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Li J, Dong M, Sun Z, Li Q, Ni S. Tricuspid Regurgitation: Knowledge of Tricuspid Valve Morphology, Etiology of Regurgitation, and Grading of Regurgitation Severity. Echocardiography 2025; 42:e70147. [PMID: 40198679 DOI: 10.1111/echo.70147] [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: 10/13/2024] [Revised: 03/18/2025] [Accepted: 03/19/2025] [Indexed: 04/10/2025] Open
Abstract
With the aging of the population, the number of patients with tricuspid regurgitation (TR) is increasing. Severe TR is associated with global morbidity and mortality of cardiovascular events. In recent years, the rapid development of transcatheter interventions for tricuspid valve disease has made TR a current research hotspot. More preoperative information about the patient's tricuspid valve anatomy, the etiology leading to TR, and the severity of TR will aid in intraoperative maneuvers and postoperative prognosis assessments.
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Affiliation(s)
- Jun Li
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Mingliang Dong
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhenyun Sun
- Tengzhou Central People's Hospital, Tengzhou, China
| | - Qiao Li
- Department of Ultrasonography, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Shouxiang Ni
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Piperata A, Van den Eynde J, Marin-Cuartas M, Bortolussi G, Fila P, Walter T, Sarıcaoğlu MC, Gofus J, Rajdeep B, Sá MP, Rosati F, De la Cuesta M, Gastino E, Cuko B, Ternacle J, de Vincentiis C, Czerny M, Akar AR, Lucchese G, Ramlawi B, Borger MA, Modine T. Long-term outcomes after bioprosthetic tricuspid valve replacement: a multicenter study. Eur J Cardiothorac Surg 2025; 67:ezaf107. [PMID: 40128150 DOI: 10.1093/ejcts/ezaf107] [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: 11/22/2024] [Revised: 02/24/2025] [Accepted: 03/22/2025] [Indexed: 03/26/2025] Open
Abstract
OBJECTIVES Long-term evidence about bioprosthetic tricuspid valve replacement is scarce. This study aims to investigate the long-term clinical outcomes of patients who underwent tricuspid valve replacement with bioprostheses. METHODS This multicentre retrospective study included patients from 10 high-volume centres in 7 different countries, who underwent tricuspid valve replacement with bioprostheses. Echocardiographic and clinical data were reviewed. Long-term outcomes were investigated using Kaplan-Meier estimates, Cox regression, and competing risk analysis. RESULTS Of 675 patients, isolated tricuspid valve replacement was performed in 358 patients (53%), while 317 (47%) underwent concomitant procedures. Between these 2 groups, patients who underwent combined procedures reported a significantly higher incidence of infection, atrioventricular block, multi-organ failure, longer intensive care unit and hospital stay and higher 30-day mortality over patients who underwent isolated procedure. The overall 30-day mortality occurred in 70 patients (10.4%) [46 (14.6%) combined vs 24 (6.74%) isolated, P = 0.001]. During the follow-up, there was a continuous rate of attrition due to death, with cumulative incidences of death at 5, 10 and 15 years being 27.2%, 46.2% and 60.6%, respectively. In contrast, the risk of reintervention starts to significantly increase after 10 years of follow-up, with cumulative incidences of reintervention being 6.1%, 10.8% and 23.3%, respectively. Freedom from tricuspid valve reintervention, pacemaker implantation, tricuspid valve endocarditis and major thromboembolic events at 15 years were 56.5%, 77.3%, 84.0% and 86.4%, respectively. CONCLUSIONS Tricuspid valve replacement with bioprostheses is an effective treatment for valvular disease, despite being associated with relatively high early and long-term mortality. However, the risk of structural valve degeneration rises significantly after 10 years.
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Affiliation(s)
- Antonio Piperata
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France
| | | | | | - Giacomo Bortolussi
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Petr Fila
- Centre of Cardiovascular Surgery and Transplantation, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tim Walter
- Universitatslinikum Freiburg/Standort Bad kr Krozingen, Baden-Württemberg, Freiburg, Germany
| | - Mehmet Cahit Sarıcaoğlu
- Department of Cardiovascular Surgery, Ankara University Medical Faculty, İç Anadolu Bölgesi, Ankara, Turkey
| | - Jan Gofus
- Department of Cardiac Surgery, Charles University, Faculty of Medicine and University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Bilkhu Rajdeep
- Cardiovascular Department, St Thomas' Hospital, London, UK
| | - Michel Pompeu Sá
- Department of Cardiovascular Surgery, Lankenau Heart Institute, Lankenau Medical Center, Philadelphia, PA, USA
| | - Fabrizio Rosati
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | | | - Elisa Gastino
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Besart Cuko
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France
| | - Julien Ternacle
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France
| | | | - Martin Czerny
- Universitatslinikum Freiburg/Standort Bad kr Krozingen, Baden-Württemberg, Freiburg, Germany
| | - Ahmet Rüçhan Akar
- Department of Cardiovascular Surgery, Ankara University Medical Faculty, İç Anadolu Bölgesi, Ankara, Turkey
| | | | - Basel Ramlawi
- Department of Cardiovascular Surgery, Lankenau Heart Institute, Lankenau Medical Center, Philadelphia, PA, USA
| | - Michael A Borger
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Thomas Modine
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France
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Stein L, Haik B, Salemi A. No Longer Forgotten: More Understanding of Tricuspid Valve Replacement. Am J Cardiol 2024; 228:78-79. [PMID: 39033869 DOI: 10.1016/j.amjcard.2024.07.022] [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: 07/04/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024]
Affiliation(s)
- Louis Stein
- Department of Cardiothoracic Surgery, RWJ-Barnabas Health - Northern Division, Newark, New Jersey.
| | - Bruce Haik
- Division of Cardiology, RWJ-Barnabas Cooperman Medical Center, Livingston, New Jersey
| | - Arash Salemi
- Department of Cardiothoracic Surgery, RWJ-Barnabas Health - Northern Division, Newark, New Jersey
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Mao Y, Ma Y, Zhai M, Li L, Jin P, Liu Y, Yang J. Preliminary Study of a Degenerated Tricuspid Bioprosthetic Valve Implanted via Transcatheter Valve-in-Valve Implantation Guided by 3-Dimensional Printing. CJC Open 2024; 6:978-988. [PMID: 39211748 PMCID: PMC11357757 DOI: 10.1016/j.cjco.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/30/2023] [Indexed: 09/04/2024] Open
Abstract
Background The procedures of transcatheter tricuspid valve-in-valve (TTViV) replacement are challenging, and the clinical outcomes are still unclear. Our goal was to report the short- and mid-term clinical outcomes of patients who underwent a TTViV implantation guided by 3-dimensional (3D) printing. Methods A retrospective analysis was performed on 6 patients who had TTViV implantation from May 2021 to March 2022. The median age was 51 years (range: 18-71 years), and 50.0% of the patients were male. Imaging assessments and 3D printing were performed on all 6 patients before the procedures. The perioperative data were evaluated, and the patients were followed up. Results Among the 6 patients, the etiologies of conditions affecting the tricuspid valves at baseline varied widely, including 1 case of Ebstein anomaly, 2 cases of infective endocarditis, 1 case of ventricular septal defect, and 2 cases of rheumatic heart disease. TTViV implantation was successfully performed in all 6 patients via the femoral vein approach; postoperative tricuspid regurgitation disappeared immediately, and the hemodynamic results were satisfactory. During the follow-up, all patients had significant improvement in symptoms and functional status. Conclusions TTViV implantation for the treatment of degenerated tricuspid bioprostheses should be considered safe and effective. Multimodal imaging and 3D printing may provide effective guidance for conducting the procedure. Clinical Trial Registration ClinicalTrials.gov Protocol Registration System (NCT02917980).
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Affiliation(s)
- Yu Mao
- Department of Cardiovascular Surgery, Xijing Hospital, Xi’an, China
| | - Yanyan Ma
- Department of Cardiovascular Surgery, Xijing Hospital, Xi’an, China
| | - Mengen Zhai
- Department of Cardiovascular Surgery, Xijing Hospital, Xi’an, China
| | - Lanlan Li
- Department of Cardiovascular Surgery, Xijing Hospital, Xi’an, China
| | - Ping Jin
- Department of Cardiovascular Surgery, Xijing Hospital, Xi’an, China
| | - Yang Liu
- Department of Cardiovascular Surgery, Xijing Hospital, Xi’an, China
| | - Jian Yang
- Department of Cardiovascular Surgery, Xijing Hospital, Xi’an, China
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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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Sohn SH, Kang Y, Kim JS, Hwang HY, Kim KH, Choi JW. Early and long-term outcomes of bioprosthetic versus mechanical tricuspid valve replacement: A nationwide population-based study. J Thorac Cardiovasc Surg 2024; 167:2117-2128.e11. [PMID: 36894350 DOI: 10.1016/j.jtcvs.2023.01.025] [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: 09/10/2022] [Revised: 01/09/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We compared early and long-term clinical outcomes of bioprosthetic versus mechanical tricuspid valve replacement in a nationwide study based on the database from the National Health Insurance Service. METHODS Of 1425 patients who underwent tricuspid valve replacement from 2003 to 2018, 1241 patients were enrolled after excluding retricuspid valve replacement, complex congenital heart disease, Ebstein anomaly, and age less than 18 years at operation. Bioprostheses (group B) and mechanical prostheses (group M) were used in 562 patients (45.3%) and 679 patients (54.7%), respectively. The median follow-up duration was 5.6 years. Propensity score matching was performed. Subgroup analysis was performed in patients aged 50 to 65 years. RESULTS There was no difference in operative mortality or postoperative complications between the groups. All-cause mortality was higher in group B (7.8 vs 4.6 per 100 patient-years, hazard ratio, 1.75, 95% confidence interval, 1.33-2.30, P < .001). The cumulative incidence of stroke was higher in group M (hazard ratio, 0.65, 95% confidence interval, 0.43-0.99, P = .043), whereas the cumulative incidence of reoperation was higher in group B (hazard ratio, 4.20, 95% confidence interval, 1.53-11.54, P = .005). In terms of the age-dependent hazard of all-cause mortality, group B demonstrated a higher hazard than group M below the age of 75 years, and it was statistically significant between 54 and 65 years of age. In the subgroup analysis, all-cause mortality was also higher in group B. CONCLUSIONS Mechanical tricuspid valve replacement demonstrated higher long-term survival than bioprosthetic tricuspid valve replacement. In particular, mechanical tricuspid valve replacement showed significantly higher overall survival between 54 and 65 years of age.
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Affiliation(s)
- Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Seong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Patlolla SH, Saran N, Schaff HV, Crestanello J, Pochettino A, Stulak JM, Greason KL, King KS, Lee AT, Daly RC, Dearani JA. Prosthesis choice for tricuspid valve replacement: Comparison of clinical and echocardiographic outcomes. J Thorac Cardiovasc Surg 2024; 167:668-679.e2. [PMID: 36028365 DOI: 10.1016/j.jtcvs.2022.07.003] [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: 10/17/2021] [Revised: 06/10/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES There is limited evidence evaluating valve function and right heart remodeling after tricuspid valve replacement (TVR), as well as whether the choice of prosthesis has an impact on these outcomes. METHODS We reviewed 1043 consecutive adult patients who underwent first-time TVR; 33% had previous aortic and/or mitral valve operations. Severe tricuspid valve regurgitation (TR) was the indication for surgery in 94% patients. A mechanical valve was used in 149 (14%) patients and a bioprosthetic valve in 894 (86%). Concomitant major cardiac procedures were performed in 57% of patients. RESULTS The median age of the cohort was 68.8 (range, 25-94) years, and 57% were female. Overall survival at 5 and 10 years was 50% and 31%, respectively. Adjusted survival and cumulative incidence of reoperation after TVR were similar in patients with bioprosthetic and mechanical valves. Overall, right ventricular (RV) function and dilation improved postoperatively with the estimated proportion of patients with moderate or greater RV systolic dysfunction/dilatation decreasing by around 20% at 3 years follow-up. After adjusting for preoperative degree of dysfunction/dilatation, valve type had no effect on late improvement in RV function and dilation. Bioprosthetic TVR was associated with greater rates of recurrence of moderate or greater TR over late follow-up. Overall, a slight decline in tricuspid valve gradients was observed over time. CONCLUSIONS Mechanical and bioprosthetic valves provide comparable survival, incidence of reoperation, and recovery of RV systolic function and size after TVR. Bioprosthetic valves develop significant TR over time, and mechanical valves may have an advantage for younger patients and those needing anticoagulation.
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Affiliation(s)
| | - Nishant Saran
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
| | | | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Katherine S King
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minn
| | - Alexander T Lee
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minn
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
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Ríos-Ortega JC, Sisniegas-Razón J, Robles-Velarde V, Rodríguez-Urteaga Z. Is It Possible to Place a Pacemaker Lead Through a Bileaflet Mechanical Prosthesis? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:190-192. [PMID: 36872582 DOI: 10.1177/15569845231158656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
We present a 64-year-old woman who underwent mitral, aortic, and tricuspid valve (TV) replacement with mechanical prostheses. Two months after TV surgery, she presented third-degree atrioventricular block. After attempting to place a pacemaker lead through the coronary sinus, it was placed through the mechanical valve in the tricuspid position as the last option. At 1 year of follow-up, the device shows no signs of dysfunction, and the prosthesis has moderate regurgitation.
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Affiliation(s)
- Josías C Ríos-Ortega
- EsSalud, National Cardiovascular Institute, Cardiovascular Surgery Department, Lima, Peru
| | - Josué Sisniegas-Razón
- EsSalud, National Cardiovascular Institute, Cardiovascular Surgery Department, Lima, Peru
| | - Víctor Robles-Velarde
- EsSalud, National Cardiovascular Institute, Cardiovascular Surgery Department, Lima, Peru
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Ríos-Ortega JC, Paredes-Acevedo FE, Rojas-Sánchez PI. Isolated torrential tricuspid regurgitation and porcelain aorta due to mediastinal radiation therapy. Challenging surgical treatment. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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10
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Prosthesis choice for tricuspid valve replacement in the era of transcatheter valve-in-valve technique. J Thorac Cardiovasc Surg 2022. [DOI: 10.1016/j.jtcvs.2022.09.018] [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: 11/06/2022]
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Transcatheter Tricuspid Valve-in-Valve Replacement Using a J-Valve System for a Failed Tricuspid Bioprosthesis. Case Rep Cardiol 2022; 2022:7353522. [PMID: 35813080 PMCID: PMC9259371 DOI: 10.1155/2022/7353522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Redo operation for failed tricuspid bioprosthetic valves is associated with high morbidity and mortality. Transcatheter tricuspid valve-in-valve implantation has become an acceptable option for high-risk patients with a failed tricuspid bioprosthesis. We present a case of successful tricuspid valve-in-valve implantation using a J-valve in a failed tricuspid bioprosthesis position. Case Summary. A 48-year-old male, who had a failed tricuspid bioprosthesis, presented with right-side heart failure, right-to-left shunting at the atrial level, severe dyspnea, cyanosis, peripheral edema, hepatauxe, and ascites. After the interdisciplinary assessment, we successfully performed transcatheter tricuspid valve-in-valve implantation with the J-valve system. At 34-month postoperative follow-up, the patient had no symptoms of heart failure and the echocardiogram showed good valve position and well hemodynamic status. Conclusions This case demonstrated that the J-valve system may be a new option for high-risk patients with a failed tricuspid bioprosthetic valve.
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Romeo JD, Bashline MJ, Fowler JA, Kliner DE, Toma C, Smith AJC, Sultan I, Sanon S. Current Status of Transcatheter Tricuspid Valve Therapies. Heart Int 2022; 16:49-58. [PMID: 36275351 PMCID: PMC9524678 DOI: 10.17925/hi.2022.16.1.49] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/10/2022] [Indexed: 01/04/2024] Open
Abstract
Tricuspid regurgitation is a complex disease that carries a poor prognosis, and surgical repair is associated with high mortality. In light of the success of other transcatheter-based valve interventions, transcatheter tricuspid therapy has recently seen exponential use both clinically and in innovation. Given the rapid development of many tricuspid systems and multiple on-going clinical trials, the aim of this review is to highlight the current state of transcatheter tricuspid therapeutics and to provide an up-to-date view of their clinical use, outcomes and future directions.
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Affiliation(s)
- Jared D Romeo
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael J Bashline
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jeffrey A Fowler
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Dustin E Kliner
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Catalin Toma
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - AJ Conrad Smith
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ibrahim Sultan
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Saurabh Sanon
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Haji-Zeinali AM, Etesamifard N, Mohammadi Z, Haji-Zeinali MM, Sahebjam M, Abbasi K. Transcatheter tricuspid valve-in-valve implantation with bioprosthetic balloon expandable valve. Gen Thorac Cardiovasc Surg 2022; 70:947-953. [PMID: 35622220 DOI: 10.1007/s11748-022-01829-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/02/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study was conducted to evaluate the outcome of the transcatheter valve-in-valve implantation for degenerated tricuspid bioprosthetic valves with transcatheter aortic valves. METHODS This retrospective study enrolled all consecutive patients who were considered high risk for reoperations by the heart team and who underwent transcatheter valve-in-valve implantation for degenerated tricuspid bioprosthetic valves in Tehran Heart Center, Tehran, Iran. All the procedures were performed via the transfemoral venous route under echocardiography and fluoroscopy guidance with Edwards SAPIEN transcatheter heart valves (Edwards Lifesciences, Irvine, CA). RESULTS Ten patients underwent successful transcatheter valve-in-valve implantation in the tricuspid position without any major complications or need for emergency surgical interventions. The mean age was 54.1 ± 17.1 years, and 8 patients were female. The median follow-up was 19.5 months (16-32.25 mon). The mean period between the last tricuspid valve replacement and transcatheter valve-in-valve implantation was 4.9 ± 2.2 years. The bioprosthetic valves were Hancock in three patients, Mosaic in the other three patients, and Biocor, Pericarbon, Perimount, and Epic in the other patients. After the procedure, the clinical and functional status improved significantly in all the patients. The mean transvalvular gradient decreased from 6.75 ± 2.66 mm Hg to 2.85 ± 0.89 (P < 0.001), and the postoperative tricuspid regurgitation severity decreased significantly in almost all the patients. The hospitalization period after the procedure was 4.4 ± 1.7 days. CONCLUSIONS In high-risk patients, transcatheter valve-in-valve implantation seems to be a safe and minimally invasive alternative to reoperations for degenerated tricuspid bioprosthetic valves.
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Affiliation(s)
- Ali-Mohammad Haji-Zeinali
- Interventional Cardiology, Head of the Endovascular and Structural Heart Intervention Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nasrin Etesamifard
- Interventional Cardiology, Head of the Endovascular and Structural Heart Intervention Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohre Mohammadi
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Sahebjam
- Department of Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kiomars Abbasi
- Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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14
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Neonatal Marfan syndrome with missense variant of c.3706T> C undergoing bilateral atrioventricular valve replacement. Cardiol Young 2022; 32:833-836. [PMID: 34526162 DOI: 10.1017/s1047951121003905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Neonatal Marfan syndrome is a rare condition with poor prognosis because of severe mitral and/or tricuspid valve insufficiency. Mitral valve replacement is sometimes required in early infancy, while tricuspid valve replacement is rarely done. We report the first infant neonatal Marfan syndrome case with a missense variant of c.3706T>C in the fibrillin-1 gene that was successfully managed by mitral and tricuspid valve replacement. Early multiple-valve replacement may sometimes be required during infant age in this genetic syndrome.
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15
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Poschner T, Mach M, Andreas M, Russo M. Editorial commentary: Cutting the Gordian knot of right-sided prosthetic valve thrombosis. J Card Surg 2022; 37:865-867. [PMID: 34996127 DOI: 10.1111/jocs.16210] [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: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022]
Abstract
With limited data available for the tricuspid valve, there are no stringent recommendations in the current guidelines (ESC 2021). Valve replacement for the right-sided heart is inherently problematic and bears the potential for complications - including prosthetic valve thrombosis (PVT). The purpose of this editorial is to review the key features of this clinical scenario and to outline the essential aspects for optimized patient management and improved outcome. Depending on the clinical presentation of PVT, either immediate surgery, thrombolysis, or anticoagulation may be considered - with the sole intensification of anticoagulation likely being the most inferior. Given the high risk of re-thrombosis, a dedicated follow-up program is essential to identify complications early and offer adequate treatment.
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Affiliation(s)
- Thomas Poschner
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Markus Mach
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Marco Russo
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital of Rome, Rome, Italy
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16
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Kodali S, Hahn RT, George I, Davidson CJ, Narang A, Zahr F, Chadderdon S, Smith R, Grayburn PA, O'Neill WW, Wang DD, Herrmann H, Silvestry F, Elmariah S, Inglessis I, Passeri J, Lim DS, Salerno M, Makar M, Mack MJ, Leon MB, Makkar R. Transfemoral Tricuspid Valve Replacement in Patients With Tricuspid Regurgitation: TRISCEND Study 30-Day Results. JACC Cardiovasc Interv 2022; 15:471-480. [PMID: 35272771 DOI: 10.1016/j.jcin.2022.01.016] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The TRISCEND study (Edwards EVOQUE Tricuspid Valve Replacement: Investigation of Safety and Clinical Efficacy after Replacement of Tricuspid Valve with Transcatheter Device) is evaluating the safety and performance of transfemoral transcatheter tricuspid valve replacement in patients with clinically significant tricuspid regurgitation (TR) and elevated surgical risk. BACKGROUND Transcatheter valve replacement could lead to a paradigm shift in treating TR and improving patient quality of life. METHODS In the prospective, single-arm, multicenter TRISCEND study, patients with symptomatic moderate or greater TR, despite medical therapy, underwent percutaneous transcatheter tricuspid valve replacement with the EVOQUE system. A composite rate of major adverse events, echocardiographic parameters, and clinical, functional, and quality-of-life measures were assessed at 30 days. RESULTS Fifty-six patients (mean age of 79.3 years, 76.8% female, 91.1% TR severe or greater, 91.1% atrial fibrillation, and 87.5% New York Heart Association functional class III or IV) were treated. At 30 days, TR was reduced to mild or less in 98%. The composite major adverse events rate was 26.8% at 30 days caused by 1 cardiovascular death in a patient with a failed procedure, 2 reinterventions after device embolization, 1 major access site or vascular complication, and 15 severe bleeds, of which none were life-threatening or fatal. No myocardial infarction, stroke, renal failure, major cardiac structural complications, or device-related pulmonary embolism were observed. New York Heart Association significantly improved to functional class I or II (78.8%; P < 0.001), 6-minute walk distance improved 49.8 m (P < 0.001), and Kansas City Cardiomyopathy Questionnaire score improved 19 points (P < 0.001). CONCLUSIONS Early experience with the transfemoral EVOQUE system in patients with clinically significant TR demonstrated technical feasibility, acceptable safety, TR reduction, and symptomatic improvement at 30 days. The TRISCEND II randomized trial (NCT04482062) is underway.
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Affiliation(s)
- Susheel Kodali
- Columbia University Irving Medical Center, New York, New York, USA.
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Isaac George
- Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - Firas Zahr
- Oregon Health and Science University, Portland, Oregon, USA
| | | | - Robert Smith
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | - Paul A Grayburn
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | | | | | - Howard Herrmann
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frank Silvestry
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sammy Elmariah
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - D Scott Lim
- University of Virginia, Charlottesville, VA, USA
| | | | - Moody Makar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael J Mack
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York, USA
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
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17
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Saleh M, Gjeka R, Wilson S, Rutkin B, Singh A, Koss E, Yu PJ, Epstein LM. Multidisciplinary heart team approach with laser lead extraction and transcatheter tricuspid valve-in-valve replacement. HeartRhythm Case Rep 2022; 8:102-105. [PMID: 35242547 PMCID: PMC8858740 DOI: 10.1016/j.hrcr.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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18
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Shojaeifard M, Omidi N, Erami S, Dehghani Mohammad Abadi H, Hekmat H, Ghorashi SM, Sarrafi Rad N. Mechanical tricuspid valve thrombosis: A midterm follow‐up study. J Card Surg 2022; 37:855-864. [DOI: 10.1111/jocs.16209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/05/2021] [Accepted: 11/12/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Maryam Shojaeifard
- Departement of Echocardiography, Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center Iran University of Medical Sciences Tehran Iran
| | - Negar Omidi
- Department of Cardiovascular Disease Research, Tehran Heart Center (THC) Tehran University of Medical Sciences Tehran Iran
| | - Sajad Erami
- Departemnet of Cardiology Shahid Sadoughi University of Medical Sciences Yazd Iran
| | | | - Hamidreza Hekmat
- Interventional Cardiology, Cardiology Department, Ziaeian Hospital Tehran University of Medical Sciences Tehran Iran
| | - Seyyed M. Ghorashi
- Department of Cardiovascular Disease Research, Tehran Heart Center (THC) Tehran University of Medical Sciences Tehran Iran
| | - Negar Sarrafi Rad
- Departemnet of Echocardiography, Rajaie Cardiovascular Medical and Research Center Iran University of Medical Sciences Tehran Iran
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19
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Saccocci M, Ferraro F, Blasi S, Del Zanna N, Villa E, Messina A, Cirillo M, Mhagna Z, Tomba MD, Troise G. First Case of Tricuspid Valve Surgery in a Neurofibromatosis Type 1 Patient. Heart Views 2021; 22:214-219. [PMID: 34760055 PMCID: PMC8574087 DOI: 10.4103/heartviews.heartviews_17_21] [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: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 11/04/2022] Open
Abstract
The neurofibromatosis is a large class of different genetic disorders: Neurofibromatosis type 1, type 2, type 3 (or Schwannomatosys), which have different clinical characterization. Neurofibromatosis type 1 (NF1), also known as Von Recklinghausen disease, represents 95% of the total cases. It is a complex autosomal dominant disorder with multisystem involvement, frequently associated to cardiac malformation. We present the case of a 52-years-old male affected by NF-1 with severe tricuspid regurgitation and atrial septal defect (ASD). No previous report about tricuspid valve surgery in NF-1 are available in the literature. A complete perioperative assessment was performed, including dermatologist evaluation, angio-CT scan and transesophageal echocardiography. The patient underwent uneventfully tricuspid valve replacement and ASD closure, with no wound complication even at 6-months follow-up. Treating congenital malformation in patient with complex genetic disorders like NF-1 is safe and can be resolutive, permitting to reduce long-term risk of complications for the patients. Preoperative assessments are fundamental, as well as in-hospital care and expertise on congenital heart defects.
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Affiliation(s)
- Matteo Saccocci
- Cardiac Surgery Unit, Cardiovascular Department, H Poliambulanza Foundation, Brescia, Italy
| | - Francesco Ferraro
- Cardiac Surgery Unit, Cardiovascular Department, H Poliambulanza Foundation, Brescia, Italy.,Department of Cardiovascular Surgery, University Hospital Policlinico A. Gemelli, Rome, Italy
| | - Stefania Blasi
- Cardiac Surgery Unit, Cardiovascular Department, H Poliambulanza Foundation, Brescia, Italy
| | - Niccolò Del Zanna
- Cardiac Surgery Unit, Cardiovascular Department, H Poliambulanza Foundation, Brescia, Italy.,Department of Cardiovascular Surgery, University Hospital Policlinico A. Gemelli, Rome, Italy
| | - Emmanuel Villa
- Cardiac Surgery Unit, Cardiovascular Department, H Poliambulanza Foundation, Brescia, Italy
| | - Antonio Messina
- Cardiac Surgery Unit, Cardiovascular Department, H Poliambulanza Foundation, Brescia, Italy
| | - Marco Cirillo
- Cardiac Surgery Unit, Cardiovascular Department, H Poliambulanza Foundation, Brescia, Italy.,Heart Failure Surgery Unit, Cardiovascular Department, H Poliambulanza Foundation, Brescia, Italy
| | - Zean Mhagna
- Cardiac Surgery Unit, Cardiovascular Department, H Poliambulanza Foundation, Brescia, Italy
| | - Margherita Dalla Tomba
- Cardiac Surgery Unit, Cardiovascular Department, H Poliambulanza Foundation, Brescia, Italy
| | - Giovanni Troise
- Cardiac Surgery Unit, Cardiovascular Department, H Poliambulanza Foundation, Brescia, Italy
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20
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Wang TKM, Unai S, Xu B. Contemporary review in the multi-modality imaging evaluation and management of tricuspid regurgitation. Cardiovasc Diagn Ther 2021; 11:804-817. [PMID: 34295707 DOI: 10.21037/cdt.2020.01.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/08/2020] [Indexed: 11/06/2022]
Abstract
The tricuspid valve has gained interest recently because of the poor outcomes with current treatments and advances in percutaneous valve interventions. A sound understanding of the anatomy and pathologies of the tricuspid valve is critical in its evaluation and management of tricuspid regurgitation (TR). A multi-modality imaging approach with transthoracic echocardiography, transesophageal echocardiography, computed tomography, magnetic resonance imaging all have their individual and collective roles in the evaluation of TR and guidance of surgical and percutaneous procedures. This combined with clinical factors will contribute to defining timing, indications, modality selection and risk stratification for tricuspid valve interventions, which currently remains controversial.
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Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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21
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Lake P, Kuhn EW, Mauri V, Macherey S, Kaliba J, Baldus S, Frerker C, Schmidt T. Transcatheter valve-in-valve-in-valve replacement in tricuspid position in a patient with pre-existing permanent dual-chamber pacemaker. Clin Res Cardiol 2021; 110:2010-2014. [PMID: 33909128 PMCID: PMC8639564 DOI: 10.1007/s00392-021-01842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
Graphic abstract
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Affiliation(s)
- Philipp Lake
- Department of Internal Medicine III, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Elmar W Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Victor Mauri
- Department of Internal Medicine III, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Sascha Macherey
- Department of Internal Medicine III, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | | | - Stephan Baldus
- Department of Internal Medicine III, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Christian Frerker
- Department of Internal Medicine II, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany
| | - Tobias Schmidt
- Department of Internal Medicine II, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany
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22
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Tagliari AP, Perez-Camargo D, Taramasso M. Tricuspid regurgitation: when is it time for surgery? Expert Rev Cardiovasc Ther 2021; 19:47-59. [DOI: 10.1080/14779072.2021.1854734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Ana Paula Tagliari
- Cardiac Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Postgraduate Program in Health Science: Cardiology and Cardiovascular Science, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Daniel Perez-Camargo
- Cardiac Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Fundación Interhospitalaria para la Investigación Cardiovascular, Madrid, Spain
| | - Maurizio Taramasso
- Cardiac Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- HerzZentrum Hirlsanden Zurich, Zurich, Switzerland
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23
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Kang Y, Hwang HY, Sohn SH, Choi JW, Kim KH, Kim KB. Fifteen-Year Outcomes After Bioprosthetic and Mechanical Tricuspid Valve Replacement. Ann Thorac Surg 2020; 110:1564-1571. [DOI: 10.1016/j.athoracsur.2020.02.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/09/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
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24
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Liu P, Xia DS, Qiao WH, Hu D, Ahmed A, Dong NG, Chen S. Which is the best prosthesis in an isolated or combined tricuspid valve replacement? Eur J Cardiothorac Surg 2020; 59:170-179. [PMID: 33049775 DOI: 10.1093/ejcts/ezaa273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/17/2020] [Accepted: 06/27/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
The debate concerning the optimal choice of tricuspid position continues. We compared the long-term results of mechanical and biological prostheses in patients who underwent isolated or combined tricuspid valve replacement, at 2 major cardiac surgical centres in central China.
METHODS
From January 1999 to December 2018, 338 patients underwent tricuspid valve replacement. Patients were divided into an isolated group or a combined group according to whether their surgery was combined with a left heart valve surgery. Mechanical tricuspid valve replacement was performed in 142 patients (isolated group: 41 vs combined group: 101), and 196 patients underwent bioprosthetic tricuspid valve replacement (isolated group: 145 vs combined group: 51). Operative results, long-term survival and tricuspid valve-related events were compared.
RESULTS
Early mortality in the combined group was higher (n = 6, 4%) than that in the isolated group (n = 3, 2%), but no significant difference was observed between the mechanical and biological subgroups. In the isolated group, there was a higher event-free rate in the biological subgroup than in the mechanical subgroup (P = 0.042) and a similar result was also observed for patients without Ebstein’s anomaly (P = 0.039). In the combined group, no significant difference was observed (P = 0.98). Survival rates were similar between the mechanical and biological subgroups in both the isolated (P = 0.54) and combined (P = 0.81) groups. Mechanical valves in isolated tricuspid valve replacement were more prone to valve thrombosis and bleeding.
CONCLUSIONS
Every decision regarding tricuspid valve prostheses should be individualized, but biological prostheses may be an optimal choice for patients, especially for patients without Ebstein’s anomaly, in isolated tricuspid valve replacement.
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Affiliation(s)
- Peng Liu
- Department of Cardiovascular Surgery, Fuwai Central China Cardiovascular Hospital, Henan Province People’s Hospital, Henan Cardiovascular Hospital and Zhengzhou University, Zhengzhou, Henan, China
| | - Dong-Sheng Xia
- Department of Cardiovascular Surgery, Fuwai Central China Cardiovascular Hospital, Henan Province People’s Hospital, Henan Cardiovascular Hospital and Zhengzhou University, Zhengzhou, Henan, China
| | - Wei-Hua Qiao
- Department of Cardiovascular Surgery, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dan Hu
- Department of Cardiovascular Surgery, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Adnan Ahmed
- Department of Cardiovascular Surgery, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Nian-Guo Dong
- Department of Cardiovascular Surgery, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Si Chen
- Department of Cardiovascular Surgery, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
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25
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Kobayashi K, Uchida T, Kuroda Y, Yamashita A, Ohba E, Nakai S, Ochiai T, Sadahiro M. Right-sided double valve replacement in an adult patient who underwent surgery for pulmonary stenosis in childhood: a case report. J Cardiothorac Surg 2020; 15:170. [PMID: 32664912 PMCID: PMC7362504 DOI: 10.1186/s13019-020-01207-x] [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: 04/27/2020] [Accepted: 06/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulmonary regurgitation and the subsequent functional tricuspid regurgitation are frequently observed in adult patients who previously underwent pulmonary valvular operations. Pulmonary valve replacement, in combination with tricuspid annuloplasty, is frequently performed in adult patients. However, postoperative worsening or recurrence of tricuspid regurgitation is a major concern after pulmonary valve replacement with tricuspid annuloplasty. CASE PRESENTATION Herein, we describe the case of a 56-year-old woman with severe pulmonary regurgitation and functional tricuspid regurgitation after congenital pulmonary stenosis surgery in childhood. Functional tricuspid regurgitation was due to tricuspid annular dilatation, marked right ventricle enlargement, and significant tethering. We performed a bioprosthetic double valve replacement, and the postoperative course was uneventful. The patient is doing well one year after the surgery without prosthetic valve dysfunction. CONCLUSIONS When functional tricuspid regurgitation is severe and is associated with right ventricular dilatation and subsequent tethering, tricuspid valve replacement rather than annuloplasty should be considered.
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Affiliation(s)
- Kimihiro Kobayashi
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
| | - Tetsuro Uchida
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Yoshinori Kuroda
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Atsushi Yamashita
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Eiichi Ohba
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Shingo Nakai
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Tomonori Ochiai
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Mitsuaki Sadahiro
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
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26
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The better substitute for tricuspid valve replacement in patients with severe isolated tricuspid regurgitation. Anatol J Cardiol 2019; 22:172-176. [PMID: 31584434 PMCID: PMC6955081 DOI: 10.14744/anatoljcardiol.2019.47381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The ideal alternative for tricuspid valve replacement (TVR) in patients with severe isolated tricuspid regurgitation remains unclear. The aim of the present study was to retrospectively investigate the outcomes of using bioprosthetic and mechanical valves at the tricuspid position. METHODS A total of 98 consecutive patients without left-side cardiac disease or history of heart surgery who underwent first-time TVR between January 2010 and March 2017 at the West China Hospital, China were included in the study. Patient data, including all-cause death and need for tricuspid valve reoperation as the main end points, were retrospectively evaluated. RESULTS A total of 76 patients were enrolled into the study. The mean follow-up period was 43.3±21.9 (10-87) months. The mean age of the patients was 45.7±13.4 years. The study comprised 32.9% of male patients. During the follow-up period, 4, 3, 12, and 3 cases of death, reoperation, prosthesis dysfunctions, and prosthesis-related thrombosis were noted, respectively. Biological and mechanical valves were used in 56.6% and 43.4% of the patients, respectively. However, there was no significant difference between mechanical and biological valves with respect to echocardiographic date and survival, reoperation, prosthetic valve dysfunction, and thromboembolism rate. CONCLUSION TVR is not a very high-risk procedure in patients with isolated tricuspid regurgitation, and the decision for prosthesis implantation in TVR should be made on an individual basis according to suitable clinical judgment.
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27
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Chang CC, Veen KM, Hahn RT, Bogers AJJC, Latib A, Oei FBS, Abdelghani M, Modolo R, Ho SY, Abdel-Wahab M, Fattouch K, Bosmans J, Caliskan K, Taramasso M, Serruys PW, Bax JJ, van Mieghem NMDA, Takkenberg JJM, Lurz P, Modine T, Soliman O. Uncertainties and challenges in surgical and transcatheter tricuspid valve therapy: a state-of-the-art expert review. Eur Heart J 2019; 41:1932-1940. [DOI: 10.1093/eurheartj/ehz614] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/04/2019] [Accepted: 08/09/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Tricuspid regurgitation (TR) is a frequent and complex problem, commonly combined with left-sided heart disease, such as mitral regurgitation. Significant TR is associated with increased mortality if left untreated or recurrent after therapy. Tricuspid regurgitation was historically often disregarded and remained undertreated. Surgery is currently the only Class I Guideline recommended therapy for TR, in the form of annuloplasty, leaflet repair, or valve replacement. As growing experience of transcatheter therapy in structural heart disease, many dedicated transcatheter tricuspid repair or replacement devices, which mimic well-established surgical techniques, are currently under development. Nevertheless, many aspects of TR are little understood, including the disease process, surgical or interventional risk stratification, and predictors of successful therapy. The optimal treatment timing and the choice of proper surgical or interventional technique for significant TR remain to be elucidated. In this context, we aim to highlight the current evidence, underline major controversial issues in this field and present a future roadmap for TR therapy.
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Affiliation(s)
- Chun Chin Chang
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Kevin M Veen
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Rebecca T Hahn
- Structural Heart & Valve Center, New York Presbyterian Hospital, Columbia University Medical Center,161 Fort Washington Avenue, New York, NY 10032, USA
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, 3400 Bainbridge Ave, The Bronx, New York, NY, USA
| | - Frans B S Oei
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Mohammad Abdelghani
- Heart Center, Segeberger Kliniken, Am Kurpark 1, 23795, Bad Segeberg, Germany
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Rodrigo Modolo
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Cardiology Division, Department of Internal Medicine, University of Campinas (UNICAMP), Campinas- SP, 13083-970, Brazil
| | - Siew Yen Ho
- Brompton Cardiac Morphology Unit, Royal Brompton Hospital, Imperial College London, London, SW7 2AZ UK
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig, University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Viale Regione Siciliana 1571, 90100 Palermo, Italy
- GVM Care and Research, Maria Cecilia Hospital, Via Madonna di Genova, 1, 48033, Cotignola, Italy
| | - Johan Bosmans
- Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Kadir Caliskan
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Patrick W Serruys
- National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, Chelsea, London SW3 6LY, UK
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Nicolas M D A van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Philip Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Thomas Modine
- Department of Cardiovascular Surgery, Hopital Cardiologique CHRU de Lille, 2 Avenue Oscar Lambret, 59000 Lille, France
| | - Osama Soliman
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
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Alaa M, Tsopanomichalou Gklotsou M, Vu TD, Ti LK, Lee CN, Kofidis T. Comprehensive and Integrative Experimentation Setup for Large Animal Hybrid Valvular Heart Surgery. J Surg Res 2018; 234:249-261. [PMID: 30527481 DOI: 10.1016/j.jss.2018.09.019] [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: 04/04/2018] [Revised: 08/24/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Experimental surgical procedures for atrioventricular valves present promising translational capabilities, and preclinical studies are necessary to assess their applicability and to train young enthusiastic heart teams. Here, we present a synopsis of experimental surgical procedures on porcine models for mitral valvular (MV) and tricuspid valvular (TV) interventions; mitral valve-in-valve implantation (MViV), transapical cardioscopic (TAC) MV replacement (MVR), TAC-MV annuloplasty, and tricuspid valve-in-a-ring (TViR) procedures. METHODS Twenty-five (n = 25) female Yorkshire pigs of 55-65 kg is the total number used in the four approaches; seven animals underwent MViV, six TAC-MVR, six TAC-MV annuloplasty, and six TViR, respectively. All were subjected to a first conventional valvular surgery (bioprosthetic valve replacement and/or prosthetic ring repair). Then, after 4 wk, a less-invasive second surgery was performed using the transcatheter approaches under investigation. Except for the TAC-MVR and annuloplasty procedures, all animals were followed up for additional 4 wk. RESULTS (1) MViV (n = 7): Standard MVR was successfully performed in all animals. Transvalvular pressure gradients and flow velocities were (Pmax 3.77 ± 0.8 mmHg; Pmean 2.1 ± 0.6 mmHg, Vmax 97 ± 13 cm/s; Vmean 68 ± 21 cm/s). Effective MViV followed (Pmax 16.7 ± 1.8 mmHg; Pmean 6.2 ± 1.2 mmHg, Vmax 216 ± 32 cm/s; Vmean 110 ± 24 cm/s). (2) TAC-MVR (n = 6): The overall bypass time was 177.2 ± 44.2 min. Transprosthetic Pmean was 4.6 ± 2.4 mmHg; no paravalvular leaks in all animals. (3) TAC-MV annuloplasty (n = 6): The implantation time was 47 ± 6 min. MV was competent, left ventricular ejection fraction (LV-EF%) was 63 ± 4%. (4) TViR (n = 6): Conventional TV ring repair was performed in all animals (Pmax 2.42 ± 0.7 mmHg; Pmean 1.3 ± 0.6 mmHg, Vmax 82 ± 10.4 cm/s; Vmean 65.4 ± 21 cm/s). All TViRs were implanted efficiently (Pmax 4.7 ± 1.6 mmHg; Pmean 2.7 ± 0.8 mmHg, Vmax 105 ± 31 cm/s; Vmean 81 ± 16 cm/s). A mild paravalvular leak was observed in one animal (16%). CONCLUSIONS All studied experimental valvular interventions are feasible, within the context of well-trained cardiac surgery specialists, and all possibilities should be considered when treating a patient to determine which one suits best his individual challenges and scope.
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Affiliation(s)
- Mohamed Alaa
- Department of Cardiac, Thoracic and Vascular Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Maria Tsopanomichalou Gklotsou
- Department of Cardiac, Thoracic and Vascular Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Thang Duc Vu
- Department of Cardiac, Thoracic and Vascular Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lian Kah Ti
- Department of Anesthesia, National University of Singapore, Singapore
| | - Chuen Neng Lee
- Department of Cardiac, Thoracic and Vascular Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Hospital, National University Health System, Singapore
| | - Theo Kofidis
- Department of Cardiac, Thoracic and Vascular Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Hospital, National University Health System, Singapore
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McCartney SL, Taylor BS, Nicoara A. Functional Tricuspid Regurgitation in Mitral Valve Disease. Semin Cardiothorac Vasc Anesth 2018; 23:108-122. [PMID: 30382771 DOI: 10.1177/1089253218807922] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Functional tricuspid regurgitation is a common finding in patients with left-sided heart disease. If left untreated, it may reduce survival, limit functional capacity and cause end-organ dysfunction. Annulus dilation and leaflet tethering due to right ventricle remodeling are 2 major pathophysiologic mechanisms in functional tricuspid regurgitation. Even if surgical treatment remains the gold standard, indication and timing of surgical interventions remain the object of debate in the medical community. More recently, numerous transcatheter therapies have been developed in order to offer less invasive options to patients who otherwise would have a high risk of mortality and morbidity with surgical interventions.
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Affiliation(s)
| | - Bradley S Taylor
- 2 Department of Surgery, University of Maryland Medical Center, Baltimore, USA
| | - Alina Nicoara
- 1 Department of Anesthesiology, Duke University, Durham, NC, USA
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García Borges N, Daroca Martínez T, Martín Domínguez MÁ, Gómez Vidal MÁ, Carmona Vela C, Bermúdez García A, Vignau Cano JM, Macías Rubio D, Jaén Garrido C. Implantación de válvula tricúspide transcatéter en paciente con disfunción de bioprótesis. CIRUGIA CARDIOVASCULAR 2018. [DOI: 10.1016/j.circv.2018.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Belluschi I, Del Forno B, Lapenna E, Nisi T, Iaci G, Ferrara D, Castiglioni A, Alfieri O, De Bonis M. Surgical Techniques for Tricuspid Valve Disease. Front Cardiovasc Med 2018; 5:118. [PMID: 30234129 PMCID: PMC6127626 DOI: 10.3389/fcvm.2018.00118] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/10/2018] [Indexed: 11/17/2022] Open
Abstract
Tricuspid valve disease affects millions of patients worldwide. It has always been considered less relevant than the left-side valves of the heart, but this “forgotten valve” still represents a great challenge for the cardiac surgeons, especially in the most difficult symptomatic scenarios. In this review we analyze the wide spectrum of surgical techniques for the treatment of a diseased tricuspid valve.
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Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Milan, Italy
| | - Benedetto Del Forno
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Milan, Italy
| | - Elisabetta Lapenna
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Milan, Italy
| | - Teodora Nisi
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Milan, Italy
| | - Giuseppe Iaci
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Milan, Italy
| | - David Ferrara
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Milan, Italy
| | | | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Milan, Italy
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Praz F, George I, Kodali S, Koulogiannis KP, Gillam LD, Bechis MZ, Rubenson D, Li W, Duncan A. Transcatheter Tricuspid Valve-in-Valve Intervention for Degenerative Bioprosthetic Tricuspid Valve Disease. J Am Soc Echocardiogr 2018; 31:491-504. [DOI: 10.1016/j.echo.2017.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Indexed: 12/18/2022]
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Chen J, Abudupataer M, Hu K, Maimaiti A, Lu S, Wei L, Hong T, Wang C. Risk factors associated with perioperative morbidity and mortality following isolated tricuspid valve replacement. J Surg Res 2017; 221:224-231. [PMID: 29229133 DOI: 10.1016/j.jss.2017.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 05/26/2017] [Accepted: 06/20/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Reports of isolated tricuspid valve replacement (iTVR) are relatively rare. The present study aimed to evaluate independent risk factors of perioperative morbidity and mortality after iTVR. MATERIALS AND METHODS We retrospectively reviewed 118 consecutive patients (42 males; mean age, 49.1 ± 12.9 y) who underwent iTVR from May 2003 to April 2016 in our center. The multivariate logistic regression model was used to analyze the independent risk factors associated with perioperative morbidity and mortality following iTVR. RESULTS One hundred one patients (85.6%) were classified as New York Heart Association functional class III or IV preoperatively. The overall perioperative mortality was 11.8% (14/118), and a significant difference was observed between the nonreoperative group and the reoperative group (6.7% versus 18.3%, P = 0.047). The multivariate logistic regression analyses identified that preoperative New York Heart Association functional class IV (OR [odds ratio] = 15.43, 95% CI [confidence interval] = 3.46-68.83, P = 0.000) and ascites (OR = 4.88, 95% CI = 1.24-19.27, P = 0.024) were independent risk factors of perioperative deaths. The previous cardiac surgery (OR = 3.28, 95% CI = 1.41-7.62, P = 0.006) was independently associated with perioperative major adverse events. CONCLUSIONS The present study revealed that iTVR has relatively high mortality and morbidity rates. Timely surgery may be recommended for this high-risk cohort of patients before the development of severe heart and end-organ failure.
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Affiliation(s)
- Jinmiao Chen
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Shanghai, China
| | - Mieradilijiang Abudupataer
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Shanghai, China
| | - Kui Hu
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Shanghai, China; Department of Cardiovascular Surgery, People's Hospital of Guizhou Province, Guiyang, Guizhou, China
| | - Aikebaier Maimaiti
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Shanghai, China
| | - Shuyang Lu
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Shanghai, China
| | - Lai Wei
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Shanghai, China
| | - Tao Hong
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Shanghai, China.
| | - Chunsheng Wang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Shanghai, China.
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Fender EA, Zack CJ, Nishimura RA. Isolated tricuspid regurgitation: outcomes and therapeutic interventions. Heart 2017; 104:798-806. [PMID: 29229649 PMCID: PMC5931246 DOI: 10.1136/heartjnl-2017-311586] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 11/02/2017] [Accepted: 11/15/2017] [Indexed: 01/08/2023] Open
Abstract
Isolated tricuspid regurgitation (TR) can be caused by primary valvular abnormalities such as flail leaflet or secondary annular dilation as is seen in atrial fibrillation, pulmonary hypertension and left heart disease. There is an increasing recognition of a subgroup of patients with isolated TR in the absence of other associated cardiac abnormalities. Left untreated isolated TR significantly worsens survival. Stand-alone surgery for isolated TR is rarely performed due to an average operative mortality of 8%–10% and a paucity of data demonstrating improved survival. When surgery is performed, valve repair may be preferred over replacement; however, there is a risk of significant recurrent regurgitation after repair. Existing society guidelines do not fully address the management of isolated TR. We propose that patients at low operative risk with symptomatic severe isolated TR and no reversible cause undergo surgery prior to the onset of right ventricular dysfunction and end-organ damage. For patients at increased surgical risk novel percutaneous interventions may offer an alternative treatment but further research is needed. Significant knowledge gaps remain and future research is needed to define operative outcomes and provide comparative data for medical and surgical therapy.
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Affiliation(s)
- Erin A Fender
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Chad J Zack
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA.,Division of Cardiology, Duke University, Durham, NC, USA
| | - Rick A Nishimura
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
PURPOSE OF REVIEW Tricuspid regurgitation is common; however, recognition and diagnosis, clinical outcomes, and management strategies are poorly defined. Here, we will describe the etiology and natural history of tricuspid regurgitation (TR), evaluate existing surgical outcomes data, and review the evolving field of percutaneous interventions to treat TR. RECENT FINDINGS Previously, the only definitive corrective therapy for TR was surgical valve repair or replacement which is associated with significant operative mortality. Advances in percutaneous valve repair techniques are now being translated to the tricuspid valve. These novel interventions may offer a lower-risk alternative treatment in patients at increased surgical risk. Significant TR adversely impacts survival. Surgery remains the only proven therapy for treatment of TR and may be underutilized due to mixed outcomes data. Early experience with percutaneous interventions is promising, but large clinical experience is lacking. Further study will be required before these therapies are introduced into broader clinical practice.
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Rossello X, Muñoz-Guijosa C, Mena E, Camprecios M, Mendez AB, Borras X, Padro JM. Tricuspid valve replacement with mechanical prostheses: Short and long-term outcomes. J Card Surg 2017; 32:542-549. [DOI: 10.1111/jocs.13193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Xavier Rossello
- Department of Cardiology; Universitat Autònoma de Barcelona; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - Christian Muñoz-Guijosa
- Department of Cardiac Surgery; Universitat Autònoma de Barcelona; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - Elisabet Mena
- Department of Cardiology; Hospital de Sant Joan Despí Moisès Broggi; Barcelona Spain
| | - Marta Camprecios
- Department of Cardiology; Hospital de Sant Joan Despí Moisès Broggi; Barcelona Spain
| | - Ana B. Mendez
- Department of Cardiology; Universitat Autònoma de Barcelona; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - Xavier Borras
- Department of Cardiology; Universitat Autònoma de Barcelona; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - Josep M. Padro
- Department of Cardiac Surgery; Universitat Autònoma de Barcelona; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
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Steinberg ZL, Dominguez-Islas CP, Otto CM, Stout KK, Krieger EV. Maternal and Fetal Outcomes of Anticoagulation in Pregnant Women With Mechanical Heart Valves. J Am Coll Cardiol 2017; 69:2681-2691. [PMID: 28571631 PMCID: PMC5457289 DOI: 10.1016/j.jacc.2017.03.605] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/26/2017] [Accepted: 03/28/2017] [Indexed: 01/18/2023]
Abstract
Background Anticoagulation for mechanical heart valves during pregnancy is essential to prevent thromboembolic events. Each regimen has drawbacks with regard to maternal or fetal risk. Objectives This meta-analysis sought to estimate and compare the risk of adverse maternal and fetal outcomes in pregnant women with mechanical heart valves who received different methods of anticoagulation. Methods Studies were identified using a Medline search including all publications up to June 5, 2016. Study inclusion required reporting of maternal death, thromboembolism, and valve failure, and/or fetal spontaneous abortion, death, and congenital defects in pregnant women treated with any of the following: 1) a vitamin K antagonist (VKA) throughout pregnancy; 2) low-molecular-weight heparin (LMWH) throughout pregnancy; 3) LMWH for the first trimester, followed by a VKA (LMWH and VKA); or 4) unfractionated heparin for the first trimester, followed by a VKA (UFH and VKA). Results A total of 800 pregnancies from 18 publications were included. Composite maternal risk was lowest with VKA (5%), compared with LMWH (16%; ratio of averaged risk [RAR]: 3.2; 95% confidence interval [CI]: 1.5 to 7.5), LMWH and VKA (16%; RAR: 3.1; 95% CI: 1.2 to 7.5), or UFH and VKA (16%; RAR: 3.1; 95% CI: 1.5 to 7.1). Composite fetal risk was lowest with LMWH (13%; RAR: 0.3; 95% CI: 0.1 to 0.8), compared with VKA (39%), LMWH and VKA (23%), or UFH and VKA (34%). No significant difference in fetal risk was observed between women taking ≤5 mg daily warfarin and those with an LMWH regimen (RAR: 0.9; 95% CI: 0.3 to 2.4). Conclusions VKA treatment was associated with the lowest risk of adverse maternal outcomes, whereas the use of LMWH throughout pregnancy was associated with the lowest risk of adverse fetal outcomes. Fetal risk was similar between women taking ≤5 mg warfarin daily and women treated with LMWH.
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Affiliation(s)
- Zachary L Steinberg
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
| | - Clara P Dominguez-Islas
- Medical Research Council Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Catherine M Otto
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Karen K Stout
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Eric V Krieger
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
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Doenst T, Essa Y, Jacoub K, Moschovas A, Gonzalez-Lopez D, Kirov H, Diab M, Bargenda S, Faerber G. Cardiac surgery 2016 reviewed. Clin Res Cardiol 2017; 106:851-867. [PMID: 28396989 DOI: 10.1007/s00392-017-1113-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/07/2017] [Indexed: 01/09/2023]
Abstract
For the year 2016, more than 20,000 published references can be found in Pubmed when entering the search term "cardiac surgery". Publications last year have helped to more clearly delineate the fields where classic surgery and modern interventional techniques overlap. The field of coronary bypass surgery (partially compared to percutaneous coronary intervention) was enriched by five large prospective randomized trials. The value of CABG for complex coronary disease was reconfirmed and for less complex main stem lesions, PCI was found potentially equal. For aortic valve treatment, more evidence was presented for the superiority of transcatheter aortic valve implantation for patients with intermediate risk. However, the 2016 evidence argued against the liberal expansion to the low-risk field, where conventional aortic valve replacement still appears superior. For the mitral valve, many publications emphasized the significant impact of mitral valve reconstruction on survival in structural mitral regurgitation. In addition, there were many relevant and other interesting contributions from the purely operative arena in the fields of coronary revascularization, surgical treatment of valve disease, terminal heart failure (i.e., transplantation and ventricular assist devices), and aortic surgery. While this article attempts to summarize the most pertinent publications it does not have the expectation of being complete and cannot be free of individual interpretation. As in recent years, it provides a condensed summary that is intended to give the reader "solid ground" for up-to-date decision-making in cardiac surgery.
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Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Yasin Essa
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Khalil Jacoub
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Alexandros Moschovas
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - David Gonzalez-Lopez
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Steffen Bargenda
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
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Panaich SS, Eleid MF. Tricuspid valve-in-valve implantation for failing bioprosthetic valves: an evolving standard of care. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:410. [PMID: 27867962 DOI: 10.21037/atm.2016.10.44] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Redo surgery for bioprosthetic tricuspid valve failure is associated with high morbidity and mortality. In recent years, transcatheter tricuspid valve-in-valve (VIV) therapy utilizing ballon-expandable transcatheter valves has become available. The tricuspid Valve-in-Valve International Data (VIVID) registry initial results represent the largest experience with tricuspid VIV therapy, demonstrating high procedural success rates with low 30 days mortality and excellent survival free of repeat tricuspid intervention in 1 year. Although longer clinic and hemodynamic follow-up will be needed to fully understand the role of this therapy, these data support the safety, feasibility and beneficial effects of tricuspid VIV therapy. For patients with bioprosthetic tricuspid valve failure, tricuspid VIV is likely to become a first-line treatment option.
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Affiliation(s)
| | - Mackram F Eleid
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
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