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Basman C, Jamal S, Yoon SH, Dudiy Y, Anderson M, Landers D, Kaple R. Transcatheter tricuspid valve intervention in the presence of a cardiac implantable electronic device; state of the art review. Catheter Cardiovasc Interv 2024. [PMID: 39169689 DOI: 10.1002/ccd.31183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/14/2024] [Accepted: 08/01/2024] [Indexed: 08/23/2024]
Abstract
A large proportion of patients referred for transcatheter tricuspid valve intervention (TTVI) will have the presence of a cardiac implantable electronic device (CIED). In such patients, surgical correction of tricuspid regurgitation (TR) is associated with high rates of morbidity and mortality. Transvenous lead extraction (TLE) could potentially ameliorate CIED-induced TR; however, it carries inherent risks and frequently does not result in TR improvement. As multiple TTVI devices are in trial to gain regulatory approval, understanding which therapy is most appropriate among patients with a CIED is essential. This review centers on the nonsurgical treatment, including TLE and transcatheter tricuspid valve repair and replacement options, aimed at enhancing outcomes in patients with TR who also have concurrent CIEDs.
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Affiliation(s)
- Craig Basman
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Sameer Jamal
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Sung-Han Yoon
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Yuriy Dudiy
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Mark Anderson
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - David Landers
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Ryan Kaple
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
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2
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Marschall A, Rivero F, Bastante T, Cuesta J, del Val D, Sarnago F, Alfonso F. Diaphragmatic Paralysis After Heterotopic Bicaval Stenting. JACC Case Rep 2024; 29:102422. [PMID: 39157563 PMCID: PMC11328756 DOI: 10.1016/j.jaccas.2024.102422] [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: 04/16/2024] [Revised: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 08/20/2024]
Abstract
Heterotopic bicaval stenting offers an alternative therapeutic approach for indirectly addressing the systemic effects of tricuspid regurgitation (TR) in patients with severe symptomatic TR, despite optimal medical therapy. In this report, we describe 2 cases of procedure-related unilateral diaphragmatic paralysis, a clinically important complication not previously documented in the literature.
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Affiliation(s)
- Alexander Marschall
- Department of Cardiology, La Princesa University Hospital, Network Biomedical Research Center-Cardiovascular (CIBER-CV), Princesa Health Research Institute (IIS-IP), Autonomous University of de Madrid, Madrid, Spain
| | - Fernando Rivero
- Department of Cardiology, La Princesa University Hospital, Network Biomedical Research Center-Cardiovascular (CIBER-CV), Princesa Health Research Institute (IIS-IP), Autonomous University of de Madrid, Madrid, Spain
| | - Teresa Bastante
- Department of Cardiology, La Princesa University Hospital, Network Biomedical Research Center-Cardiovascular (CIBER-CV), Princesa Health Research Institute (IIS-IP), Autonomous University of de Madrid, Madrid, Spain
| | - Javier Cuesta
- Department of Cardiology, La Princesa University Hospital, Network Biomedical Research Center-Cardiovascular (CIBER-CV), Princesa Health Research Institute (IIS-IP), Autonomous University of de Madrid, Madrid, Spain
| | - David del Val
- Department of Cardiology, La Princesa University Hospital, Network Biomedical Research Center-Cardiovascular (CIBER-CV), Princesa Health Research Institute (IIS-IP), Autonomous University of de Madrid, Madrid, Spain
| | - Fernando Sarnago
- Department of Cardiology, 12 October University Hospital, Madrid, Spain
| | - Fernando Alfonso
- Department of Cardiology, La Princesa University Hospital, Network Biomedical Research Center-Cardiovascular (CIBER-CV), Princesa Health Research Institute (IIS-IP), Autonomous University of de Madrid, Madrid, Spain
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3
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Bashir A, Tahir Z, Ahmad M, Mouyis K, Kirresh AZ, Atta S, Lloyd C, Dalrymple-Hay M. A decade's summary of transcatheter tricuspid valve repair. Monaldi Arch Chest Dis 2024. [PMID: 39058095 DOI: 10.4081/monaldi.2024.3029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Tricuspid regurgitation (TR) is the most common pathology for the tricuspid valve. Moderate to severe TR is associated with morbidity and adverse outcomes. The concept that TR resolves on its own if the underlying disease is successfully treated has proven to be false. Only a few patients with significant TR are deemed suitable for surgery. Given the late presentation of patients with high perioperative risks and substantial perioperative mortality, the development of transcatheter therapies and the experience gained with transcatheter aortic valve implantation operations have turned attention towards treating this challenging group of patients. In this article, we review the treatment options and highlight the role of transcatheter valve therapies in patients with severe TR.
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Affiliation(s)
| | | | | | | | | | - Sameh Atta
- University Hospitals Plymouth NHS Trust.
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4
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Plant A, Stewart F, Hooks D. Implantable cardioverter-defibrillator lead failure and revision following transcutaneous bicaval valve (TricValve®) implantation. J Cardiovasc Electrophysiol 2024; 35:1050-1054. [PMID: 38501328 DOI: 10.1111/jce.16249] [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: 01/30/2024] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Tricuspid regurgitation is associated with significant morbidity and mortality, and occurs at a higher rate in patients with cardiovascular implantable electronic devices. Percutaneous strategies for managing tricuspid regurgitation are evolving, including the development of bicaval valve implantation which has been successfully used in patients with pacing leads. METHODS AND RESULTS We present the first documented case of lead failure following TricValve® implantation, a dedicated self-expanding system for bicaval valve implantation, and the first successful lead revision procedure in this setting. CONCLUSION The case illustrates important considerations in undertaking percutaneous intervention in patients with cardiovascular implantable electronic devices, and their ongoing management.
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Affiliation(s)
- Allan Plant
- Department of Cardiology, Wellington Regional Hospital, Te Whatu Ora Capital and Coast, Newtown, Wellington, New Zealand
| | - Fergus Stewart
- Department of Cardiology, Wellington Regional Hospital, Te Whatu Ora Capital and Coast, Newtown, Wellington, New Zealand
| | - Darren Hooks
- Department of Cardiology, Wellington Regional Hospital, Te Whatu Ora Capital and Coast, Newtown, Wellington, New Zealand
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5
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Maisano F, Hahn R, Sorajja P, Praz F, Lurz P. Transcatheter treatment of the tricuspid valve: current status and perspectives. Eur Heart J 2024; 45:876-894. [PMID: 38426859 DOI: 10.1093/eurheartj/ehae082] [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: 08/02/2023] [Revised: 01/13/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Transcatheter tricuspid valve interventions (TTVI) are emerging as alternatives to surgery in high-risk patients with isolated or concomitant tricuspid regurgitation. The development of new minimally invasive solutions potentially more adapted to this largely undertreated population of patients, has fuelled the interest for the tricuspid valve. Growing evidence and new concepts have contributed to revise obsolete and misleading perceptions around the right side of the heart. New definitions, classifications, and a better understanding of the disease pathophysiology and phenotypes, as well as their associated patient journeys have profoundly and durably changed the landscape of tricuspid disease. A number of registries and a recent randomized controlled pivotal trial provide preliminary guidance for decision-making. TTVI seem to be very safe and effective in selected patients, although clinical benefits beyond improved quality of life remain to be demonstrated. Even if more efforts are needed, increased disease awareness is gaining momentum in the community and supports the establishment of dedicated expert valve centres. This review is summarizing the achievements in the field and provides perspectives for a less invasive management of a no-more-forgotten disease.
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Affiliation(s)
- Francesco Maisano
- Division of Cardiac Surgery and Valve Center, IRCCS Ospedale San Raffaele, Università Vita Salute, Via Olgettina 60, 20132 Milano, Italy
| | - Rebecca Hahn
- Department of Medicine, Columbia University Irving Medical Center, New York, 161 Fort Washington Avenue, 10032 New York, NY, USA
| | - Paul Sorajja
- Minneapolis Heart Institute at Abbott Northwestern Hospital, 920 East 28th Street, Suite 100, 55407 Minneapolis, MN, USA
| | - Fabien Praz
- Bern University Hospital, University of Bern, Anna-Seiler-Haus Freiburgstrasse 20, 3010 Bern, Switzerland
| | - Philipp Lurz
- Department of Cardiology, Universitätsmedizin Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
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6
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Farooq MU, Latib A, Jorde UP. Tricuspid Regurgitation in Congestive "End-Organ" Failure: Outline of an Opportunity. Cardiol Rev 2024; 32:18-23. [PMID: 35452428 DOI: 10.1097/crd.0000000000000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tricuspid regurgitation (TR) is a progressive disease that can be addressed only partially by medical therapy. Progression of TR is associated with worsening end-organ function and worse survival, yet tricuspid valve interventions are usually only performed in advanced stages. Recent evidence suggests a pivotal role for TR and pulsatile venous congestion in the pathophysiology of renal and hepatic dysfunction. This critical knowledge has provided the opportunity to optimally define the appropriate timing of transcatheter tricuspid valve interventions, integrating concurrent or impending functional consequences with severity of TR.
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Affiliation(s)
- Muhammed U Farooq
- From the Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
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7
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Agarwal V, Hahn R. Tricuspid Regurgitation and Right Heart Failure: The Role of Imaging in Defining Pathophysiology, Presentation, and Novel Management Strategies. Interv Cardiol Clin 2024; 13:81-99. [PMID: 37980069 DOI: 10.1016/j.iccl.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
During the last few years, there has been a substantial shift in efforts to understand and manage secondary or functional tricuspid regurgitation (TR) given its prevalence, adverse prognostic impact, and symptom burden associated with progressive right heart failure. Understanding the pathophysiology of TR and right heart failure is crucial for determining the best treatment strategy and improving outcomes. In this article, we review the complex relationship between right heart structural and hemodynamic changes that drive the pathophysiology of secondary TR and discuss the role of multimodality imaging in the diagnosis, management, and determination of outcomes.
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Affiliation(s)
- Vratika Agarwal
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/ New York Presbyterian Hospital, 177 Fort Washington Avenue, Room 5C-501, New York, NY 10032, USA.
| | - Rebecca Hahn
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/ New York Presbyterian Hospital, 177 Fort Washington Avenue, Room 5C-501, New York, NY 10032, USA
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8
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Adsuar-Gómez A, Rodríguez-Mora F, González-Calle A, Ramos-Barragán B, Rezaei K, Sobrino-Márquez JM, Rangel-Sousa D, Borrego-Domínguez JM. Heart Transplantation in a Patient With a Heterotopic Percutaneous Tricuspid Valve Prosthesis: A Case Report. Transplant Proc 2023; 55:2312-2314. [PMID: 37925232 DOI: 10.1016/j.transproceed.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/23/2023] [Indexed: 11/06/2023]
Abstract
The bicaval transcatheter prosthesis (TricValve) allows the treatment of cava reflux in patients with severe tricuspid regurgitation and high surgical risk. It consists of the implantation of 2 self-expanding valves in both vena cava without directly approaching the native tricuspid valve. Heart transplantation in this setting may require some modifications compared with the conventional bicaval technique. We describe the clinical case of a 69-year-old woman with a background of rheumatic mitral valve disease who required a mitral valve replacement a few decades before. Ongoing clinical deterioration with biventricular dysfunction and severe tricuspid regurgitation was treated with a percutaneous bicaval heterotopic self-expanding valve system, with no clinical benefit. The patient underwent an elective heart transplantation. For the surgical approach, venous cannulation was performed percutaneously for both the right internal jugular and right femoral vein. Due to the impossibility of extracting percutaneous caval valves, the biatrial technique was selected for heart implantation. The postoperative course was difficult, but the patient was successfully discharged home 2 months postoperatively. She remains in good clinical condition with normal heart function 1 year after the transplant. To our knowledge, this is the first report describing a heart transplant in a patient with a bicaval transcatheter prosthesis.
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Affiliation(s)
- Alejandro Adsuar-Gómez
- Cardiac Surgery Department, Heart Area, Virgen del Rocío University Hospital, Seville, Spain.
| | - Felipe Rodríguez-Mora
- Cardiac Surgery Department, Heart Area, Virgen del Rocío University Hospital, Seville, Spain
| | - Antonio González-Calle
- Cardiac Surgery Department, Heart Area, Virgen del Rocío University Hospital, Seville, Spain
| | - Belén Ramos-Barragán
- Cardiac Surgery Department, Heart Area, Virgen del Rocío University Hospital, Seville, Spain
| | - Kambiz Rezaei
- Cardiac Surgery Department, Heart Area, Virgen del Rocío University Hospital, Seville, Spain
| | | | - Diego Rangel-Sousa
- Cardiology Department, Heart Area, Virgen del Rocío University Hospital, Seville, Spain
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9
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Gabriels JK, Schaller RD, Koss E, Rutkin BJ, Carrillo RG, Epstein LM. Lead management in patients undergoing percutaneous tricuspid valve replacement or repair: a 'heart team' approach. Europace 2023; 25:euad300. [PMID: 37772978 PMCID: PMC10629975 DOI: 10.1093/europace/euad300] [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: 08/03/2023] [Revised: 09/11/2023] [Accepted: 09/24/2023] [Indexed: 09/30/2023] Open
Abstract
Clinically significant tricuspid regurgitation (TR) has historically been managed with either medical therapy or surgical interventions. More recently, percutaneous trans-catheter tricuspid valve (TV) replacement and tricuspid trans-catheter edge-to-edge repair have emerged as alternative treatment modalities. Patients with cardiac implantable electronic devices (CIEDs) have an increased incidence of TR. Severe TR in this population can occur for multiple reasons but most often results from the interactions between the CIED lead and the TV apparatus. Management decisions in patients with CIED leads and clinically significant TR, who are undergoing evaluation for a percutaneous TV intervention, need careful consideration as a trans-venous lead extraction (TLE) may both worsen and improve TR severity. Furthermore, given the potential risks of 'jailing' a CIED lead at the time of a percutaneous TV intervention (lead fracture and risk of subsequent infections), consideration should be given to performing a TLE prior to a percutaneous TV intervention. The purpose of this 'state-of-the-art' review is to provide an overview of the causes of TR in patients with CIEDs, discuss the available therapeutic options for patients with TR and CIED leads, and advocate for including a lead management specialist as a member of the 'heart team' when making treatment decisions in patients TR and CIED leads.
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Affiliation(s)
- James K Gabriels
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY, USA
| | - Robert D Schaller
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elana Koss
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | - Bruce J Rutkin
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | | | - Laurence M Epstein
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY, USA
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10
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Rogatinsky J, Recco D, Feichtmeier J, Kang Y, Kneier N, Hammer P, O’Leary E, Mah D, Hoganson D, Vasilyev NV, Ranzani T. A multifunctional soft robot for cardiac interventions. SCIENCE ADVANCES 2023; 9:eadi5559. [PMID: 37878705 PMCID: PMC10599628 DOI: 10.1126/sciadv.adi5559] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023]
Abstract
In minimally invasive endovascular procedures, surgeons rely on catheters with low dexterity and high aspect ratios to reach an anatomical target. However, the environment inside the beating heart presents a combination of challenges unique to few anatomic locations, making it difficult for interventional tools to maneuver dexterously and apply substantial forces on an intracardiac target. We demonstrate a millimeter-scale soft robotic platform that can deploy and self-stabilize at the entrance to the heart, and guide existing interventional tools toward a target site. In two exemplar intracardiac procedures within the right atrium, the robotic platform provides enough dexterity to reach multiple anatomical targets, enough stability to maintain constant contact on motile targets, and enough mechanical leverage to generate newton-level forces. Because the device addresses ongoing challenges in minimally invasive intracardiac intervention, it may enable the further development of catheter-based interventions.
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Affiliation(s)
- Jacob Rogatinsky
- Department of Mechanical Engineering, Boston University, Boston, MA 02215, USA
| | - Dominic Recco
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA 02115, USA
| | | | - Yuchen Kang
- Department of Mechanical Engineering, Boston University, Boston, MA 02215, USA
| | - Nicholas Kneier
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Peter Hammer
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Edward O’Leary
- Department of Cardiology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Douglas Mah
- Department of Cardiology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - David Hoganson
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Nikolay V. Vasilyev
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Tommaso Ranzani
- Department of Mechanical Engineering, Boston University, Boston, MA 02215, USA
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11
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Badwan OZ, Skoza W, Mirzai S, Bansal A, Braghieri L, Karmali RH, Nero N, Harb SC, Puri R, Kapadia S. Clinical Outcomes After Caval Valve Implantation for Severe Symptomatic Tricuspid Regurgitation: A Meta-Analysis. Am J Cardiol 2023; 205:84-86. [PMID: 37595412 DOI: 10.1016/j.amjcard.2023.07.003] [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: 03/02/2023] [Revised: 06/18/2023] [Accepted: 07/04/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Osamah Z Badwan
- Departments of Internal Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Warren Skoza
- Departments of Internal Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Saeid Mirzai
- Departments of Internal Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Agam Bansal
- Departments of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lorenzo Braghieri
- Departments of Internal Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rehan H Karmali
- Departments of Internal Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Neil Nero
- Medical Library, Cleveland Clinic Floyd D. Loop Alumni Library, Cleveland, Ohio
| | - Serge C Harb
- Departments of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi Puri
- Departments of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir Kapadia
- Departments of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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12
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Agarwal V, Hahn R. Tricuspid Regurgitation and Right Heart Failure: The Role of Imaging in Defining Pathophysiology, Presentation, and Novel Management Strategies. Heart Fail Clin 2023; 19:505-523. [PMID: 37714590 DOI: 10.1016/j.hfc.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
During the last few years, there has been a substantial shift in efforts to understand and manage secondary or functional tricuspid regurgitation (TR) given its prevalence, adverse prognostic impact, and symptom burden associated with progressive right heart failure. Understanding the pathophysiology of TR and right heart failure is crucial for determining the best treatment strategy and improving outcomes. In this article, we review the complex relationship between right heart structural and hemodynamic changes that drive the pathophysiology of secondary TR and discuss the role of multimodality imaging in the diagnosis, management, and determination of outcomes.
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Affiliation(s)
- Vratika Agarwal
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/ New York Presbyterian Hospital, 177 Fort Washington Avenue, Room 5C-501, New York, NY 10032, USA.
| | - Rebecca Hahn
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/ New York Presbyterian Hospital, 177 Fort Washington Avenue, Room 5C-501, New York, NY 10032, USA
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13
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Zhu QM, Berry N. Tricuspid Regurgitation: Disease State and Advances in Percutaneous Therapy. Eur Cardiol 2023; 18:e55. [PMID: 37860699 PMCID: PMC10583156 DOI: 10.15420/ecr.2023.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/31/2023] [Indexed: 10/21/2023] Open
Abstract
Tricuspid regurgitation (TR) is a relatively common finding. There has been growing recognition of the morbidity and adverse prognosis of severe TR, which affects 1.6 million people in the US. However, symptomatic TR remains undertreated despite emerging therapeutic modalities. In this review, the pathophysiological and epidemiological features of TR are examined and the diagnosis, natural history, and clinical presentation are discussed. An overview of TR therapy is provided, including medical and surgical treatments, as well as novel percutaneous approaches. The currently available studies on percutaneous therapy demonstrate promise for transcatheter valve repair and replacement with favourable clinical outcomes and short-term durability. However, further study is needed.
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Affiliation(s)
- Qiuyu Martin Zhu
- Kaiser Permanente Mid-Atlantic States Internal Medicine Residency Program Gaithersburg, MD, US
| | - Natalia Berry
- Mid-Atlantic Permanente Medical Group McLean, VA, US
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14
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Grazina A, Ferreira A, Ramos R, Cacela D. Heterotopic caval valve-in-valve procedure for prosthetic migration: two case reports. Eur Heart J Case Rep 2023; 7:ytad368. [PMID: 37601228 PMCID: PMC10433101 DOI: 10.1093/ehjcr/ytad368] [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: 03/03/2023] [Revised: 07/19/2023] [Accepted: 07/31/2023] [Indexed: 08/22/2023]
Abstract
Background Heterotopic bicaval stenting or caval valve implantation (CAVI) either with non-dedicated balloon-expandable Sapien™ valves (Edwards Lifesciences) or with dedicated TricValve™ (Products + Features) has emerged as a safe and effective percutaneous treatment for high-risk patients with severe tricuspid regurgitation (TR). One technical difficulty of CAVI is the lack of native calcified structures to anchor the device, which may lead to paravalvular leak or migration. Cases summary We describe two patients with severe TR and high surgical risk who underwent CAVI procedures, both of them complicated with device migration to the right atrium (one inferior vena cava device and one superior vena cava device). Both cases were treated with a caval valve-in-valve procedure, with good technical and clinical results. Discussion With the recent development of several percutaneous interventions for high-risk patients with severe TR, the rate of some possible complications is not well established, and neither are the better managing strategies. Device embolization is a rare complication of transcatheter heart interventions but with potential catastrophic consequences. Less invasive strategies such as the valve-in-valve procedure may be preferable in order to avoid the exposure of these patients to complex heart surgeries with extracorporeal circulation.
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Affiliation(s)
- André Grazina
- Cardiology Service, Central Lisbon Hospital and University Centre, Lisbon, Portugal
| | - André Ferreira
- Cardiology Service, Central Lisbon Hospital and University Centre, Lisbon, Portugal
| | - Ruben Ramos
- Cardiology Service, Central Lisbon Hospital and University Centre, Lisbon, Portugal
| | - Duarte Cacela
- Cardiology Service, Central Lisbon Hospital and University Centre, Lisbon, Portugal
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15
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Dimitriadis K, Pyrpyris N, Aznaouridis K, Iliakis P, Valatsou A, Tsioufis P, Beneki E, Mantzouranis E, Aggeli K, Tsiamis E, Tsioufis K. Transcatheter Tricuspid Valve Interventions: A Triumph for Transcatheter Procedures? Life (Basel) 2023; 13:1417. [PMID: 37374199 PMCID: PMC10302828 DOI: 10.3390/life13061417] [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: 04/20/2023] [Revised: 05/30/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Tricuspid regurgitation (TR) is a common valvular pathology, estimated to affect 1.6 million people in the United States alone. Even though guidelines recommend either medical therapy or surgical treatment for TR, the misconception of TR as a benign disease along with the high mortality rates of surgical intervention led to undertreating this disease and commonly describing it as a "forgotten" valve. Recently, the development of transcatheter interventions for TR show promising potential for use in the clinical setting. There are currently few approved and numerous tested percutaneously delivered devices, which can be categorized, based on their mechanism of action, to either valve repair or valve replacement procedures. Both procedures were tested in clinical trials and show an echocardiographic reduction in TR sustained for at least 1 year after the procedure, as well as symptom relief and functional improvement of the patients. Device selection should be personalized, taking into consideration the anatomy of each valve and the available options at each heart center. Moreover, appropriate patient selection and timing of the procedure are also crucial for the success of the procedure. In this review, we analyze the clinical trials available for all devices currently approved or tested, aiming to provide a comprehensive summary of the most recent evidence in the field of transcatheter TR interventions.
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Affiliation(s)
- Kyriakos Dimitriadis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (N.P.);; (K.A.); (P.I.); (A.V.); (P.T.); (E.B.); (E.M.); (K.A.); (E.T.); (K.T.)
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Nicolò F, Russo M, Ranocchi F, Cammardella AG, Bellomo F, Polizzi V, Pergolini A, Sbaraglia F, Lio A, Musumeci F. Transcatheter heterotopic valve implantation with the TricValve system: focus on preoperative assessment and patient selection. J Cardiovasc Med (Hagerstown) 2023; 24:365-372. [PMID: 37016790 DOI: 10.2459/jcm.0000000000001442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Affiliation(s)
- Francesca Nicolò
- Department of Cardiac Surgery and Transplantation, S. Camillo Hospital, Rome, Italy
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17
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Tagliari AP, Taramasso M. Investigating the unmet need for the treatment of tricuspid regurgitation. Expert Rev Cardiovasc Ther 2023:1-12. [PMID: 37144916 DOI: 10.1080/14779072.2023.2211265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Tricuspid regurgitation has been increasingly recognized as a clinically relevant entity with long-term prognostic impact on quality of life and survival. Despite this, there are still some unmet clinical needs regarding the management of tricuspid regurgitation that require further investigation. AREAS COVERED This review addresses current evidence for the treatment of tricuspid regurgitation, focusing primarily on new catheter-based technologies. In addition, we discuss recent registries and clinical trial results. EXPERT OPINION A multimodality and multiparametric integrative approach has been preconized to assess tricuspid regurgitation mechanism and severity, and new technologies have been developed to address the main causative factors of tricuspid regurgitation. Matching the right device to the right patient and deciding when is the best time for intervention are major challenges in the management of tricuspid regurgitation.
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Affiliation(s)
- Ana Paula Tagliari
- Cardiovascular Surgery Department, Hospital São Lucas da PUC/RS, Porto Alegre 90619-900, Brazil
- Cardiovascular Surgery Department, Hospital Mãe de Deus, Porto Alegre 90880-0481, Brazil
| | - Maurizio Taramasso
- HerzZentrum Hirslanden Zurich Clinic of Cardiac Surgery, 8008 Zurich, Switzerland
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18
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Datta R, Bharadwaj P, Keshavamurthy G, Ratheesh K, Guleria V. Caval valve implantation: First of its kind in a rare environment. Med J Armed Forces India 2023. [DOI: 10.1016/j.mjafi.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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19
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Transjugular Transcatheter Tricuspid Valve Implantation of LuX-Valve Bioprosthesis in a Preclinical Model. J Cardiovasc Transl Res 2023; 16:31-41. [PMID: 36151450 DOI: 10.1007/s12265-022-10325-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/14/2022] [Indexed: 10/14/2022]
Abstract
The purpose of this preclinical study in a sheep model was to confirm the feasibility and safety of the LuX-Valve transjugular tricuspid valve (TV) replacement apparatus and to optimize the implantation procedure before beginning first-in-man study. The LuX-Valve was implanted in a sheep model (n = 8) via transjugular approach. Six of eight sheep underwent successful implantation procedure on beating heart. The first two sheep died during the prostheses deployment. In the remaining 6 sheep that survived, postoperative echocardiography results showed there was no paravalvular leakage (PVL) and central tricuspid regurgitation in 5 animals, whereas 1 animal had mild PVL. The mean transvalvular gradient was 1.1 ± 0.9 mm Hg at the 4-week follow-up. No right ventricular outflow tract (RVOT) obstruction, device malposition, pericardial effusion, coronary artery compression, or arrhythmias were observed. This technology may be a promising alternative for TR patients who are at high risk for open-heart surgery. Transjugular tricuspid valved-stent implantation. a Transjugular tricuspid valve replacement in a sheep model. b and c Valved stent. d, e, and f Schematic depiction of the implantation procedure.
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20
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Dannenberg V, Koschutnik M, Donà C, Nitsche C, Spinka G, Heitzinger G, Mascherbauer K, Kammerlander A, Schneider-Reigbert M, Winter MP, Bartko P, Goliasch G, Hengstenberg C, Mascherbauer J, Gwechenberger M. Monitoring of mitral- and tricuspid valve interventions with CardioMEMS: Insights beyond imaging. Eur J Clin Invest 2023; 53:e13961. [PMID: 36710528 DOI: 10.1111/eci.13961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mitral- and tricuspid regurgitation are associated with significant morbidity and mortality and are increasingly treated interventionally. CardioMEMS is a transcutaneously implanted pressure sensor placed in the pulmonary artery that allows invasive measurement of pulmonary artery pressure and cardiac output. METHODS This proof-of-concept study aimed to observe hemodynamic changes as determined by CardioMEMS after transcatheter atrioventricular valve interventions, assess the additional value of CardioMEMS on top of echocardiography, and investigate a potential effect of CardioMEMS on outcome. Patients treated with transcatheter mitral- or tricuspid valve interventions (mitral: TMVR, tricuspid: TTVR) or bicaval valve implantation (bi-CAVI) were recruited. All patients were followed for 12 months. RESULTS Thirty-six patients were included (4 with CardioMEMS, 32 controls). Patients with CardioMEMS were monitored prior to intervention and 3-12 months thereafter (one received TMVR, one bi-CAVI, one both TMVR and TTVR, and one isolated TTVR). CardioMEMS group: In both patients with TMVR and in the patient with bi-CAVI, mean pulmonary artery pressures decreased (all p < .001) and cardiac output increased significantly (both TMVR p < .001 and bi-CAVI p = .006) while functional parameters, echocardiography, and NT-proBNP were difficult to interpret, unreliable, or both. Changes after TTVR remained inconclusive. CONCLUSION Invasive monitoring using CardioMEMS provides important information after mitral- and tricuspid valve interventions. Such data pave the way for a deeper understanding of the prerequisites for optimal patient selection and management for catheter-based interventions.
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Affiliation(s)
- Varius Dannenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Matthias Koschutnik
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Carolina Donà
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Christian Nitsche
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Georg Spinka
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Gregor Heitzinger
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Katharina Mascherbauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Andreas Kammerlander
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Matthias Schneider-Reigbert
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Max-Paul Winter
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Philipp Bartko
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Julia Mascherbauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Marianne Gwechenberger
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
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21
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Alipour Symakani RS, Bartelds B, Merkus D, Bogers AJJC, Taverne YJHJ. Guiding Interventions for Secondary Tricuspid Regurgitation: Follow the Intricate Interplay Between Form and Function. Cardiol Rev 2023; 31:7-15. [PMID: 34495894 DOI: 10.1097/crd.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Secondary tricuspid regurgitation (TR) has long been considered a benign and well-tolerated valvular lesion that resolves after treatment of the underlying disease. This view has been challenged by data indicating that long-standing TR can be a progressive disorder, contributing to right ventricular failure and end-organ damage, despite adequate treatment of the underlying disease. Surgical correction is curative, but infrequently performed and historically associated with poor outcomes. This may be due to delayed diagnosis, lack of well-defined surgical indications, and, consequently, late intervention in patients in poor clinical condition with failing right ventricles. Because of limited evidence about timing and corresponding outcome of tricuspid valve surgery, current guideline recommendations are rather conservative and show several inconsistencies. Nevertheless, there has been a trend toward a more aggressive approach in the surgical treatment of TR with improved outcomes. Moreover, emerging transcatheter options claim to provide a lower-risk alternative for selected patients. This may facilitate earlier treatment and improve the attitude toward an early treatment strategy of secondary TR, yet is not reflected in the guidelines. Future research is needed for risk stratification to determine inclusion criteria and optimal timing for intervention.
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Affiliation(s)
- Rahi S Alipour Symakani
- From the Division of Experimental Cardiology, Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Beatrijs Bartelds
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Daphne Merkus
- From the Division of Experimental Cardiology, Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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22
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Stolz L, Doldi PM, Weckbach LT, Schwinger RH, Stocker TJ, Massberg S, Näbauer M, Hausleiter J. Heterotopic Transcatheter Tricuspid Valve Replacement in a Patient With Carcinoid Heart Disease. JACC: CASE REPORTS 2022; 4:101679. [PMID: 36438434 PMCID: PMC9681668 DOI: 10.1016/j.jaccas.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022]
Abstract
Neuroendocrine tumors can lead to carcinoid heart disease with subsequent development of severe tricuspid regurgitation due to thickening and restriction of the tricuspid leaflets. We present a patient who underwent successful heterotopic transcatheter tricuspid valve replacement for torrential tricuspid regurgitation due to carcinoid heart disease. (Level of Difficulty: Intermediate.)
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23
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Analysis of Cardiac Computed Tomography Anatomy in Patients With Severe Tricuspid Regurgitation Considered for Transcatheter Intervention. STRUCTURAL HEART 2022. [DOI: 10.1016/j.shj.2022.100100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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24
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Ben Ali W, Ruf T, Perrin N, Bouhout I, Fam N, Kresoja KP, Lurz P, von Bardeleben RS, Modine T, Ibrahim R. Indications, Limitations, and Development of Tricuspid Valve Interventions in Adults. Can J Cardiol 2022; 38:S66-S78. [PMID: 34464691 DOI: 10.1016/j.cjca.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/19/2021] [Accepted: 08/03/2021] [Indexed: 12/30/2022] Open
Abstract
Tricuspid regurgitation is associated with excessive mortality and poor outcomes regardless of the cause and associated comorbidities. Despite this clear association with mortality, tricuspid valve diseases remain undertreated. Tricuspid valve surgery, either repair or replacement, has shown little detectable survival benefit. Transcatheter tricuspid valve interventions have emerged as a less invasive approach to tricuspid valve diseases. They can be categorised into coaptation devices, annuloplasty devices, transcatheter tricuspid valve replacement, heterotopic caval valve implantation, and tricuspid valve-in-valve. Despite the late referral and the patient's profile, results remain fairly acceptable at least in the short term, with good procedural device success, excellent safety profile, and sustained reduction of tricuspid regurgitation for up to 1 year. Because results are limited to the mid-term, transcatheter tricuspid valve intervention durability will need to be established before broader adoption of these technologies.
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Affiliation(s)
- Walid Ben Ali
- Structural Heart Program and Interventional Cardiology, Université de Montréal, Montréal Heart Institute, Montréal, Québec, Canada; Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France.
| | - Tobias Ruf
- Heart Valve Center Mainz, Universitätsmedizin, Mainz, Germany
| | - Nils Perrin
- Structural Heart Program and Interventional Cardiology, Université de Montréal, Montréal Heart Institute, Montréal, Québec, Canada; Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Ismail Bouhout
- Structural Heart Program and Interventional Cardiology, Université de Montréal, Montréal Heart Institute, Montréal, Québec, Canada
| | - Neil Fam
- Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Philipp Lurz
- Heart Center Leipzig-University Hospital, Leipzig, Germany
| | | | - Thomas Modine
- Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France
| | - Reda Ibrahim
- Structural Heart Program and Interventional Cardiology, Université de Montréal, Montréal Heart Institute, Montréal, Québec, Canada
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25
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Alperi A, Almendárez M, Álvarez R, Moris C, Leon V, Silva I, Hernández-Vaquero D, Pascual I, Avanzas P. Transcatheter tricuspid valve interventions: Current status and future perspectives. Front Cardiovasc Med 2022; 9:994502. [PMID: 36187002 PMCID: PMC9518720 DOI: 10.3389/fcvm.2022.994502] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
The development of transcatheter therapies to treat valvular heart diseases has changed the rules of the game, particularly in the case of aortic stenosis and mitral regurgitation. In the last years, the tricuspid valve has also been the focus of these percutaneous techniques for several reasons: (1) tricuspid regurgitation is a frequent disease associated with poor clinical outcomes in spite of medical treatment, leading to end-stage right ventricular heart failure, (2) surgical tricuspid valve repair or replacement has been the treatment of choice for patients with tricuspid valve disease, but high mortality rates for isolated surgical tricuspid valve intervention have been reported in the literature, and (3) most patients with tricuspid pathology are ultimately denied cardiac surgery because of their comorbidity burden. Thus, in this context the development of less invasive catheter-based therapies would be of high clinical relevance. The present review provides an overview regarding the framework of chronic tricuspid regurgitation transcatheter therapeutic options, summarizes the transcatheter systems under clinical use or clinical evaluation with their technical features, and describes the updated current evidence in this challenging and evolving field.
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Affiliation(s)
- Alberto Alperi
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Marcel Almendárez
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Rut Álvarez
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Cesar Moris
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Victor Leon
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Iria Silva
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Daniel Hernández-Vaquero
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
- Isaac Pascual
| | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Cardiac Pathology Department, Health Research Institute of Asturias (Instituto de investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
- *Correspondence: Pablo Avanzas ;
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26
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Bart NK, Liu K, Kotlyar E, Keogh AM. Portopulmonary Hypertension: The Interplay Between the Liver and Pulmonary Arteries. Heart Lung Circ 2022; 31:1185-1187. [PMID: 36028294 DOI: 10.1016/j.hlc.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Nicole K Bart
- Heart Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia; School of Medicine, University of Notre Dame, Sydney, NSW, Australia; School of Medicine, University of New South Wales, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia.
| | - Ken Liu
- Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Eugene Kotlyar
- Heart Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia; School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - Anne M Keogh
- Heart Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia; School of Medicine, University of New South Wales, Sydney, NSW, Australia
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27
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Pugliese L, Ricci F, Luciano A, De Stasio V, Presicce M, Spiritigliozzi L, Di Tosto F, Di Donna C, D'Errico F, Benelli L, Pasqualetto M, Grimaldi F, Mecchia D, Sbordone P, Cesareni M, Cerimele C, Cerocchi M, Laudazi M, Leomanni P, Rellini C, Dell'Olio V, Patanè A, Romeo F, Barillà F, Garaci F, Floris R, Chiocchi M. Role of computed tomography in transcatheter replacement of 'other valves': a comprehensive review of preprocedural imaging. J Cardiovasc Med (Hagerstown) 2022; 23:575-588. [PMID: 35994705 DOI: 10.2459/jcm.0000000000001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Transcatheter procedures for heart valve repair or replacement represent a valid alternative for treating patients who are inoperable or at a high risk for open-heart surgery. The transcatheter approach has become predominant over surgical intervention for aortic valve disease, but it is also increasingly utilized for diseases of the 'other valves', that is the mitral and, to a lesser extent, tricuspid and pulmonary valve. Preprocedural imaging is essential for planning the transcatheter intervention and computed tomography has become the main imaging modality by providing information that can guide the type of treatment and choice of device as well as predict outcome and prevent complications. In particular, preprocedural computed tomography is useful for providing anatomic details and simulating the effects of device implantation using 3D models. Transcatheter mitral valve replacement is indicated for the treatment of mitral regurgitation, either primary or secondary, and computed tomography is crucial for the success of the procedure. It allows evaluating the mitral valve apparatus, the surrounding structures and the left heart chambers, identifying the best access route and the landing zone and myocardial shelf, and predicting obstruction of the left ventricular outflow tract, which is the most frequent postprocedural complication. Tricuspid valve regurgitation with or without stenosis and pulmonary valve stenosis and regurgitation can also be treated using a transcatheter approach. Computer tomography provides information on the tricuspid and pulmonary valve apparatus, the structures that are spatially related to it and may be affected by the procedure, the right heart chambers and the right ventricular outflow tract.
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Affiliation(s)
- Luca Pugliese
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Francesca Ricci
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Alessandra Luciano
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Vincenzo De Stasio
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Matteo Presicce
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Luigi Spiritigliozzi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Federica Di Tosto
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Carlo Di Donna
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Francesca D'Errico
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Leonardo Benelli
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Monia Pasqualetto
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Francesco Grimaldi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Daniele Mecchia
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Paolo Sbordone
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Matteo Cesareni
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Cecilia Cerimele
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Martina Cerocchi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Mario Laudazi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Paola Leomanni
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Carlotta Rellini
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Vito Dell'Olio
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Alberto Patanè
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Francesco Romeo
- Department of System Medicine, University of Rome Tor Vergata and Unit of Cardiology and Interventional Cardiology, Policlinico Tor Vergata, Rome, Italy
| | - Francesco Barillà
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Francesco Garaci
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Roberto Floris
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Marcello Chiocchi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
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28
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Transcatheter interventions for severe tricuspid regurgitation: a literature review. J Geriatr Cardiol 2022; 19:539-550. [PMID: 35975018 PMCID: PMC9361160 DOI: 10.11909/j.issn.1671-5411.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The prevalence of tricuspid regurgitation (TR) increases with age, affecting 65%-85% of adults. Primary TR is caused by a congenital or acquired abnormality of the tricuspid valve apparatus (leaflets, chordae, papillary muscles, or annulus). Secondary TR is due to insufficient coaptation from dilation of tricuspid valve annulus due to the right ventricle (RV) or right atrium (RA) remodeling and increased RV pressures. Isolated TR is without increased RV pressures and is associated with atrial fibrillation. Mild TR is a benign disease. Moderate to severe tricuspid regurgitation has independently been associated with increased mortality. Most of these patients are treated medically due to poor outcomes with surgical repair of isolated TR. The in-hospital mortality rate is 8.8%, and the median length of stay in hospital is 11 days resulting in higher healthcare costs. Even if the patients undergo surgical repair or replacement, available data do not show improvement in survival. With a more detailed understanding of the complex anatomy and physiology of the tricuspid valve and significant complications from untreated tricuspid valve disease, the approach to the management of TR has shifted from a conservative approach to a process of prevention and intervention. In the past decade, transcatheter tricuspid valve interventions and tricuspid annuloplasty rings have been developed, contributing to decreased mortality from surgical repair. Transcatheter tricuspid valve intervention techniques have improved survival, quality of life, and reduced heart failure rehospitalization. This review summarizes normal anatomy, types of TR, etiology and different mechanisms of TR, echocardiographic assessment of the severe TR, and highlights various percutaneous transcatheter techniques for tricuspid valve repair.
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Sannino A, Ilardi F, Hahn RT, Lancellotti P, Lurz P, Smith RL, Esposito G, Grayburn PA. Clinical and Echocardiographic Outcomes of Transcatheter Tricuspid Valve Interventions: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:919395. [PMID: 35898276 PMCID: PMC9309386 DOI: 10.3389/fcvm.2022.919395] [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: 04/13/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Medically managed tricuspid regurgitation (TR) has detrimental outcomes. Transcatheter tricuspid valve interventions (TTVIs) represent an alternative to surgery in high-risk patients; however, only early experiences exist. Aim The aim of this study was to analyze the clinical and echocardiographic outcomes of TTVI. Methods MEDLINE, ISI Web of Science, and SCOPUS databases were searched for studies published up to June 2021. Studies reporting data on outcome post-TTVIs were included. This study was designed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) requirements. The primary endpoint was all-cause mortality at 30-day and 1-year post-TTVI. Results Out of 2,718 studies, 27 were included. Notably, 30-day and 1-year all-cause mortalities were 5% (95% confidence interval [CI]: 4-8%, p < 0.001) and 25% (95% CI: 12-45%, p = 0.016). Procedural success was associated with a 58% risk reduction in 1-year mortality vs. lack thereof (odds ratio 0.42, 95% CI: 0.27-0.66, p < 0.001). TTVI is associated with a significant reduction in TR severity (TR EROA, mean difference [MD] 0.31 cm2; 95% CI: 0.23-0.39 cm2, p < 0.001; regurgitant volume, MD 23.54 ml; 95% CI: 17.4-29.68 ml, p = 0.03) and increase in forward stroke volume (FSV, MD 3.98 ml; 95% CI: 0.11-7.86 ml, p = 0.04). Conclusion TTVI significantly reduces TR severity and increases FSV and is associated with improved survival at 1 year compared with patients without procedural success. Long-term outcomes compared with medical therapy await the results of ongoing pivotal trials; nonetheless, TTVIs appear to be a promising alternative to surgery for TR.
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Affiliation(s)
- Anna Sannino
- The Heart Hospital Baylor Plano, Plano, TX, United States
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Rebecca T. Hahn
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY, United States
| | - Patrizio Lancellotti
- Department of Cardiology and Radiology, GIGA Cardiovascular Sciences, CHU SartTilman, University of Liège Hospital, Liège, Belgium
- Gruppo Villa Maria Care and Research, Lugo, Italy
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
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30
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Dreyfus J, Dreyfus GD, Taramasso M. Tricuspid valve replacement: The old and the new. Prog Cardiovasc Dis 2022; 72:102-113. [PMID: 35738423 DOI: 10.1016/j.pcad.2022.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
Tricuspid regurgitation is a frequent and serious condition but tricuspid valve (TV) surgery, that may be a valve replacement when a repair is not feasible, is rarely performed. Recent development of transcatheter TV interventions offers new options for those high-surgical risk patients, especially TV replacement for patients who are not eligible for transcatheter TV repair. In this review, we describe indications and outcome after surgical TV replacement, and devices available or in development for transcatheter TV replacement.
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Affiliation(s)
- Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France.
| | - Gilles D Dreyfus
- Department of Cardiac Surgery, Montsouris Institute, Paris, France
| | - Maurizio Taramasso
- Cardiovascular Surgical Department, University Hospital of Zurich, Zurich, Switzerland
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31
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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: 3] [Impact Index Per Article: 1.5] [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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Matli K, Mahdi A, Zibara V, Costanian C, Ghanem G. Transcatheter tricuspid valve intervention techniques and procedural steps for the treatment of tricuspid regurgitation: a review of the literature. Open Heart 2022; 9:openhrt-2022-002030. [PMID: 35654481 PMCID: PMC9163538 DOI: 10.1136/openhrt-2022-002030] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022] Open
Abstract
Severe tricuspid regurgitation (TR) is an undertreated common pathology associated with significant morbidity and mortality. Classically, surgical repair or valve replacement were the only therapeutic options and are associated with up to 10% postprocedural mortality. Transcatheter tricuspid valve interventions are a novel and effective therapeutic option for the treatment of significant TR. Several devices have been developed with different mechanisms of action. They are classified as annuloplasty devices, replacement devices, caval valve implantation and coaptation devices. In this review, we provide a step-by-step description of the procedural steps and techniques of every device along with video support.
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Affiliation(s)
- Kamal Matli
- Cardiology, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon.,Cardiologie, Centre Hospitalier de Haguenau, Haguenau, Alsace-Champagne-Ardenne-Lorraine, France
| | - Ahmad Mahdi
- LAU Gilbert and Rose-Marie Chagoury School of Medicine, Byblos, Lebanon
| | - Victor Zibara
- LAU Gilbert and Rose-Marie Chagoury School of Medicine, Byblos, Lebanon
| | - Christy Costanian
- LAU Gilbert and Rose-Marie Chagoury School of Medicine, Byblos, Lebanon
| | - Georges Ghanem
- Cardiology, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
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Estévez-Loureiro R, Sánchez-Recalde A, Amat-Santos IJ, Cruz-González I, Baz JA, Pascual I, Mascherbauer J, Abdul-Jawad Altisent O, Nombela-Franco L, Pan M, Trillo R, Moreno R, Delle Karth G, Salido-Tahoces L, Santos-Martinez S, Núñez JC, Moris C, Goliasch G, Jimenez-Quevedo P, Ojeda S, Cid-Álvarez B, Santiago-Vacas E, Jimenez-Valero S, Serrador A, Martín-Moreiras J, Strouhal A, Hengstenberg C, Zamorano JL, Puri R, Íñiguez-Romo A. Six-Month Outcomes of the TricValve® System in Patients with Tricuspid Regurgitation: TRICUS EURO Study. JACC Cardiovasc Interv 2022; 15:1366-1377. [PMID: 35583363 DOI: 10.1016/j.jcin.2022.05.022] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Severe tricuspid regurgitation (TR) is frequently associated with significant morbidity and mortality; such patients often deemed to be at high surgical risk. Heterotopic bi-caval stenting is an emerging, attractive transcatheter solution for these patients. OBJECTIVES To evaluate the 30-day safety and 6-month efficacy outcomes of specifically designed bioprosthetic valves for the superior and inferior vena cava. METHODS TRICUS EURO is a non-blinded, non-randomized, single-arm, multicenter, prospective trial that enrolled patients from 12 European centers between December 2019 to February 2021. High risk individuals with severe symptomatic TR despite optimal medical therapy were included. Primary end point was quality of life (QOL) improvement measured by Kansas City Cardiomyopathy Questionnaire (KCCQ12) and New York Heart Association functional class (NYHA) improvement at 6-month follow-up. RESULTS 35 patients (mean age 76±6.8 years; 83% women) were treated with TricValve® system. All patients at baseline were at NYHA ≥ 3 status. At 30-days, procedural success was 94% with no procedural deaths or conversions to surgery. A significant increase in QOL at 6-months follow-up was observed (baseline and 6-month KCCQ: 42.01±22.3 vs. 59.7±23.6 respectively; p=0.004), correlating with a significant improvement in NYHA functional class with 79.4% of patients noted to be in class I or II at 6 months (p=0.0006). The 6-month all-cause mortality and heart failure hospitalization rates were 8.5% and 20%, respectively. CONCLUSIONS The dedicated bi-caval system for treating severe, symptomatic TR was associated with high procedural success rate and significant increase in both, QOL and functional improvements at 6-months follow-up.
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Affiliation(s)
| | | | | | | | - Jose A Baz
- Complejo Hospitalario Universitario Alvaro Cunqueiro, Vigo, Spain
| | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Julia Mascherbauer
- Division of Cardiology, Department for Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Manuel Pan
- Hospital Universitario Reina Sofia, Córdoba, Spain
| | - Ramiro Trillo
- Hospital Clinico Universitario de Santiago de Compostela, CIBERCV, Santiago, Spain
| | - Raul Moreno
- Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | - Jean C Núñez
- Hospital Clinico Universitario de Salamanca, CIBERCV. IBSAL. Salamanca, Spain
| | - Cesar Moris
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Georg Goliasch
- Division of Cardiology, Department for Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | | | - Belén Cid-Álvarez
- Hospital Clinico Universitario de Santiago de Compostela, CIBERCV, Santiago, Spain
| | | | | | - Ana Serrador
- CIBERCV. Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Christian Hengstenberg
- Division of Cardiology, Department for Internal Medicine II, Medical University of Vienna, Vienna, Austria
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Vinciguerra M, Sitges M, Luis Pomar J, Romiti S, Domenech-Ximenos B, D'Abramo M, Wretschko E, Miraldi F, Greco E. Functional Tricuspid Regurgitation: Behind the Scenes of a Long-Time Neglected Disease. Front Cardiovasc Med 2022; 9:836441. [PMID: 35265685 PMCID: PMC8899114 DOI: 10.3389/fcvm.2022.836441] [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: 12/15/2021] [Accepted: 01/24/2022] [Indexed: 11/17/2022] Open
Abstract
Severe tricuspid valve regurgitation has been for a long time a neglected valve disease, which has only recently attracted an increasing interest due to the notable negative impact on the prognosis of patients with cardiovascular disease. It is estimated that around 90% of tricuspid regurgitation is diagnosed as “functional” and mostly secondary to a primary left-sided heart disease and, therefore, has been usually interpreted as a benign condition that did not require a surgical management. Nevertheless, the persistence of severe tricuspid regurgitation after left-sided surgical correction of a valve disease, particularly mitral valve surgery, has been associated to adverse outcomes, worsening of the quality of life, and a significant increase in mortality rate. Similar results have been found when the impact of isolated severe tricuspid regurgitation has been studied. Current knowledge is shifting the “functional” categorization toward a more complex and detailed pathophysiological classification, identifying various phenotypes with completely different etiology, natural history and, potentially, an invasive management. The aim of this review is to offer a comprehensive guide for clinicians and surgeons with a systematic description of “functional” tricuspid regurgitation subtypes, an analysis centered on the effectiveness of existing surgical techniques and a focus on the emergent percutaneous procedures. This latter may be an attractive alternative to a standard surgical approach in patients with high-operative risk or isolated tricuspid regurgitation.
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Affiliation(s)
- Mattia Vinciguerra
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
- *Correspondence: Mattia Vinciguerra
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
- Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose Luis Pomar
- Department of Cardiac Surgery, Clinic Barcelona Hospital University, Barcelona, Spain
- Department of Cardiac Surgery, Barnaclinic, Barcelona, Spain
| | - Silvia Romiti
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Blanca Domenech-Ximenos
- Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Radiology, Hospital Clínic, Barcelona, Spain
| | - Mizar D'Abramo
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Eleonora Wretschko
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Fabio Miraldi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Ernesto Greco
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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35
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Galiuto L, Massetti M. OUP accepted manuscript. Eur Heart J 2022; 43:1792-1793. [PMID: 35567550 DOI: 10.1093/eurheartj/ehac132] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- Leonarda Galiuto
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, Rome 00168, Italy
| | - Massimo Massetti
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, Rome 00168, Italy
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36
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Byeon J, Lee KY, Oh GC, Choo EH, Hwang BH, Chung WB, Chang K. The First Application of Transcatheter Caval Valve Implantation for Severe Tricuspid Regurgitation in a Patient With High Surgical Risk. Korean Circ J 2022; 52:246-250. [PMID: 35257536 PMCID: PMC8907993 DOI: 10.4070/kcj.2021.0392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/06/2022] [Accepted: 01/26/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jaeho Byeon
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Kwan Yong Lee
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gyu-Chul Oh
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun-Ho Choo
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung-Hee Hwang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woo-Baek Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Russo G, Taramasso M, Pedicino D, Gennari M, Gavazzoni M, Pozzoli A, Muraru D, Badano LP, Metra M, Maisano F. Challenges and future perspectives of transcatheter tricuspid valve interventions: adopt old strategies or adapt to new opportunities? Eur J Heart Fail 2021; 24:442-454. [PMID: 34894039 DOI: 10.1002/ejhf.2398] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 01/08/2023] Open
Abstract
Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease and is associated with an increased risk of cardiovascular events and death at long-term follow-up. Functional TR accounts for over 90% of TR and is mainly due to annular or right ventricular dilatation. Most often, TR is observed in patients with left-sided valvular heart disease (with or without previous surgical correction) and pulmonary hypertension. Isolated TR is less frequent, though burdened by high surgical mortality. This, together with an incomplete understanding of the disease, has brought to a significant undertreatment in spite of the growing evidence of the impact of severe TR on mortality. Moreover, uncertainties about the appropriate timing for intervention and the predictors of procedural success have contributed to limit TR treatment. Transcatheter tricuspid valve replacement or repair interventions represent novel and less invasive alternatives to surgery and have shown early promising results. The purpose of this review is to provide a complete and updated overview of TR pathology with a special focus on current percutaneous treatment options, future challenges and directions.
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Affiliation(s)
- Giulio Russo
- Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Daniela Pedicino
- Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Mara Gavazzoni
- IRCCS, Instituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, Milan, Italy
| | - Alberto Pozzoli
- Heart Surgery Unit, Cardiocentro Ticino, Lugano, Switzerland
| | - Denisa Muraru
- IRCCS, Instituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, Milan, Italy
| | - Luigi P Badano
- IRCCS, Instituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, Milan, Italy
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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38
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Caval Valve Implantation. Interv Cardiol Clin 2021; 11:95-102. [PMID: 34838301 DOI: 10.1016/j.iccl.2021.09.010] [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: 11/22/2022]
Abstract
Transcathetertherapy has expanded the treatment options for patients with heart valve disease. Interventional therapy for aortic, mitral, and pulmonic valve disease is well established; however, catheter-based approaches to tricuspid regurgitation (TR) are still in early stages of development. For some of the interventional concepts to TR, including the edge-to-edge-repair, transcatheter annuloplasty, the tricuspid spacer, and caval valves, procedural feasibility and favorable early clinical outcome have been demonstrated in small compassionate case series. This article reviews the pathophysiological background and current evidence for caval valve implantation and examines the potential role of this approach for the treatment of severe TR.
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Mesnier J, Alperi A, Panagides V, Bédard E, Salaun E, Philippon F, Rodés-Cabau J. Transcatheter tricuspid valve interventions: Current devices and associated evidence. Prog Cardiovasc Dis 2021; 69:89-100. [PMID: 34801577 DOI: 10.1016/j.pcad.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 11/14/2021] [Indexed: 11/15/2022]
Abstract
Tricuspid regurgitation (TR) is a common finding in patients with chronic cardiopathy, and often a marker of an advanced disease. Being silent or with symptoms intertwined with the primitive left heart disease, TR has often been neglected, leading to the late referral of patients with advanced right-heart failure. Hence, isolated tricuspid surgery has been associated with high morbidity and mortality rates, the worse of all valve interventions, and medical management has been limited to symptomatic treatment. In this context, percutaneous therapies for severe TR have gained traction, addressing the unmet therapeutic gap for a less invasive disease-modifying management. The aim of this review is to provide an updated overview on transcatheter tricuspid valve interventions, focusing on devices' characteristics, associated evidence, and future perspectives.
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Affiliation(s)
- Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Alberto Alperi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Vassili Panagides
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Elisabeth Bédard
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Erwan Salaun
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - François Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clínic Barcelona, Barcelona, Spain.
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40
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Renal and hepatic function of patients with severe tricuspid regurgitation undergoing inferior caval valve implantation. Sci Rep 2021; 11:21800. [PMID: 34750484 PMCID: PMC8576027 DOI: 10.1038/s41598-021-01322-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022] Open
Abstract
Due to progressive abdominal-venous congestion severe tricuspid regurgitation (TR) is a common cause of cardiorenal and cardiohepatic syndrome. We initiated the TRICAVAL study to compare interventional valve implantation into the inferior vena cava (CAVI) versus optimal medical therapy (OMT) in severe TR. In the present subanalysis, we aimed to evaluate the effects of CAVI on clinical signs of congestion, renal and hepatic function. TRICAVAL was an investigator-initiated, randomized trial. Twenty-eight patients with severe TR were randomized to OMT or CAVI using an Edwards Sapien XT valve. Probands who completed the 3-month follow-up (CAVI [n = 8], OMT [n = 10]) were evaluated by medical history, clinical examination, and laboratory testing at baseline, 3 and 12 months. After 3 months, the CAVI group exhibited a significant reduction of body weight (from 80.7 [69.0–87.7] kg to 75.5 [63.8–84.6] kg, p < 0.05) and abdominal circumference (from 101.5 ± 13.8 cm to 96.3 ± 15.4 cm, p ≤ 0.01) and a trend to lower doses of diuretics compared to OMT. Renal and hepatic function parameters did not change significantly. Within a short-term follow-up, CAVI led to an improvement of clinical signs of venous congestion and a non-significant reduction of diuretic doses compared to OMT.
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Abdul-Jawad Altisent O, Benetis R, Rumbinaite E, Mizarien V, Codina P, Gual-Capllonch F, Spitaleri G, Fernandez-Nofrerias E, Bayes-Genis A, Puri R. Caval Valve Implantation (CAVI): An Emerging Therapy for Treating Severe Tricuspid Regurgitation. J Clin Med 2021; 10:jcm10194601. [PMID: 34640619 PMCID: PMC8509289 DOI: 10.3390/jcm10194601] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
Severe tricuspid regurgitation remains a challenging heart-valve disease to effectively treat with high morbidity and mortality at mid-term. Currently guideline-directed medical treatment is limited to escalating dose of diuretics, and the rationale and timing of open-heart surgery remains controversial. Emerging percutaneous therapies for severe tricuspid regurgitation continue to show promising results in early feasibility studies. However, randomized trial data is lacking. Additionally, many patients are deemed unsuitable for these emerging therapies due to anatomical or imaging constraints. Given the technical simplicity of the bicaval valve implantation (CAVI) technique compared to other transcatheter devices, CAVI is postulated as a suitable alternative for a wide variety of patients affected with severe+ tricuspid regurgitation. In this review we illustrate the current evidence and ongoing uncertainties of CAVI, focusing on the novel CAVI-specific devices.
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Affiliation(s)
- Omar Abdul-Jawad Altisent
- Department of Cardiology, Germans Trias University Hospital, 08916 Badalona, Spain; (P.C.); (F.G.-C.); (G.S.); (E.F.-N.); (A.B.-G.)
- Correspondence: or ; Tel./Fax: +34-93-4978-988
| | - Rimantas Benetis
- Department of Cardiothoracic and Vascular Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Egle Rumbinaite
- Department of Cardiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (E.R.); (V.M.)
| | - Vaida Mizarien
- Department of Cardiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (E.R.); (V.M.)
| | - Pau Codina
- Department of Cardiology, Germans Trias University Hospital, 08916 Badalona, Spain; (P.C.); (F.G.-C.); (G.S.); (E.F.-N.); (A.B.-G.)
| | - Francisco Gual-Capllonch
- Department of Cardiology, Germans Trias University Hospital, 08916 Badalona, Spain; (P.C.); (F.G.-C.); (G.S.); (E.F.-N.); (A.B.-G.)
| | - Giosafat Spitaleri
- Department of Cardiology, Germans Trias University Hospital, 08916 Badalona, Spain; (P.C.); (F.G.-C.); (G.S.); (E.F.-N.); (A.B.-G.)
| | - Eduard Fernandez-Nofrerias
- Department of Cardiology, Germans Trias University Hospital, 08916 Badalona, Spain; (P.C.); (F.G.-C.); (G.S.); (E.F.-N.); (A.B.-G.)
| | - Antoni Bayes-Genis
- Department of Cardiology, Germans Trias University Hospital, 08916 Badalona, Spain; (P.C.); (F.G.-C.); (G.S.); (E.F.-N.); (A.B.-G.)
| | - Rishi Puri
- Department of Cardiology, Cleveland Clinic, Cleveland, OH 44195, USA;
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Transcatheter Tricuspid Valve-in-Valve Procedure-An Illustrative Case Report and Review. J Clin Med 2021; 10:jcm10174004. [PMID: 34501452 PMCID: PMC8432540 DOI: 10.3390/jcm10174004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/21/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022] Open
Abstract
Severe tricuspid commitment is no longer understood as merely a marker of disease but is now widely thought of as a significant contributor to cardiac morbidity and mortality. However, isolated tricuspid valve surgery remains rare and to this day continues to be associated with the highest surgical risk among all valve procedures and high operative mortality rates, especially in reoperations. Therefore, the development of tricuspid transcatheter procedures is as necessary as it was for the other valves a couple of years ago. Recently, multiple percutaneous therapies have been developed for the management of severe tricuspid disease, initially only repair and more recently replacement, thus creating a new branch for the management of patients who have already undergone surgery and who present with dysfunctional bioprostheses. The purpose of this review and report is to demonstrate current and possible future challenges, and to show that the valve-in-valve procedure of the tricuspid valve is feasible and safe, and now can be performed in all its range, in the smallest to the largest sizes of presentation, without incurring the untoward risks of conventional surgery.
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Ho EC, Latib A. Imaging for transcatheter native tricuspid valve intervention: patient selection, procedural planning and interventional guidance. Minerva Cardiol Angiol 2021; 69:707-719. [PMID: 34472772 DOI: 10.23736/s2724-5683.21.05697-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There are an increasing number of transcatheter tricuspid valve interventions being performed worldwide using commercially available and investigational devices. Imaging in the pre-procedural and periprocedural period is essential for procedural and clinical success. Echocardiographic-based techniques are particularly important in these procedures, especially for interventional guidance. This review summarizes the current devices in use and how imaging is used for patient selection, procedural planning, and interventional guidance. The most commonly used method of transcatheter tricuspid intervention is edge-to-edge repair using the MitraClip or TriClip devices (Abbott, Santa Clara, CA, USA). Randomized controlled data is pending but observational studies have demonstrated success, especially in the setting of smaller coaptation gaps and adequate transesophageal imaging windows. Direct annuloplasty with the Cardioband (Edwards Lifesciences, Irvine, CA, USA) has also been used in many centers and has demonstrated success when the anatomy and mechanism of tricuspid regurgitation are appropriate for annuloplasty based on imaging evaluation. Lastly, transcatheter valve replacement is becoming more common using several investigational devices and relies heavily on imaging methods to achieve procedural success.
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Affiliation(s)
- Edwin C Ho
- Division of Cardiology, Montefiore Medical Center - Weiler Division, Albert Einstein College of Medicine, New York, NY, USA -
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center - Weiler Division, Albert Einstein College of Medicine, New York, NY, USA
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Parody-Cuerda G, Rodríguez-Caulo E, Barquero-Aroca JM. Tratamiento endovascular de la válvula tricúspide: estado actual. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2021.06.004] [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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Mangieri A, Laricchia A, Cereda A, Khokhar AA, Regazzoli D, Giannini F, Reimers B, Colombo A. Diagnosis and Management of Failed Surgical Tricuspid Valve Annuloplasty. Curr Cardiol Rep 2021; 23:137. [PMID: 34410511 DOI: 10.1007/s11886-021-01569-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF THE REVIEW Annular-based strategies for treating tricuspid valve (TV) regurgitation do not always have satisfactory long-term outcomes. Management of failed TV annuloplasty can be challenging and requires a dedicated heart team approach. This review explores the treatment options available for failed TV annuloplasty. RECENT FINDINGS Recent developments and novel percutaneous treatment options have emerged as promising alternatives for patients with failed TV annuloplasty. Leaflet-based interventions, valve-in-valve procedures, transcatheter tricuspid valves and new-generation trans-caval valves are all feasible options, which can assure good results whilst minimizing risks for the patient. Failure of tricuspid annuloplasty is not uncommon amongst patients treated with either a tricuspid ring or suture-based device. The complex anatomy, physiology and clinical risk profile should be carefully evaluated on an individual patient-by-patient basis in order to select the most appropriate clinical and percutaneous treatment strategy. Different transcatheter tricuspid valve repair or replacement techniques may provide an attractive alternative treatment option for managing this challenging patient cohort.
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Affiliation(s)
- Antonio Mangieri
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Alberto Cereda
- Cardiovascular Department, ASST Santi Paolo e Carlo, Milan, Italy
| | - Arif A Khokhar
- GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Damiano Regazzoli
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Bernhard Reimers
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Antonio Colombo
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
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Hell MM, Emrich T, Kreidel F, Kreitner KF, Schoepf UJ, Münzel T, von Bardeleben RS. Computed tomography imaging needs for novel transcatheter tricuspid valve repair and replacement therapies. Eur Heart J Cardiovasc Imaging 2021; 22:601-610. [PMID: 33247897 DOI: 10.1093/ehjci/jeaa308] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/30/2020] [Indexed: 01/03/2023] Open
Abstract
Transcatheter tricuspid valve therapies are an emerging field in structural heart interventions due to the rising number of patients with severe tricuspid regurgitation and the high risk for surgical treatment. Computed tomography (CT) allows exact measurements of the annular plane, evaluation of adjacent structures, assessment of the access route, and can also be used to identify optimal fluoroscopic projection planes to enhance periprocedural imaging. This review provides an overview of current transcatheter tricuspid valve repair and replacement therapies and to what extent CT can support these interventions.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany.,Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Felix Kreidel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Ralph Stephan von Bardeleben
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
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Schlotter F, Miura M, Kresoja KP, Alushi B, Alessandrini H, Attinger-Toller A, Besler C, Biasco L, Braun D, Brochet E, Connelly K, de Bruijn S, Denti P, Estévez-Loureiro R, Fam NP, Gavazzoni M, Himbert D, Ho E, Juliard JM, Kalbacher D, Kaple R, Kreidel F, Latib A, Lubos E, Ludwig S, Mehr M, Monivas V, Nazif T, Nickenig G, Pedrazzini G, Pozzoli A, Praz F, Puri R, Rodés-Cabau J, Rommel KP, Schäfer U, Schofer J, Sievert H, Tang G, Thiele H, Unterhuber M, Vahanian A, von Bardeleben R, von Roeder M, Webb J, Weber M, Wild MG, Windecker S, Zuber M, Hausleiter J, Maisano F, Leon MB, Hahn RT, Lauten A, Taramasso M, Lurz P. Outcomes of transcatheter tricuspid valve intervention by right ventricular function: a multicentre propensity-matched analysis. EUROINTERVENTION 2021; 17:e343-e352. [PMID: 33956637 PMCID: PMC9724849 DOI: 10.4244/eij-d-21-00191] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Tricuspid regurgitation (TR) has a poor prognosis and limited treatment options and is frequently accompanied by right ventricular (RV) dysfunction. Transcatheter tricuspid valve interventions (TTVI) to reduce TR have been shown to be safe and feasible with encouraging early results. Patient selection for TTVI remains challenging, with the role of right ventricular (RV) function being unknown. AIMS The aims of this study were 1) to investigate survival in a TTVI-treated patient population and a conservatively treated TR population, and 2) to evaluate the outcome of TTVI as compared to conservative treatment stratified according to the degree of RV function. METHODS We studied 684 patients from the multicentre TriValve cohort (TTVI cohort) and compared them to 914 conservatively treated patients from two tertiary care centres. Propensity matching identified 213 pairs of patients with severe TR. As we observed a non-linear relationship of RV function and TTVI outcome, we stratified patients according to tricuspid annular plane systolic excursion (TAPSE) to preserved (TAPSE >17 mm), mid-range (TAPSE 13-17 mm) and reduced (TAPSE <13 mm) RV function. The primary outcome was one-year all-cause mortality. RESULTS TTVI was associated with a survival benefit in patients with severe TR when compared to matched controls (one-year mortality rate: 13.1% vs 25.8%; p=0.031). Of the three RV subgroups, only in patients with mid-range RV function was TTVI associated with an improved survival (p log-rank 0.004). In these patients, procedural success was associated with a reduced hazard ratio for all-cause mortality (HR 0.22; 95% CI: 0.09, 0.57). CONCLUSIONS TTVI is associated with reduced mortality compared to conservative therapy and might exert its highest treatment effect in patients with mid-range reduced RV function.
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Affiliation(s)
- Florian Schlotter
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Mizuki Miura
- Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Karl-Patrik Kresoja
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Brunilda Alushi
- HELIOS Klinikum Erfurt, Department of General and Interventional Cardiology & Rhythmology, Erfurt, Germany,Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, and German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | | | | | - Christian Besler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Luigi Biasco
- Cardiology Department, Cardiocentro, Lugano, Switzerland
| | - Daniel Braun
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Eric Brochet
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | - Kim Connelly
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, ON, Canada
| | - Sabine de Bruijn
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | | | - Neil P. Fam
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, ON, Canada
| | - Mara Gavazzoni
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Dominique Himbert
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | - Edwin Ho
- Cardiology Department, Montefiore Medical Center, New York, NY, USA
| | | | | | - Ryan Kaple
- Division of Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Felix Kreidel
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Azeem Latib
- Cardiology Department, Montefiore Medical Center, New York, NY, USA
| | - Edith Lubos
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | | | - Michael Mehr
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Vanessa Monivas
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Tamim Nazif
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Georg Nickenig
- Cardiology Department, Universitaetsklinikum Bonn, Bonn, Germany
| | | | - Alberto Pozzoli
- Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabien Praz
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Josep Rodés-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Ulrich Schäfer
- Cardiology, Angiology and Intensive Care Medicine, Catholic Marienhospital, Hamburg, Germany
| | - Joachim Schofer
- MVZ Department Structural Heart Disease, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Horst Sievert
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Gilbert Tang
- Cardiac Surgery Department, Mount Sinai Hospital, New York, NY, USA
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Matthias Unterhuber
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Alec Vahanian
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | | | - Maximilian von Roeder
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - John Webb
- Cardiology Department, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Marcel Weber
- Cardiology Department, Universitaetsklinikum Bonn, Bonn, Germany
| | - Mirjam G. Wild
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michel Zuber
- Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jörg Hausleiter
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | | | - Martin B. Leon
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Rebecca T. Hahn
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Alexander Lauten
- HELIOS Klinikum Erfurt, Department of General and Interventional Cardiology & Rhythmology, Erfurt, Germany,Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, and German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Maurizio Taramasso
- Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Struempellstr. 39, 04289 Leipzig, Germany
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Rahgozar K, Ho E, Goldberg Y, Chau M, Latib A. Transcatheter tricuspid valve repair and replacement: a landscape review of current techniques and devices for the treatment of tricuspid valve regurgitation. Expert Rev Cardiovasc Ther 2021; 19:399-411. [PMID: 33834941 DOI: 10.1080/14779072.2021.1915133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background and ObjectiveTricuspid regurgitation is a prevalent and undertreated cardiac pathology impacting millions across the globe. While historically surgical interventions for isolated tricuspid regurgitation were largely avoided due to data citing poor surgical outcomes, advances in transcatheter techniques and imaging modalities have reframed the approach to tricuspid valve disease in promising new ways.MethodsHere we sought to provide a landscape review of the current state of the field for transcatheter tricuspid valve interventions. We first start with a descriptive overview of the tricuspid valve, reviewing the anatomy, imaging characteristics, and the current guidelines for tricuspid interventions. We then review both transcatheter valve repair and valve replacement modalities, highlighting the devices, techniques, and valves currently under investigation, summarizing available outcomes data for each modality when possible.Results and ConclusionOur aim in writing this landscape review is the create an all-encompassing, up-to-date resource for clinicians to refer to when seeking to learn about the current state of transcatheter tricuspid valve interventions. We also hope to highlight the exciting promise of transcatheter tricuspid valve replacement in appropriate patients, and review the valves currently under development for use in the tricuspid position.
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Affiliation(s)
- Kusha Rahgozar
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Edwin Ho
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ythan Goldberg
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mei Chau
- Department of Cardiothoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Goldberg YH, Ho E, Chau M, Latib A. Update on Transcatheter Tricuspid Valve Replacement Therapies. Front Cardiovasc Med 2021; 8:619558. [PMID: 33659278 PMCID: PMC7917079 DOI: 10.3389/fcvm.2021.619558] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/25/2021] [Indexed: 11/17/2022] Open
Abstract
Severe tricuspid regurgitation is relatively common, especially in the elderly, and portends poor survival. Neither medical therapy nor conventional surgery is efficacious for most patients. In contrast, transcatheter tricuspid valve interventions are showing promise to improve quality of life and mortality. Although there is more clinical experience with transcatheter tricuspid valve repair, there are many patients for which repair is either not possible or cannot optimally reduce the severity of tricuspid regurgitation. Transcatheter tricuspid valve replacement is rapidly emerging and may ultimately become the preferred treatment option. In this review, we discuss transcatheter tricuspid valve replacement, analyze the devices in development and in clinical trials, and highlight the advantages and drawbacks of transcatheter tricuspid valve replacement vs. repair.
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Affiliation(s)
- Ythan H Goldberg
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States
| | - Edwin Ho
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States
| | - Mei Chau
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States
| | - Azeem Latib
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States
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50
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Aoi S, Wiley J, Ho E, Goldberg Y, Chau M, Latib A. Transcatheter tricuspid valve implantation with the Cardiovalve system. Future Cardiol 2021; 17:963-969. [PMID: 33512242 DOI: 10.2217/fca-2020-0181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Historically considered the 'forgotten valve', there has been increasing attention on the percutaneous transcatheter treatment of tricuspid regurgitation (TR). Prevalence of TR is high in the elderly population and prior studies have shown worse outcomes in patients with severe TR. Advances in transcatheter-based therapies have shed a new light in the treatment of TR and one such treatment option is tricuspid valve replacement with the Cardiovalve system. This device is approved as an early feasibility study in the US and also approved for clinical study in Germany, Italy and Switzerland. The Cardiovalve device is in the early stage of clinical studies and this article reviews the existing clinical data and future studies on percutaneous transcatheter treatment of severe TR.
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Affiliation(s)
- Shunsuke Aoi
- Department of Cardiology, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Jose Wiley
- Department of Cardiology, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Edwin Ho
- Department of Cardiology, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Ythan Goldberg
- Department of Cardiology, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Mei Chau
- Department of Cardiology, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, Bronx, NY 10467, USA
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