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Iwasieczko A, Malinowski M, Solarewicz M, Bush J, MacDougall B, Rausch M, Timek TA. Impact of reductive tricuspid ring annuloplasty on right ventricular size, geometry and strain in an ovine model of functional tricuspid regurgitation. Interact Cardiovasc Thorac Surg 2022; 35:6628589. [PMID: 35781336 PMCID: PMC9270866 DOI: 10.1093/icvts/ivac187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/18/2022] [Accepted: 06/01/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
Reductive ring annuloplasty of the tricuspid annulus represents the contemporary surgical approach to functional tricuspid regurgitation (FTR). We set out to investigate the influence of moderate reductive tricuspid ring annuloplasty on tricuspid regurgitation and right ventricular (RV) size, geometry and strain in an ovine model of chronic FTR.
METHODS
Eight healthy Dorsett male sheep (62.8 + 2kg) underwent a left thoracotomy for placement and tightening of pulmonary artery band to at least double proximal pulmonary artery blood pressure. After 8 weeks of recovery, animals underwent sternotomy, epicardial echocardiography and sonomicrometry crystal implantation. Six crystals were placed around tricuspid annulus and 13 on RV free wall epicardium along 3 parallels defining 3 wall regions (basal, mid and lower) and 1 on the RV apex. All animals underwent beating heart implantation of 26 mm MC3 annuloplasty ring during a second cardiopulmonary bypass run after baseline data acquisition. Simultaneous haemodynamic, sonomicrometry and echocardiography data were acquired at Baseline and after reductive tricuspid ring annuloplasty.
RESULTS
Implantation of reductive ring annuloplasty resulted in 47 ± 7% annular area reduction (996 ± 152 mm vs 516 ± 52 mm2, P = 0.0002) and significantly decreased RV end-diastolic volume (185 ± 27 vs 165 ± 30 ml, P = 0.02). Tricuspid ring annuloplasty effectively reduced FTR grade (3.75 ± 0.6 vs 0.3 ± 0.5, P = 0.00004) and had little influence on RV function, cross-sectional area, radius of curvature or free wall regional strains.
CONCLUSIONS
In adult sheep with 8 weeks of pulmonary artery banding and FTR, tricuspid annulus reduction of 47% with prosthetic ring annuloplasty effectively abolished FTR while maintaining regional RV function and strain patterns.
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Affiliation(s)
- Artur Iwasieczko
- Division of Cardiothoracic Surgery, Spectrum Health , Michigan State College of Human Medicine, Grand Rapids, MI, USA
- Clinical Department of Cardiac Surgery, District Hospital No. 2, University of Rzeszow , Rzeszow, Poland
| | - Marcin Malinowski
- Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice , Katowice, Poland
| | - Monica Solarewicz
- Division of Cardiothoracic Surgery, Spectrum Health , Michigan State College of Human Medicine, Grand Rapids, MI, USA
| | - Jared Bush
- Division of Cardiothoracic Surgery, Spectrum Health , Michigan State College of Human Medicine, Grand Rapids, MI, USA
| | - Brian MacDougall
- Division of Cardiothoracic Surgery, Spectrum Health , Michigan State College of Human Medicine, Grand Rapids, MI, USA
| | - Manuel Rausch
- Department of Aerospace Engineering & Engineering Mechanics, Department of Biomedical Engineering, Institute of Computational Engineering and Science, University of Texas at Austin , Austin, TX, USA
| | - Tomasz A Timek
- Division of Cardiothoracic Surgery, Spectrum Health , Michigan State College of Human Medicine, Grand Rapids, MI, USA
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Jazwiec T, Malinowski M, Ferguson H, Wodarek J, Quay N, Bush J, Goehler M, Parker J, Rausch M, Timek TA. Effect of variable annular reduction on functional tricuspid regurgitation and right ventricular dynamics in an ovine model of tachycardia-induced cardiomyopathy. J Thorac Cardiovasc Surg 2021; 161:e277-e286. [DOI: 10.1016/j.jtcvs.2019.10.194] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/11/2019] [Accepted: 10/27/2019] [Indexed: 11/30/2022]
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The influence of tricuspid annuloplasty prostheses on ovine annular geometry and kinematics. J Thorac Cardiovasc Surg 2021; 161:e191-e207. [DOI: 10.1016/j.jtcvs.2019.09.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 11/19/2022]
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Sakata T, Mogi K, Matsuura K, Sakurai M, Shiko Y, Kawasaki Y, Matsumiya G, Takahara Y. Mid-term functional recovery after tricuspid annuloplasty concomitant with left-sided valve surgery. Gen Thorac Cardiovasc Surg 2020; 69:662-672. [PMID: 33011880 DOI: 10.1007/s11748-020-01501-4] [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: 04/23/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND To elucidate the impact of tricuspid annuloplasty concomitant with left-sided valve surgery on the right ventricular (RV) function in patients with mild or more tricuspid regurgitation (TR). METHODS We enrolled 136 patients with mild or more TR who underwent left-sided valve surgery. Seventy-three patients underwent left-sided valve surgery alone (group non-T) and 63 underwent concomitant tricuspid annuloplasty (group T). The echocardiographic data at the latest follow-up (mean 1019 days) were compared using multiple regression analysis to adjust cofounding factors. Propensity score was calculated and included in the analysis as a covariate. In addition, propensity score matching was used for sensitive analysis (12 pairs). RESULTS In group non-T, there were more aortic valve surgeries, and fewer mitral valve surgeries. At baseline, body surface area, New York Heart Association class, and prevalence of atrial fibrillation were significantly different between groups. On preoperative echocardiography, left and right atrial diameter, RV diameter, and tricuspid annular diameter were larger in group T, whereas there was no significant difference in RV fractional area change. In multiple regression analyses, RV diameter in diastole was significantly lower and RV fractional area change was significantly higher at the follow-up period in group T. These results were not attenuated even in subgroup analysis in patients with only mild TR or mitral valve surgery alone. CONCLUSION Among patients with mild or more TR, RV dimensional and functional recovery was not obtained with left-sided valve surgery alone. Adding tricuspid annuloplasty may potentially achieve both outcomes.
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Affiliation(s)
- Tomoki Sakata
- Division of Cardiovascular Surgery, Heart and Vascular Institute, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Chiba, Funabashi, 273-8588, Japan. .,Department of Cardiovascular Surgery, Chiba University Hospital, Chiba, Japan.
| | - Kenji Mogi
- Division of Cardiovascular Surgery, Heart and Vascular Institute, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Chiba, Funabashi, 273-8588, Japan
| | - Kaoru Matsuura
- Department of Cardiovascular Surgery, Chiba University Hospital, Chiba, Japan
| | - Manabu Sakurai
- Division of Cardiovascular Surgery, Heart and Vascular Institute, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Chiba, Funabashi, 273-8588, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Hospital, Chiba, Japan
| | - Yoshiharu Takahara
- Division of Cardiovascular Surgery, Heart and Vascular Institute, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Chiba, Funabashi, 273-8588, Japan
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Sakata T, Mogi K, Sakurai M, Tani K, Hashimoto M, Shiko Y, Kawasaki Y, Matsumiya G, Takahara Y. Impact of tricuspid annuloplasty on postoperative changes in the right ventricular systolic and diastolic function: A retrospective cohort study. J Card Surg 2020; 35:1464-1470. [DOI: 10.1111/jocs.14611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Tomoki Sakata
- Division of Cardiovascular Surgery Funabashi Municipal Medical Center Heart and Vascular Institute Funabashi Japan
- Department of Cardiovascular Surgery Chiba University Hospital Chiba Japan
| | - Kenji Mogi
- Division of Cardiovascular Surgery Funabashi Municipal Medical Center Heart and Vascular Institute Funabashi Japan
| | - Manabu Sakurai
- Division of Cardiovascular Surgery Funabashi Municipal Medical Center Heart and Vascular Institute Funabashi Japan
| | - Kengo Tani
- Division of Cardiovascular Surgery Funabashi Municipal Medical Center Heart and Vascular Institute Funabashi Japan
| | - Masafumi Hashimoto
- Division of Cardiovascular Surgery Funabashi Municipal Medical Center Heart and Vascular Institute Funabashi Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center Chiba University Hospital Chiba Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center Chiba University Hospital Chiba Japan
| | - Goro Matsumiya
- Department of Cardiovascular Surgery Chiba University Hospital Chiba Japan
| | - Yoshiharu Takahara
- Division of Cardiovascular Surgery Funabashi Municipal Medical Center Heart and Vascular Institute Funabashi Japan
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Charles EJ, Ailawadi G. Commentary: Addressing tricuspid annular dilation: Cinch it down but not too tight. J Thorac Cardiovasc Surg 2020; 161:e288-e289. [PMID: 31973892 DOI: 10.1016/j.jtcvs.2019.11.117] [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: 11/29/2019] [Revised: 11/29/2019] [Accepted: 11/30/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Eric J Charles
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
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Aldea GS. Commentary: Tricuspid valve ring characteristics: Physiologically important, clinically relevant, or too little too late? J Thorac Cardiovasc Surg 2019; 161:e209-e210. [PMID: 31703897 DOI: 10.1016/j.jtcvs.2019.09.133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Gabriel S Aldea
- Department of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, Wash.
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Anselmi A. Commentary: Right ventricular-tricuspid valve interdependence and the challenges for structural heart valve therapy. J Thorac Cardiovasc Surg 2019; 158:769-770. [PMID: 30712916 DOI: 10.1016/j.jtcvs.2018.12.094] [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: 12/30/2018] [Accepted: 12/31/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France.
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