors of improvement and its impact on longer term mortality. METHODS Using Centers for Medicare and Medicaid Services-linked TVT (Transcatheter Valve Therapy) Registry data, a propensity-matched analysis was performed among patients undergoing TAVR with baseline mild, moderate, or severe TR. Kaplan-Meier estimates were used to assess the impact of TR on 3-year mortality. Multivariable analysis identified predictors of 30-day TR improvement. RESULTS Of the 312,320 included patients, 84% had mild, 13% moderate, and 3% severe TR. In a propensity-matched cohort, severe baseline TR was associated with higher in-hospital mortality (2.5% vs 2.1% for moderate TR and 1.8% for mild TR; P = 0.009), higher 1-year mortality (24% vs 19.6% for moderate TR and 16.6% for mild TR; P < 0.0001), and 3-year mortality (54.2% vs 48.5% for moderate TR and 43.3% for mild TR; P < 0.0001). Among the patients with severe TR at baseline, 76.4% improved to moderate or less TR 30 days after TAVR. Baseline mitral regurgitation moderate or greater, preserved ejection fraction, higher aortic valve gradient, and better kidney function predicted TR improvement after TAVR. However, severe 30-day residual TR was associated with higher 1-year mortality (27.4% vs 18.7% for moderate TR and 16.8% for mild TR; P < 0.0001). CONCLUSIONS Severe baseline and 30-day residual TR after TAVR are associated with increased mortality up to 3 years. This analysis identifies a higher risk group that could be evaluated for the recently approved tricuspid interventions.
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Affiliation(s)
- Firas Zahr
- Department of Cardiovascular Medicine, Knight Cardiovascular Institute Cardiology Clinic, Oregon Health and Science University, Portland, Oregon, USA.
| | - Sammy Elmariah
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Sreekanth Vemulapalli
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Susheel K Kodali
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Rebecca T Hahn
- Department of Cardiology, Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Allen S Anderson
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Charles J Davidson
- Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rahul P Sharma
- Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - William W O'Neill
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Brian Bethea
- Department of Cardiothoracic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Vinod H Thourani
- Department of Cardiac Surgery, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Tarun Chakravarty
- Division of Cardiology, Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, California, USA
| | - Aakriti Gupta
- Division of Cardiology, Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, California, USA
| | - Raj R Makkar
- Division of Cardiology, Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, California, USA
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30
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Stolz L, Cheung A, Boone R, Fam N, Ong G, Villablanca P, Jabri A, De Backer O, Mølller JE, Tchétché D, Oliva O, Chak-Yu So K, Lam YY, Latib A, Scotti A, Coisne A, Sudre A, Dreyfus J, Nejjari M, Favre PE, Cruz-Gonzalez I, Estévez-Loureiro R, Barreiro-Perez M, Makkar R, Patel D, Leurent G, Donal E, Modine T, Hausleiter J. Transjugular Transcatheter Tricuspid Valve Replacement: Early Compassionate Use Outcomes. JACC Cardiovasc Interv 2024; 17:1936-1945. [PMID: 39197992 DOI: 10.1016/j.jcin.2024.06.014] [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: 02/21/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Data on procedural and early outcomes after transjugular transcatheter tricuspid valve replacement (TTVR) are limited. OBJECTIVES This study sought to evaluate first-in-man procedural and clinical outcomes after transjugular TTVR with a special focus on patients who received large device sizes in whom TTVR outcomes have been questioned. METHODS The retrospective registry included patients who underwent TTVR using the LuX-Valve Plus system (Jenscare Biotechnology Co Ltd) for symptomatic tricuspid regurgitation (TR) from January 2022 until February 2024 at 15 international centers in a compassionate use setting. The endpoints were procedural TR reduction, in-hospital death, adverse events, and 1-month survival. We further stratified results according to the size of the implanted device (<55 vs ≥55 mm). RESULTS The registry included a total of 76 patients at a median age of 78 years (Q1-Q3: 72-83 years, 47.4% women). TR was reduced to ≤2+ and ≤1+ in 94.7% and 90.8% of patients (75.0% of patients received TTVR devices ≥55 mm) with well-sustained results at 1-month follow-up (TR ≤2+ in 95.0% and ≤1+ 86.8%). Residual TR was paravalvular in all cases. In-hospital death occurred in 4 patients (5.3%). Four patients (5.3%) underwent cardiac surgery during index hospitalization. Major in-hospital bleeding events occurred in 5 patients (6.6%). New in-hospital pacemaker implantation was required in 3.9% of patients in the overall cohort (5.7% in "pacemaker-naive" individuals). No cases of valve thrombosis, stroke, myocardial infarction, or pulmonary embolism were observed. At 1-month follow-up, survival was 94.4%, and NYHA functional class significantly improved. One further patient received a pacemaker, 1 further bleeding event occurred, and 2 patients underwent reintervention or surgery within the first 30 days after TTVR. No differences in procedural outcomes or adverse events were observed after stratification for valve size. CONCLUSIONS Transjugular TTVR appears to be a safe and effective treatment option for patients with severe TR with comparable outcomes in very large tricuspid anatomies.
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Affiliation(s)
- Lukas Stolz
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians University Klinikum, Ludwig-Maximilians University München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany. https://twitter.com/stolz_l
| | - Anson Cheung
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Robert Boone
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Neil Fam
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Geraldine Ong
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Pedro Villablanca
- Department of Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Ahmad Jabri
- Department of Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Kent Chak-Yu So
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yat-Yin Lam
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Augustin Coisne
- University of Lille, Inserm U1011-EGID, Centre Hospitalier Universitaire Lille, Institut Pasteur de Lille, Lille, France
| | - Arnaud Sudre
- University of Lille, Inserm U1011-EGID, Centre Hospitalier Universitaire Lille, Institut Pasteur de Lille, Lille, France
| | - Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | - Mohammed Nejjari
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | - Paul-Emile Favre
- Department of Cardiology and Cardiovascular Surgery, Heart Valve Center, Institut Cœur Poumon, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Ignacio Cruz-Gonzalez
- Department of Cardiology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Manuel Barreiro-Perez
- Department of Interventional Cardiology, Hospital Alvaro Cunqueiro, Vigo, Spain; Instituto de Investigación Galicia Sur, Servizo Galego de Saude, Vigo, Spain
| | - Raj Makkar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dhairya Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Guillaume Leurent
- Department of Cardiology, Centre Hospitalier Universitaire Rennes, Inserm, LTSI-UMR 1099, University of Rennes 1, Rennes, France
| | - Erwan Donal
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Thomas Modine
- Department of Cardiology and Cardiovascular Surgery, Heart Valve Center, Institut Cœur Poumon, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians University Klinikum, Ludwig-Maximilians University München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.
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Hoerbrand IA, Kraus MJ, Gruber M, Geis NA, Schlegel P, Frey N, Konstandin MH. Favorable safety profile of NOAC therapy in patients after tricuspid transcatheter edge-to-edge repair. Clin Res Cardiol 2024:10.1007/s00392-024-02517-z. [PMID: 39158599 DOI: 10.1007/s00392-024-02517-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 08/05/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Transcatheter edge-to-edge repair for severe tricuspid regurgitation (TR) is a new treatment option (t-TEER). Data on optimal antithrombotic therapy after t-TEER in patients with an indication for anticoagulation are scarce and evidence-based guideline recommendations are lacking. We sought to investigate efficacy and safety of novel oral anticoagulation (NOAC) and vitamin-K-antagonists (VKA) in patients undergoing t-TEER. METHODS Among 78 consecutive patients with t-TEER of severe TR, 69 patients were identified with concomitant indication for oral anticoagulation. Outcomes of these patients treated with NOAC or VKA were compared over a median follow-up period of 327 (177-460) days. RESULTS Despite elevated thromboembolic and bleeding risk scores (CHA2DS2-VASc 4.2 ± 1.1, HEMORR2HAGES 3.0 ± 1.0 and HAS-BLED 2.1 ± 0.8), only one major bleeding incidence occurred under NOAC therapy. The risk for overall (NOAC 8% vs. VKA group 26%, p = 0.044) and major bleeding events (NOAC 2% vs. VKA 21%, p = 0.010) was significantly lower in the NOAC compared to the VKA group. No significant difference was found between NOAC and VKA treatment in terms of mortality (NOAC 18% vs. VKA 16%, p = 0.865) or the combined endpoint of death, heart failure hospitalization, stroke, embolism, thrombosis, myocardial infarction, and severe bleeding (NOAC 48% vs. VKA 42%, p = 0.801). A comparison between apixaban (n = 27) and rivaroxaban (n = 16) treated patients revealed no significant differences between NOAC substances (all bleeding events apixaban 7% vs. rivaroxaban 13%, p = 0.638). CONCLUSION Results of this study indicate that NOACs may offer a favorable risk-benefit profile for patients with concomitant indication for anticoagulation therapy following t-TEER.
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Affiliation(s)
- Isabel A Hoerbrand
- Department of Internal Medicine III, Division of Cardiology, University Hospital Heidelberg, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Martin J Kraus
- Department of Internal Medicine III, Division of Cardiology, University Hospital Heidelberg, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Martin Gruber
- Department of Internal Medicine III, Division of Cardiology, University Hospital Heidelberg, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Nicolas A Geis
- Department of Internal Medicine III, Division of Cardiology, University Hospital Heidelberg, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Philipp Schlegel
- Department of Internal Medicine III, Division of Cardiology, University Hospital Heidelberg, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Division of Cardiology, University Hospital Heidelberg, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Mathias H Konstandin
- Department of Internal Medicine III, Division of Cardiology, University Hospital Heidelberg, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
- DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany.
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Grayburn PA, Kodali SK, Hahn RT, Lurz P, Thourani VH, Kozorovitsky ER, Gilmore SY, Vinekar C, Zhang B, Boulware K, Krzmarzick AM, Nguyen D, Vu MT, Feldman T, Mack MJ, Leon MB. TRISCEND II: Novel Randomized Trial Design for Transcatheter Tricuspid Valve Replacement. Am J Cardiol 2024; 225:171-177. [PMID: 38897265 DOI: 10.1016/j.amjcard.2024.06.009] [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: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024]
Abstract
Severe tricuspid regurgitation remains largely undertreated given limited treatment options. Transcatheter tricuspid valve interventions have emerged as a promising therapy for these patients, and the TRISCEND II pivotal trial is the first randomized controlled trial to evaluate transcatheter tricuspid valve replacement (TTVR). The TRISCEND II pivotal trial studies the transcatheter EVOQUE (Edwards Lifesciences, Irvine, California) tricuspid valve replacement system using a United States Food and Drug Administration Breakthrough Device Designation-a program intended to provide timely access to medical devices by speeding up development, assessment, and review. The TRISCEND II trial is a prospective, multicenter trial that randomizes patients with symptomatic severe tricuspid regurgitation to treatment with either TTVR in conjunction with optimal medical therapy or optimal medical therapy alone. The trial's novel 2-phase design evaluates 30-day safety and 6-month effectiveness end points for the first 150 patients in the initial phase and a 1-year safety and effectiveness end point for the full cohort of 400 patients in the second phase. The TRISCEND II trial's 2-phase trial design provided an opportunity for early review and led to the first commercial approval of a TTVR system. In conclusion, the design of the TRISCEND II trial will likely inform future transcatheter tricuspid device trials.
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Affiliation(s)
- Paul A Grayburn
- Baylor Scott and White: The Heart Hospital Plano, Plano, Texas; Baylor Scott and White Research Institute Cardiac Imaging Core Laboratory, Plano, Texas.
| | | | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York
| | | | | | | | | | | | | | | | | | - Don Nguyen
- Edwards Lifesciences, Irvine, California
| | - Minh T Vu
- Edwards Lifesciences, Irvine, California
| | | | - Michael J Mack
- Baylor Scott and White: The Heart Hospital Plano, Plano, Texas
| | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York
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Synetos A, Ktenopoulos N, Katsaros O, Vlasopoulou K, Korovesis T, Drakopoulou M, Apostolos A, Koliastasis L, Toutouzas K, Tsioufis C. New Therapeutic Advances in the Management of Tricuspid Valve Regurgitation. J Clin Med 2024; 13:4599. [PMID: 39200742 PMCID: PMC11354245 DOI: 10.3390/jcm13164599] [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: 06/09/2024] [Revised: 07/21/2024] [Accepted: 08/03/2024] [Indexed: 09/02/2024] Open
Abstract
Tricuspid regurgitation (TR) is an intricate disorder that has a negative outlook, while surgical treatment is linked to increased mortality. Primary TR occurs due to a structural defect in the tricuspid valve (TV), while secondary TR is a more prevalent condition often associated with pulmonary hypertension, heart failure, and atrial fibrillation. The use of specific surgical procedures to improve TR is limited in everyday clinical practice due to the heightened surgical risk and delayed patient presentation. The development of other transcatheter heart valve procedures has led to a significant increase in transcatheter TV operations, which can be attributed to certain technological advancements. This review aims to provide an updated overview of transcatheter TV procedures, available alternative therapies, and standards for patient selection. It will also highlight the current state of development in this field, which is characterized by rapid progress and numerous ongoing clinical trials.
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Affiliation(s)
- Andreas Synetos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (K.V.); (T.K.); (A.A.); (L.K.)
- School of Medicine, European University of Cyprus, Egkomi 2404, Cyprus
| | - Nikolaos Ktenopoulos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (K.V.); (T.K.); (A.A.); (L.K.)
| | - Odysseas Katsaros
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (K.V.); (T.K.); (A.A.); (L.K.)
| | - Konstantina Vlasopoulou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (K.V.); (T.K.); (A.A.); (L.K.)
| | - Theofanis Korovesis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (K.V.); (T.K.); (A.A.); (L.K.)
| | - Maria Drakopoulou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (K.V.); (T.K.); (A.A.); (L.K.)
| | - Anastasios Apostolos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (K.V.); (T.K.); (A.A.); (L.K.)
| | - Leonidas Koliastasis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (K.V.); (T.K.); (A.A.); (L.K.)
| | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (K.V.); (T.K.); (A.A.); (L.K.)
| | - Constantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (K.V.); (T.K.); (A.A.); (L.K.)
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Ning X, Xu H, Cao J, Li N, Wang W, Qiao F, Han L, Lu F, Xu Z. Transcatheter tricuspid valve interventions: Current devices and clinical evidence. J Cardiol 2024; 84:73-79. [PMID: 38583664 DOI: 10.1016/j.jjcc.2024.04.001] [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: 12/03/2023] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
The tricuspid valve is known as "the forgotten valve". Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease. TR is often late in the course of the disease when it becomes symptomatic, often being a marker of late-stage chronic heart failure with a poor prognosis and high mortality rate at long-term follow-up. Despite the clear correlation between TR and mortality, most TR patients are under-treated. Neither pharmacologic nor surgical treatment demonstrates a significant survival benefit. Isolated tricuspid valve surgery has the highest mortality rate of all valve surgeries. Therefore, there is an urgent clinical need for minimally invasive therapies to meet the needs of patients with TR. In recent years, a variety of transcatheter tricuspid valve interventions representing less invasive alternatives to surgery have shown promising results, which bring hope to patients with severe TR. The purpose of this review is to provide a complete and updated overview on current transcatheter tricuspid valve interventions and clinical evidence.
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Affiliation(s)
- Xiaoping Ning
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Hongjie Xu
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Jingyi Cao
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Ning Li
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Wei Wang
- Department of Cardiovascular Surgery, The First People's Hospital of Shanghai Transportation University, Shanghai, China
| | - Fan Qiao
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Lin Han
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Fanglin Lu
- Department of Cardiovascular Surgery, The First People's Hospital of Shanghai Transportation University, Shanghai, China.
| | - Zhiyun Xu
- Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China.
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35
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Benfari G, Springhetti P, Enriquez-Sarano M. Combined tricuspid and left-sided valvular heart disease: A frequent and treatable scenario. Eur J Heart Fail 2024; 26:1861-1862. [PMID: 38957032 DOI: 10.1002/ejhf.3370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 07/04/2024] Open
Affiliation(s)
- Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Paolo Springhetti
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
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Mahboob E, Samad MA, Carver C, Chaudhry SAA, Fatima T, Abid M, Ahmed M, Ahmed R, Ullah I. TriClip G4: A game-changer for tricuspid valve regurgitation treatment. Curr Probl Cardiol 2024; 49:102687. [PMID: 38821232 DOI: 10.1016/j.cpcardiol.2024.102687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024]
Abstract
Tricuspid valve regurgitation, or TR, is a difficult-to-manage condition. In addition to EVOQUE, percutaneous annuloplasty, and surgical repair, the TriClip G4 system has been added to the interventional therapeutic choices for TR. Recently, the Food and Drug Administration (FDA) approved the use of the TriClip G4 device to treat patients with symptomatic, severe TR who have received optimal medication therapy but are at intermediate or higher risk of surgery. This review attempts to offer a thorough examination of the procedural features, learning curves, results of the device and compares the TriClip G4 system to other interventional therapies for TR. TriClip G4 has shown to have promising results in pivotal clinical trials, be cost-effective, and improve the quality of life of patients. Furthermore, it has its unique advantages against other conventional techniques and devices.
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Affiliation(s)
- Eman Mahboob
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | | | - Tehreem Fatima
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Mishal Abid
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mushood Ahmed
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Raheel Ahmed
- National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Irfan Ullah
- Department of Internal Medicine, Khyber Teaching Hospital, Peshawar, Pakistan
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37
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Stolz L, Kresoja KP, von Stein J, Fortmeier V, Koell B, Rottbauer W, Kassar M, Goebel B, Denti P, Achouh P, Rassaf T, Barreiro-Perez M, Boekstegers P, Rück A, Doldi PM, Novotny J, Zdanyte M, Adamo M, Vincent F, Schlegel P, von Bardeleben RS, Stocker TJ, Weckbach LT, Wild MG, Brunner S, Toggweiler S, Grapsa J, Patterson T, Thiele H, Kister T, Konstandin MH, Van Belle E, Metra M, Geisler T, Estévez-Loureiro R, Luedike P, Karam N, Maisano F, Lauten P, Praz F, Kessler M, Kalbacher D, Rudolph V, Iliadis C, Lurz P, Hausleiter J. Residual tricuspid regurgitation after tricuspid transcatheter edge-to-edge repair: Insights into the EuroTR registry. Eur J Heart Fail 2024; 26:1850-1860. [PMID: 38812292 DOI: 10.1002/ejhf.3274] [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: 02/27/2024] [Revised: 04/05/2024] [Accepted: 04/23/2024] [Indexed: 05/31/2024] Open
Abstract
AIMS Data on the prognostic impact of residual tricuspid regurgitation (TR) after tricuspid transcatheter edge-to-edge repair (T-TEER) are scarce. The aim of this analysis was to evaluate 2-year survival and symptomatic outcomes of patients in relation to residual TR after T-TEER. METHODS AND RESULTS Using the large European Registry of Transcatheter Repair for Tricuspid Regurgitation (EuroTR registry) we investigated the impact of residual TR on 2-year all-cause mortality and New York Heart Association (NYHA) functional class at follow-up. The study further identified predictors for residual TR ≥3+ using a logistic regression model. The study included a total of 1286 T-TEER patients (mean age 78.0 ± 8.9 years, 53.6% female). TR was successfully reduced to ≤1+ in 42.4%, 2+ in 40.0% and 3+ in 14.9% of patients at discharge, while 2.8% remained with TR ≥4+ after the procedure. Residual TR ≥3+ was an independent multivariable predictor of 2-year all-cause mortality (hazard ratio 2.06, 95% confidence interval 1.30-3.26, p = 0.002). The prevalence of residual TR ≥3+ was four times higher in patients with higher baseline TR (vena contracta >11.1 mm) and more severe tricuspid valve tenting (tenting area >1.92 cm2). Of note, no survival difference was observed in patients with residual TR ≤1+ versus 2+ (76.2% vs. 73.1%, p = 0.461). The rate of NYHA functional class ≥III at follow-up was significantly higher in patients with residual TR ≥3+ (52.4% vs. 40.5%, p < 0.001). Of note, the degree of TR reduction significantly correlated with the extent of symptomatic improvement (p = 0.012). CONCLUSIONS T-TEER effectively reduced TR severity in the majority of patients. While residual TR ≥3+ was associated with worse outcomes, no differences were observed for residual TR 1+ versus 2+. Symptomatic improvement correlated with the degree of TR reduction.
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Affiliation(s)
- Lukas Stolz
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Munich, Germany
| | - Karl-Patrik Kresoja
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jennifer von Stein
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Vera Fortmeier
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Benedikt Koell
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | | | - Mohammad Kassar
- Department of Cardiology, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Bjoern Goebel
- Department of Cardiology, Heart Center, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Paolo Denti
- Cardio-Thoracic-Vascular Department, Heart Valve Center, IRCCS, Milan, Italy
| | - Paul Achouh
- Cardiology Department, European Hospital Georges Pompidou, Université Cité, Paris, France
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, University Hospital Essen, University Duisburg-Essen, West German Heart and Vascular Center, Essen, Germany
| | | | - Peter Boekstegers
- Department of Cardiology, Helios Klinikum Siegburg, Siegburg, Germany
| | - Andreas Rück
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Philipp M Doldi
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Munich, Germany
| | - Julia Novotny
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Munich, Germany
| | - Monika Zdanyte
- Medical Clinic III, University Hospital Tübingen, Tübingen, Germany
| | - Marianna Adamo
- ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Flavien Vincent
- Cardiology Department, Centre Hospitalier Universitaire De Lille, Lille, France
| | - Philipp Schlegel
- Division of Cardiology, Department of Internal Medicine III, University Hospital Heidelberg, Ruprecht-Karl University Heidelberg, Heidelberg, Germany
| | - Ralph-Stephan von Bardeleben
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Munich, Germany
- Department of Cardiovascular Sciences, Imperial College of London, London, UK
| | - Ludwig T Weckbach
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Munich, Germany
- Department of Cardiovascular Sciences, Imperial College of London, London, UK
| | - Mirjam G Wild
- University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Germany
| | | | | | - Julia Grapsa
- Department of Cardiology, Guys and St Thomas NHS Trust, London, UK
| | - Tiffany Patterson
- Department of Cardiovascular Sciences, Imperial College of London, London, UK
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Tobias Kister
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mathias H Konstandin
- Division of Cardiology, Department of Internal Medicine III, University Hospital Heidelberg, Ruprecht-Karl University Heidelberg, Heidelberg, Germany
| | - Eric Van Belle
- Cardiology Department, Centre Hospitalier Universitaire De Lille, Lille, France
| | - Marco Metra
- ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Tobias Geisler
- Medical Clinic III, University Hospital Tübingen, Tübingen, Germany
| | | | - Peter Luedike
- Department of Cardiology and Vascular Medicine, University Hospital Essen, University Duisburg-Essen, West German Heart and Vascular Center, Essen, Germany
| | - Nicole Karam
- Cardiology Department, European Hospital Georges Pompidou, Université Cité, Paris, France
| | - Francesco Maisano
- Cardio-Thoracic-Vascular Department, Heart Valve Center, IRCCS, Milan, Italy
| | - Philipp Lauten
- Department of Cardiology, Heart Center, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Fabien Praz
- Department of Cardiology, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Mirjam Kessler
- Department of Cardiology, University Heart Center Ulm, Ulm, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Volker Rudolph
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Christos Iliadis
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Philipp Lurz
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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Stolz L, Stocker TJ, Weckbach LT, Schmid S, Novotny J, Doldi PM, Massberg S, Näbauer M, Hausleiter J. 4-Year Follow-Up After Transcatheter Tricuspid Valve Replacement Using the EVOQUE System. JACC Case Rep 2024; 29:102393. [PMID: 38973814 PMCID: PMC11225638 DOI: 10.1016/j.jaccas.2024.102393] [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: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 07/09/2024]
Abstract
Transcatheter tricuspid valve replacement (TTVR) is an increasingly used treatment technique for patients with severe tricuspid regurgitation (TR). Currently, available data from international registries and randomized controlled trials provide outcome data until a maximum follow-up of 2 years after the procedure. This case report presents 4-year follow-up data for an 84-year-old woman who underwent TTVR for torrential TR in 2019. The patient experienced durable TR reduction, symptomatic improvement, right ventricular reverse remodeling, and substantial improvement in liver and kidney function.
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Affiliation(s)
- Lukas Stolz
- 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, Partner Site Munich Heart Alliance, Munich, Germany
| | - Ludwig T. Weckbach
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Simon Schmid
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Julia Novotny
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Philipp M. Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- German Center for Cardiovascular Research, 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, 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, Partner Site Munich Heart Alliance, Munich, Germany
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Hahn RT, Lindenfeld J, Böhm M, Edelmann F, Lund LH, Lurz P, Metra M, Tedford RJ, Butler J, Borlaug BA. Tricuspid Regurgitation in Patients With Heart Failure and Preserved Ejection Fraction: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 84:195-212. [PMID: 38960514 DOI: 10.1016/j.jacc.2024.04.047] [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: 02/07/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 07/05/2024]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is associated with high morbidity and mortality. Important risk factors for the development of HFpEF are similar to risk factors for the progression of tricuspid regurgitation (TR), and both conditions frequently coexist and thus is a distinct phenotype or a marker for advanced HF. Many patients with severe, symptomatic atrial secondary TR have been enrolled in current transcatheter device trials, and may represent patients at an advanced stage of HFpEF. Management of HFpEF thus may affect the pathophysiology of TR, and the physiologic changes that occur following transcatheter treatment of TR, may also impact symptoms and outcomes in patients with HFpEF. This review discusses these issues and suggests possible management strategies for these patients.
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Affiliation(s)
- Rebecca T Hahn
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA.
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | - Frank Edelmann
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany; German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Lars H Lund
- Department of Cardiology, Heart, Vascular and Neuro Theme, Karolinska University Hospital, and Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Philip Lurz
- Department of Cardiology, Universitätsmedizin Mainz, Mainz, Germany
| | - Marco Metra
- CardiologyCardiology, Spedali Civili and University of Brescia, Brescia, Italy
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas, USA; University of Mississippi, Jackson, Mississippi, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Ktenopoulos N, Katsaros O, Apostolos A, Drakopoulou M, Tsigkas G, Tsioufis C, Davlouros P, Toutouzas K, Karanasos A. Emerging Transcatheter Therapies for Valvular Heart Disease: Focus on Mitral and Tricuspid Valve Procedures. Life (Basel) 2024; 14:842. [PMID: 39063596 PMCID: PMC11277877 DOI: 10.3390/life14070842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/22/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
The emergence of percutaneous treatment options provides novel therapeutic alternatives for older and feeble patients who are at high risk for any surgical procedure. The purpose of our review was to offer an up-to-date analysis of the rapidly expanding field of percutaneous technologies for mitral, tricuspid, and pulmonary procedures. Edge-to-edge repair is an established treatment for secondary mitral regurgitation (MR), while transcatheter mitral valve replacement is a potential and expanding option for managing both secondary and primary MR. However, additional advancements are necessary to enhance the safety and feasibility of this procedure. Transcatheter tricuspid intervention is an emerging option that was conceived after the success of transcatheter procedures in aortic and mitral valves, and it is currently still in the early stages of advancement. This can be attributed, at least in part, to the previously overlooked effect of tricuspid regurgitation on patient outcomes. The development of edge-to-edge repair represents the forefront of innovations in transcatheter procedures. There is a scarcity of data about tricuspid annuloplasty and replacement, and further study is necessary. Transcatheter mitral, tricuspid, and pulmonary procedures show prospects for the future, while their role in clinical practice has not been definitively established.
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Affiliation(s)
- Nikolaos Ktenopoulos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (A.A.); (M.D.); (C.T.); (K.T.)
| | - Odysseas Katsaros
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (A.A.); (M.D.); (C.T.); (K.T.)
| | - Anastasios Apostolos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (A.A.); (M.D.); (C.T.); (K.T.)
| | - Maria Drakopoulou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (A.A.); (M.D.); (C.T.); (K.T.)
| | - Grigorios Tsigkas
- Department of Cardiology, Patras University Hospital, 26504 Patras, Greece; (G.T.); (P.D.)
| | - Constantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (A.A.); (M.D.); (C.T.); (K.T.)
| | - Periklis Davlouros
- Department of Cardiology, Patras University Hospital, 26504 Patras, Greece; (G.T.); (P.D.)
| | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (N.K.); (O.K.); (A.A.); (M.D.); (C.T.); (K.T.)
| | - Antonios Karanasos
- Department of Cardiology, Patras University Hospital, 26504 Patras, Greece; (G.T.); (P.D.)
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Gerçek M, Narang A, Körber MI, Friedrichs KP, Puthumana JJ, Ivannikova M, Al-Kazaz M, Cremer P, Baldridge AS, Meng Z, Luedike P, Thomas JD, Rudolph TK, Geisler T, Rassaf T, Pfister R, Rudolph V, Davidson CJ. GLIDE Score: Scoring System for Prediction of Procedural Success in Tricuspid Valve Transcatheter Edge-to-Edge Repair. JACC Cardiovasc Imaging 2024; 17:729-742. [PMID: 38842961 DOI: 10.1016/j.jcmg.2024.04.008] [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: 02/26/2024] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Tricuspid valve transcatheter edge-to-edge repair (T-TEER) is the most widely used transcatheter therapy to treat patients with tricuspid regurgitation (TR). OBJECTIVES The aim of this study was to develop a simple anatomical score to predict procedural outcomes of T-TEER. METHODS All patients (n = 168) who underwent T-TEER between January 2017 and November 2022 at 2 centers were included in the derivation cohort. Additionally, 126 patients from 2 separate institutions served as a validation cohort. T-TEER was performed using 2 commercially available technologies. Core laboratory assessment of procedural transesophageal echocardiograms was used to determine septolateral and anteroposterior coaptation gap, leaflet morphology, septal leaflet length and retraction, chordal structure density, tethering height, en face TR jet morphology and TR jet location, image quality, and the presence of intracardiac leads. A scoring system was derived using univariable and multivariable logistic regression. Endpoints assessed were immediate postprocedural TR reduction ≥2 grades and TR grade moderate or less. RESULTS The median age was 82 years (Q1-Q3: 78-84 years); 48% of patients were women; and patients presented with severe (55%), massive (36%), and torrential (8%) TR. Five variables (septolateral coaptation gap, chordal structure density, en face TR jet morphology, TR jet location, and image quality) were identified as best predicting procedural outcome and were incorporated in the GLIDE (Gap, Location, Image quality, density, en-face TR morphology) score (range 0-5). TR reduction ≥2 grades and TR grade moderate or less were observed in >90% of patients with GLIDE scores of 0 and 1 and in only 5.6% and 16.7% of those with GLIDE scores ≥4. The GLIDE score was then externally validated in a separate cohort (area under the curve: 0.77; 95% CI: 0.69-0.86). TR reduction significantly correlated with functional improvement assessed by NYHA functional class and 6-minute walk distance at 3 months. CONCLUSIONS The GLIDE score is a simple, 5-component score that is readily obtained during patient imaging and can predict successful T-TEER.
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Affiliation(s)
- Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Akhil Narang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - M Isabel Körber
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kai P Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Jyothy J Puthumana
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maria Ivannikova
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Mohamed Al-Kazaz
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Paul Cremer
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Zhiying Meng
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - James D Thomas
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tanja K Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Tobias Geisler
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Roman Pfister
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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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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Madhavan MV, Agarwal V, Hahn RT. Transcatheter Therapy for the Tricuspid Valve: A Focused Review of Edge-to-Edge Repair and Orthotopic Valve Replacement. Curr Cardiol Rep 2024; 26:459-474. [PMID: 38884853 PMCID: PMC11199311 DOI: 10.1007/s11886-024-02051-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE OF REVIEW Patients with severe tricuspid regurgitation (TR) are at risk for significant morbidity and mortality. Transcatheter tricuspid valve interventions (TTVI) may offer patients less invasive treatment alternatives to surgery. This review evaluates the most common class of device currently used worldwide to treat TR, tricuspid transcatheter edge-to-edge repair (T-TEER) and orthotopic transcatheter tricuspid valve replacement (TTVR), both of which are now approved in the USA and Europe. RECENT FINDINGS The first pivotal randomized clinical trial, TRILUMINATE, demonstrated that T-TEER can safely reduce TR and is associated with improved health status outcomes. However, results of this trial have raised questions about whether this device can provide sufficient TR reduction to impact clinical outcomes. Orthotopic TTVR has recently gained attention with initial data suggesting near-complete TR elimination. The current review examines the technical features and anatomic limitations of the most commonly used devices for T-TEER and orthotopic TTVR, discusses the current clinical data for these devices, and offers a theoretical construct for device selection.
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Affiliation(s)
- Mahesh V Madhavan
- NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Vratika Agarwal
- NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA
| | - Rebecca T Hahn
- NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA.
- Cardiovascular Research Foundation, New York, NY, USA.
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Jain A, Gebhardt B, Subramani S, Mehrotra M, Gaber M, Ramakrishna H. Tricuspid Regurgitation: Analysis of Outcomes and Risk Assessment. J Cardiothorac Vasc Anesth 2024; 38:1397-1408. [PMID: 38523023 DOI: 10.1053/j.jvca.2024.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Ankit Jain
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | - Brian Gebhardt
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Medical Center, Worcester, MA
| | - Sudhakar Subramani
- Department of Anesthesiology and Perioperative Medicine, University of Iowa, Iowa City, IA
| | - Mayank Mehrotra
- Department of Anesthesiology and Perioperative Medicine (Mehrotra) Mercy Health, Rockford, IL
| | - Mohamed Gaber
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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Moubarak G, Kluis A, Eisenga J, McCullough K, Ladner J, Salih M, Banwait J, DiMaio JM, Mack MJ, George T, Szerlip MI. Causes and Clinical Outcomes of Patients Who Failed Screening for Transcatheter Tricuspid Valve Interventions. Am J Cardiol 2024; 220:67-76. [PMID: 38582312 DOI: 10.1016/j.amjcard.2024.03.030] [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: 12/15/2023] [Revised: 03/07/2024] [Accepted: 03/23/2024] [Indexed: 04/08/2024]
Abstract
Transcatheter tricuspid valve intervention (TTVI) has recently emerged as a promising alternative to surgery for tricuspid regurgitation (TR). However, a significant proportion of patients fail screening for TTVI, and little is known about their characteristics and natural history. This study sought to investigate causes of screen failure and outcomes of patients declined for TTVI. This was a retrospective single-center study of 32 patients who were ineligible for participation in transcatheter tricuspid valve replacement and tricuspid transcatheter edge-to-edge repair trials. Patients were classified into 2 groups according to the therapy they received: optimized medical therapy (OMT) group or intervention group. The mean age was 82 ± 7.8 years and 68.8% were women. The most common reasons for TTVI exclusion were anatomic/procedural impediment (53.1%), inclusion criteria not met (40.6%), and multivalvular disease (6.3%). Overall, 19 patients (59.4%) did not undergo subsequent tricuspid intervention. The clinical outcomes of these patients who received OMT alone were poor, with a 1-year composite of cardiac death or heart failure readmission of 47.4%. These rates were worse than in patients who subsequently underwent an intervention, albeit not statistically significant (OMT: 47.7% vs 23.1% interventions, p = 0.3), and were significantly more pronounced in the subgroup of patients who were excluded for anatomic/procedural limitations (OMT: 70% vs 14.3% interventions, p = 0.05). In conclusion, patients ineligible for TTVI, particularly, those with anatomic/procedural limitations, and treated medically have poor outcomes. These data underscore the importance of earlier referral and support the need for further transcatheter therapy iterations.
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Affiliation(s)
| | - Austin Kluis
- Baylor Scott and White Research Institute Plano, Texas
| | - John Eisenga
- Baylor Scott and White Research Institute Plano, Texas
| | | | | | - Mohammed Salih
- Department of Cardiology, Baylor Scott and White The Heart Hospital Plano, Texas
| | | | - J Michael DiMaio
- Baylor Scott and White Research Institute Plano, Texas; Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital Plano, Texas
| | - Michael J Mack
- Baylor Scott and White Research Institute Plano, Texas; Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital Plano, Texas
| | - Timothy George
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital Plano, Texas
| | - Molly I Szerlip
- Baylor Scott and White Research Institute Plano, Texas; Department of Cardiology, Baylor Scott and White The Heart Hospital Plano, Texas
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Vogelhuber J, Tanaka T, Kavsur R, Goto T, Öztürk C, Silaschi M, Nickenig G, Zimmer S, Weber M, Sugiura A. Outcomes of Transcatheter Tricuspid Edge-to-Edge Repair in Patients With Right Ventricular Dysfunction. Circ Cardiovasc Interv 2024; 17:e013156. [PMID: 38629314 DOI: 10.1161/circinterventions.123.013156] [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: 04/16/2023] [Accepted: 03/08/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND We assessed the safety profile of tricuspid transcatheter edge-to-edge repair (TEER) in patients with right ventricular (RV) dysfunction. METHODS We identified patients undergoing TEER to treat tricuspid regurgitation from June 2015 to October 2021 and assessed tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (RVFAC). RV dysfunction was defined as TAPSE <17 mm and RVFAC <35%. The primary end point was 30-day mortality after TEER. We also investigated the change in the RV function in the early phase and clinical outcomes at 2 years. RESULTS The study participants (n=262) were at high surgical risk (EuroSCORE II, 6.2% [interquartile range, 4.0%-10.3%]). Among them, 44 patients met the criteria of RV dysfunction. Thirty-day mortality was 3.2% in patients with normal RV function and 2.3% in patients with RV dysfunction (P=0.99). Tricuspid regurgitation reduction to ≤2+ was consistently achieved irrespective of RV dysfunction (76.5% versus 70.5%; P=0.44). TAPSE and RVFAC declined after TEER in patients with normal RV function (TAPSE, 19.0±4.7 to 17.9±4.5 mm; P=0.001; RVFAC, 46.2%±8.1% to 40.3%±9.7%; P<0.001). In contrast, those parameters were unchanged or tended to increase in patients with RV dysfunction (TAPSE, 13.2±2.3 to 15.3±4.7 mm; P=0.011; RVFAC, 29.6%±4.1% to 31.6%±8.3%; P=0.14). Two years after TEER, compared with patients with normal RV function, patients with RV dysfunction had significantly higher mortality (27.0% versus 56.3%; P<0.001). CONCLUSIONS TEER was safe and feasible to treat tricuspid regurgitation in patients with RV dysfunction. The decline in the RV function was observed in patients with normal RV function but not in patients with RV dysfunction.
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Affiliation(s)
- Johanna Vogelhuber
- Department of Internal Medicine II (J.V., T.T., R.K., C.O., G.N., S.Z., M.W., A.S.), Heart Center Bonn, University Hospital Bonn, Germany
| | - Tetsu Tanaka
- Department of Internal Medicine II (J.V., T.T., R.K., C.O., G.N., S.Z., M.W., A.S.), Heart Center Bonn, University Hospital Bonn, Germany
| | - Refik Kavsur
- Department of Internal Medicine II (J.V., T.T., R.K., C.O., G.N., S.Z., M.W., A.S.), Heart Center Bonn, University Hospital Bonn, Germany
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan (T.G.)
| | - Can Öztürk
- Department of Internal Medicine II (J.V., T.T., R.K., C.O., G.N., S.Z., M.W., A.S.), Heart Center Bonn, University Hospital Bonn, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery (M.S.), Heart Center Bonn, University Hospital Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II (J.V., T.T., R.K., C.O., G.N., S.Z., M.W., A.S.), Heart Center Bonn, University Hospital Bonn, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine II (J.V., T.T., R.K., C.O., G.N., S.Z., M.W., A.S.), Heart Center Bonn, University Hospital Bonn, Germany
| | - Marcel Weber
- Department of Internal Medicine II (J.V., T.T., R.K., C.O., G.N., S.Z., M.W., A.S.), Heart Center Bonn, University Hospital Bonn, Germany
| | - Atsushi Sugiura
- Department of Internal Medicine II (J.V., T.T., R.K., C.O., G.N., S.Z., M.W., A.S.), Heart Center Bonn, University Hospital Bonn, Germany
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Davidson LJ, Tang GHL, Ho EC, Fudim M, Frisoli T, Camaj A, Bowers MT, Masri SC, Atluri P, Chikwe J, Mason PJ, Kovacic JC, Dangas GD. The Tricuspid Valve: A Review of Pathology, Imaging, and Current Treatment Options: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1223-e1238. [PMID: 38660790 DOI: 10.1161/cir.0000000000001232] [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] [Indexed: 04/26/2024]
Abstract
Tricuspid valve disease is an often underrecognized clinical problem that is associated with significant morbidity and mortality. Unfortunately, patients will often present late in their disease course with severe right-sided heart failure, pulmonary hypertension, and life-limiting symptoms that have few durable treatment options. Traditionally, the only treatment for tricuspid valve disease has been medical therapy or surgery; however, there have been increasing interest and success with the use of transcatheter tricuspid valve therapies over the past several years to treat patients with previously limited therapeutic options. The tricuspid valve is complex anatomically, lying adjacent to important anatomic structures such as the right coronary artery and the atrioventricular node, and is the passageway for permanent pacemaker leads into the right ventricle. In addition, the mechanism of tricuspid pathology varies widely between patients, which can be due to primary, secondary, or a combination of causes, meaning that it is not possible for 1 type of device to be suitable for treatment of all cases of tricuspid valve disease. To best visualize the pathology, several modalities of advanced cardiac imaging are often required, including transthoracic echocardiography, transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, to best visualize the pathology. This detailed imaging provides important information for choosing the ideal transcatheter treatment options for patients with tricuspid valve disease, taking into account the need for the lifetime management of the patient. This review highlights the important background, anatomic considerations, therapeutic options, and future directions with regard to treatment of tricuspid valve disease.
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Chen L, Wang L, Petrossian G, Robinson N, Chung W, Henry M, Mihalatos D, Bano R, Weber J, Khan J, Cohen DJ, Berke A, Ali Z, Khalique OK. Etiologies and Impact of Exclusion Rates for Transcatheter Mitral and Tricuspid Valve Structural Heart Clinical Trials at a High-Volume Quaternary Care Hospital. Am J Cardiol 2024; 218:102-112. [PMID: 38432332 DOI: 10.1016/j.amjcard.2024.02.035] [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: 09/20/2023] [Revised: 01/31/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
There are various devices under clinical investigation for transcatheter mitral valve intervention and transcatheter tricuspid valve intervention (TTVI); however, the exclusion rates remain high. We aimed to investigate the exclusion rates for transcatheter mitral valve repair (TMVr), transcatheter mitral valve replacement (TMVR), transcatheter tricuspid valve repair (TTVr), and transcatheter tricuspid valve replacement (TTVR). There were 129 patients who were referred to St. Francis Hospital & Heart Center valve clinic and completed screening between January 2021 and July 2022. The causes for exclusion were classified into 4 categories: patient withdrawal, anatomic unsuitability, clinical criteria, and medical futility. In 129 patients, the exclusion rates for TMVr, TMVR, TTVr, and TTVR were 81%, 85%, 91%, and 87%, respectively. Patient withdrawal and medical futility were leading etiologies for exclusion, followed by anatomic unsuitability. TMVr had the highest rate of patient withdrawal (64%) and the lowest anatomic unsuitability (5%) because of short posterior leaflet length. Replacement interventions have a higher anatomic unsuitability (33%) than repair interventions (17%) (p = 0.04). Most exclusions of anatomic unsuitability were because of mitral stenosis or small annulus size for TMVR and large annulus size for TTVR. A total of 50% of exclusions from TTVr were because of the presence of pacemaker/defibrillator leads. In patients excluded from their respective trials, patients being referred for TMVr had the highest recurrent hospitalization and repair group had a higher mortality (p <0.01 and p = 0.01, respectively). In conclusion, the exclusion rates for transcatheter mitral valve intervention and TTVI trials remain high because of various reasons, limiting patient enrollment and treatment. This supports the need for further device improvement or exploring alternative means of therapy.
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Affiliation(s)
- Lu Chen
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York.
| | - Lin Wang
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
| | - George Petrossian
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
| | - Newell Robinson
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
| | - William Chung
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
| | - Matthew Henry
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
| | - Dennis Mihalatos
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
| | - Ruqiyya Bano
- Department of Nephrology and Hypertension, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Jonathan Weber
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
| | - Jaffar Khan
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
| | - David J Cohen
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
| | - Andrew Berke
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
| | - Ziad Ali
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York; New York Institute of Technology, Old Westbury, New York
| | - Omar K Khalique
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York; New York Institute of Technology, Old Westbury, New York
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Ramsay J, Tang Y, Kim JK, Frangieh AH. Transcatheter Treatment of Mitral Valve Regurgitation in the Setting of Concomitant Coronary or Multivalvular Heart Disease: A Focused Review. Interv Cardiol Clin 2024; 13:279-289. [PMID: 38432770 DOI: 10.1016/j.iccl.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Treatment for mixed valve disease has historically been limited, often surgery being the only option. With the recent advancement of transcatheter therapies, percutaneous approaches are quickly becoming viable therapeutic considerations in inoperable or high-risk patients, also offering the option for a staged or same-session treatment. Guidelines are primarily focused on single-valve disease. However, patients often present with multiple pathologies. This review summarizes the data and literature on transcatheter treatment of patients with mitral regurgitation who concomitantly have aortic stenosis or regurgitation, tricuspid regurgitation, or ischemic cardiomyopathy. Pathophysiology, hemodynamics, available therapies as well as order and timing of interventions are discussed.
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Affiliation(s)
- Jay Ramsay
- Department of Internal Medicine, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA
| | - Yicheng Tang
- Division of Cardiology, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA
| | - Jin Kyung Kim
- Division of Cardiology, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA
| | - Antonio H Frangieh
- Division of Cardiology, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA.
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Sanchez CE, Yakubov SJ. Simplifying Transcatheter Tricuspid Valve Replacement With 3-Dimensional Intracardiac Echocardiography. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101347. [PMID: 39130173 PMCID: PMC11307963 DOI: 10.1016/j.jscai.2024.101347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 08/13/2024]
Abstract
Transcatheter tricuspid valve replacement (TTVR) offers the potential for improved outcomes for the significant number of patients with severe tricuspid valve regurgitation relative to current treatment options. Imaging is a critical component of the success of this procedure. Here we describe strategies and techniques for the use of 3-dimensional intracardiac echocardiography as an adjunct to standard transesophageal echocardiography during TTVR procedure.
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Affiliation(s)
- Carlos E. Sanchez
- Department of Interventional Cardiology, OhioHealth Riverside Methodist Hospital, Columbus, Ohio
| | - Steven J. Yakubov
- Department of Interventional Cardiology, OhioHealth Riverside Methodist Hospital, Columbus, Ohio
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