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Ramsay J, Tang Y, Kim JK, Frangieh AH. Transcatheter Treatment of Mitral Valve Regurgitation in the Setting of Concomitant Coronary or Multivalvular Heart Disease: A Focused Review. Interv Cardiol Clin 2024; 13:279-289. [PMID: 38432770 DOI: 10.1016/j.iccl.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Treatment for mixed valve disease has historically been limited, often surgery being the only option. With the recent advancement of transcatheter therapies, percutaneous approaches are quickly becoming viable therapeutic considerations in inoperable or high-risk patients, also offering the option for a staged or same-session treatment. Guidelines are primarily focused on single-valve disease. However, patients often present with multiple pathologies. This review summarizes the data and literature on transcatheter treatment of patients with mitral regurgitation who concomitantly have aortic stenosis or regurgitation, tricuspid regurgitation, or ischemic cardiomyopathy. Pathophysiology, hemodynamics, available therapies as well as order and timing of interventions are discussed.
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Affiliation(s)
- Jay Ramsay
- Department of Internal Medicine, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA
| | - Yicheng Tang
- Division of Cardiology, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA
| | - Jin Kyung Kim
- Division of Cardiology, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA
| | - Antonio H Frangieh
- Division of Cardiology, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA.
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2
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Gröger M, Hirsch K, Felbel D, Paukovitsch M, Schneider LM, Markovic S, Rottbauer W, Keßler M. Predictors of Improvement in Concomitant Tricuspid Regurgitation Following Transcatheter Edge-to-Edge Mitral Valve Repair. J Clin Med 2023; 12:6191. [PMID: 37834835 PMCID: PMC10573471 DOI: 10.3390/jcm12196191] [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: 09/06/2023] [Revised: 09/20/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Improvement in concomitant tricuspid regurgitation (TR) after mitral valve transcatheter edge-to-edge repair (M-TEER) for mitral regurgitation (MR) occurs frequently; however factors determining the post-procedural course of TR are not well understood. We investigated the parameters associated with TR improvement after M-TEER. METHODS AND RESULTS A total of 300 patients were consecutively included in this retrospective analysis. MR and TR severity as well as heart chamber metrics were assessed before the procedure and at follow-up. Device success was achieved in 97.3% of patients. TR decreased in 30.2% of patients. Patients with improved TR were more often female, had more severe TR at baseline, and their right heart dimensions at baseline trended to be smaller. Female sex (odds ratio (OR) 2.997), baseline MR-Grade (OR 3.181) and baseline TR-Grade (OR 2.653) independently predicted TR reduction. More pronounced right heart reverse remodeling was observed in patients with improved TR. TR regression independently predicted lower mortality (hazard ratio (HR) 0.333, 95% confidence interval 0.112-0.996, p = 0.049). CONCLUSIONS A reduction in concomitant TR severity after M-TEER occurred mainly in females and in patients with high-grade TR and MR at baseline. TR regression is associated with better survival after M-TEER.
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Affiliation(s)
| | | | | | | | | | | | | | - Mirjam Keßler
- Department of Internal Medicine II, Ulm University Heart Center, 89081 Ulm, Germany; (M.G.); (K.H.); (D.F.); (M.P.); (L.M.S.); (S.M.); (W.R.)
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3
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Gröger M, Zeiml KP, Schneider LM, Rottbauer W, Markovic S, Keßler M. Impact of concomitant tricuspid regurgitation on outcome after edge-to-edge mitral valve repair. Catheter Cardiovasc Interv 2023; 102:528-537. [PMID: 37506125 DOI: 10.1002/ccd.30787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/23/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
AIMS To evaluate the impact of tricuspid regurgitation (TR) on echocardiographic and functional outcome after mitral valve transcatheter edge-to-edge-repair (M-TEER). METHODS AND RESULTS A total of 740 patients underwent M-TEER at our center from 2010 to 2021. Patients were analyzed according to severity of concomitant TR at the time of M-TEER procedure: low-grade TR (grade ≤I [trace-mild], 279 patients [37.7%]), moderate TR (grade II, 170 patients [23.0%]) and high-grade TR (grade III-V [severe-torrential], 291 patients [39.3%]). Patients with moderate to high-grade TR had higher morbidity. Procedural success of M-TEER was achieved similarly in all groups (98.2% vs. 97.6% vs. 95.9%, p = 0.22). TR severity decreased rapidly and consistently after M-TEER to only 48.0% of high-grade TR patients after 3 months (p < 0.001) and to 46.8% after 12 months (p = 0.99). High-grade TR patients had significantly higher mortality (21.5% vs. 18.2% vs. 11.1%, p = 0.003) up to 12 months after M-TEER. However, high-grade TR did not independently predict mortality (HR 1.302, 95% CI 0.937-1.810; p = 0.116). Echocardiographic and functional outcome was similar in both secondary and primary MR patients. CONCLUSIONS High-grade concomitant TR did not independently predict adverse outcome following M-TEER. A wait-and-observe approach for these patients is reasonable.
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Affiliation(s)
- Matthias Gröger
- Department of Internal Medicine II, Ulm University Hospital, Ulm, Germany
| | - Katharina P Zeiml
- Department of Internal Medicine II, Ulm University Hospital, Ulm, Germany
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II, Ulm University Hospital, Ulm, Germany
| | - Sinisa Markovic
- Department of Internal Medicine II, Ulm University Hospital, Ulm, Germany
| | - Mirjam Keßler
- Department of Internal Medicine II, Ulm University Hospital, Ulm, Germany
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4
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Lebehn MA, Hahn RT. Valvular Heart Failure due to Tricuspid Regurgitation: Surgical and Transcatheter Management Options. Heart Fail Clin 2023; 19:329-343. [PMID: 37230648 DOI: 10.1016/j.hfc.2023.02.003] [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: 05/27/2023]
Abstract
Given the independent association of mortality with higher grades of tricuspid regurgitation severity, there is an increasing interest in improving the outcomes of this prevalent valvular heart disease. A new classification of tricuspid regurgitation etiology allows for an improved understanding of different pathophysiologic forms of the disease, which may determine the appropriate management strategy. Current surgical outcomes remain suboptimal and multiple transcatheter device therapies are currently under investigation to give high and prohibitive surgical risk patients treatment options beyond medical therapy.
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Affiliation(s)
- Mark A Lebehn
- Department of Medicine, Columbia University Medical Center/NY Presbyterian Hospital, New York, USA
| | - Rebecca T Hahn
- Department of Medicine, Columbia University Medical Center/NY Presbyterian Hospital, New York, USA.
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5
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Latib A, Mangieri A, Nettersheim FS, Baldus S. Transcatheter tricuspid valve repair/replacement should be offered to all patients with severe tricuspid regurgitation: pros and cons. EUROINTERVENTION 2023; 18:1395-1397. [PMID: 37092268 PMCID: PMC10111126 DOI: 10.4244/eij-e-22-00045] [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: 04/25/2023]
Affiliation(s)
- Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Cardio Center IRCCS, Humanitas Research Hospital, Rozzano, Italy
| | - Antonio Mangieri
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Cardio Center IRCCS, Humanitas Research Hospital, Rozzano, Italy
| | - Felix Sebastian Nettersheim
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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6
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Adamo M, Rubbio AP, Zaccone G, Pighi M, Massussi M, Tomasoni D, Pancaldi E, Testa L, Tusa MB, De Marco F, Giannini C, Grasso C, De Felice F, Denti P, Godino C, Mongiardo A, Crimi G, Villa E, Monteforte I, Citro R, Giordano A, Bartorelli AL, Petronio AS, Chizzola G, Tarantini G, Tamburino C, Bedogni F, Metra M. Prediction of mortality and heart failure hospitalisations in patients undergoing M-TEER: external validation of the COAPT risk score. EUROINTERVENTION 2023; 18:1408-1417. [PMID: 36809256 PMCID: PMC10111134 DOI: 10.4244/eij-d-22-00992] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/15/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND A risk score was recently derived from the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) Trial. However, external validation of this score is still lacking. AIMS We aimed to validate the COAPT risk score in a large multicentre population undergoing mitral transcatheter edge-to-edge repair (M-TEER) for secondary mitral regurgitation (SMR). METHODS The Italian Society of Interventional Cardiology (GIse) Registry of Transcatheter Treatment of Mitral Valve RegurgitaTiOn (GIOTTO) population was stratified according to COAPT score quartiles. The performance of the COAPT score for 2-year all-cause death or heart failure (HF) hospitalisation was evaluated in the overall population and in patients with or without a COAPT-like profile. RESULTS Among the 1,659 patients included in the GIOTTO registry, 934 had SMR and complete data for a COAPT risk score calculation. The incidence of 2-year all-cause death or HF hospitalisation progressively increased through the COAPT score quartiles in the overall population (26.4% vs 44.5% vs 49.4% vs 59.7%; log-rank p<0.001) and COAPT-like patients (24.7% vs 32.4% vs 52.3% vs. 53.4%; log-rank p=0.004), but not in those with a non-COAPT-like profile. The COAPT risk score had poor discrimination and good calibration in the overall population, moderate discrimination and good calibration in COAPT-like patients and very poor discrimination and poor calibration in non-COAPT-like patients. CONCLUSIONS The COAPT risk score has a poor performance in the prognostic stratification of real-world patients undergoing M-TEER. However, after application to patients with a COAPT-like profile, moderate discrimination and good calibration were observed.
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Affiliation(s)
- Marianna Adamo
- Cardiology and Cardiac catheterization laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Antonio Popolo Rubbio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gregorio Zaccone
- Cardiology and Cardiac catheterization laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Mauro Massussi
- Cardiology and Cardiac catheterization laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Cardiology and Cardiac catheterization laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Edoardo Pancaldi
- Cardiology and Cardiac catheterization laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Maurizio B Tusa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Carmelo Grasso
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | - Francesco De Felice
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Cosmo Godino
- Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy
| | | | - Gabriele Crimi
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa, Genova, Italy
| | - Emmanuel Villa
- Cardiac Surgery Unit and Transcatheter Valve Therapy Group, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Ida Monteforte
- AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Rodolfo Citro
- University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Arturo Giordano
- Invasive Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | | | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giuliano Chizzola
- Cardiology and Cardiac catheterization laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology Unit, University of Padua, Padua, Italy
| | - Corrado Tamburino
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marco Metra
- Cardiology and Cardiac catheterization laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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7
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Sisinni A, Taramasso M, Praz F, Metra M, Agricola E, Margonato A, Fam N, Estevez-Loureiro R, Latib A, Messika-Zeitoun D, Conradi L, von Bardeleben RS, Sorajja P, Hahn RT, Caravita S, Maisano F, Adamo M, Godino C. Concomitant Transcatheter Edge-to-Edge Treatment of Secondary Tricuspid and Mitral Regurgitation: An Expert Opinion. JACC Cardiovasc Interv 2023; 16:127-139. [PMID: 36697147 DOI: 10.1016/j.jcin.2022.11.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/03/2022] [Accepted: 11/01/2022] [Indexed: 01/25/2023]
Abstract
Secondary (functional) tricuspid regurgitation (sTR) is common in patients with mitral regurgitation (MR). Because combined valvular heart disease affects long-term survival, in comparison with isolated MR or tricuspid regurgitation, it is essential to offer patients adequate treatment. Despite considerable experience, no conclusive data are yet available on the prognostic impact of concomitant tricuspid valve surgery at the time of mitral valve surgery. Emerging transcatheter treatments offer the opportunity to treat both conditions (MR and sTR) simultaneously or in a stepwise fashion. This review provides a clinical overview on available data regarding the rationale for treatment of sTR in patients with relevant MR undergoing mitral transcatheter edge-to-edge repair, focusing on clinical and anatomical selection criteria.
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Affiliation(s)
- Antonio Sisinni
- Cardiology Unit, IRCCS Policlinico San Donato, Milan, Italy; Università degli studi di Milano, Milan, Italy. https://twitter.com/antosis_93
| | | | - Fabien Praz
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Marco Metra
- Cardiology Unit, Cardiothoracic Department, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic- Vascular Department, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | - Alberto Margonato
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rodrigo Estevez-Loureiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David Messika-Zeitoun
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Paul Sorajja
- Department of Cardiology, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Rebecca T Hahn
- NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA
| | - Sergio Caravita
- Dyspnea and Pulmonary Hypertension Center, Department of Cardiology, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Milan, Italy; Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy
| | - Francesco Maisano
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology Unit, Cardiothoracic Department, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Cosmo Godino
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy.
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8
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Sugiura A, Kavsur R, Spieker M, Iliadis C, Mauri V, Tanaka T, Goto T, Weber M, Kelm M, Baldus S, Nickenig G, Westenfeld R, Pfister R, Becher MU. Impact of right ventricular-pulmonary arterial coupling on clinical outcomes of tricuspid regurgitation. EUROINTERVENTION 2022; 18:852-861. [PMID: 35550286 PMCID: PMC9724878 DOI: 10.4244/eij-d-22-00045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND In terms of pathophysiology, tricuspid regurgitation (TR) and right ventricular (RV) function are linked to each other. AIMS This study sought to evaluate RV-pulmonary artery (PA) coupling and its impact on clinical outcomes of TR in patients undergoing mitral transcatheter edge-to-edge repair (TEER). METHODS We calculated RV-PA coupling ratios in patients undergoing mitral TEER from August 2010 to March 2019 by dividing the tricuspid annular plane systolic excursion (TAPSE) by the echocardiographic estimated PA systolic pressure (PASP). TR was graded as none/trace, mild, moderate, or severe. The primary outcome was all-cause mortality or rehospitalisation within 12 months. RESULTS Among 744 patients analysed, severe TR was documented in 22.3% of patients and the mean TAPSE/PASP was 0.43±0.25. Technical success of TEER was achieved in 97.2% of participants. Severe TR vs TR ≤moderate (adjusted HR 1.92, 95% CI: 1.39-2.66) and TAPSE/PASP (adjusted HR 0.45, 95% CI: 0.22-0.93) were associated with the outcome. Patients were divided according to the TAPSE/PASP tertile. Compared to patients with TR ≤moderate, patients with severe TR had a higher event rate (TAPSE/PASP <0.30: 32.9% vs 45.1%; 0.30≤ TAPSE/PASP <0.44: 27.8% vs 41.8%; TAPSE/PASP ≥0.44: 16.0% vs 40.4%), whereas the prognostic significance of TR was attenuated in patients with reduced TAPSE/PASP (i.e., RV-PA uncoupling; interaction term p=0.03). The trends were consistent in the multivariable regression models, spline curves, and sensitivity analysis using post-interventional parameters. CONCLUSIONS RV-PA coupling affects the outcome correlation of TR in patients undergoing mitral TEER. The prognostic impact of TR is attenuated in patients with RV-PA uncoupling.
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Affiliation(s)
- Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Refik Kavsur
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Maximilian Spieker
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christos Iliadis
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Victor Mauri
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Tetsu Tanaka
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Malte Kelm
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephan Baldus
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Ralf Westenfeld
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Roman Pfister
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
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9
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Adamo M, Pagnesi M, Ghizzoni G, Estévez-Loureiro R, Raposeiras-Roubin S, Tomasoni D, Stolfo D, Sinagra G, Popolo Rubbio A, Bedogni F, De Marco F, Giannini C, Petronio AS, Stazzoni L, Benito-González T, Fernández-Vázquez F, Garrote-Coloma C, Godino C, Agricola E, Munafò A, Pascual I, Avanzas P, Léon V, Montefusco A, Boretto P, Pidello S, Moñivas-Palomero V, Del Trigo M, Biagini E, Berardini A, Saia F, Nombela-Franco L, Tirado-Conte G, De Augustin A, Caneiro-Queija B, De Luca A, Branca L, Zaccone G, Lupi L, Lipsic E, Voors A, Metra M. Evolution of tricuspid regurgitation after transcatheter edge-to-edge mitral valve repair for secondary mitral regurgitation and its impact on mortality. Eur J Heart Fail 2022; 24:2175-2184. [PMID: 36482160 PMCID: PMC10086984 DOI: 10.1002/ejhf.2637] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/11/2022] [Accepted: 07/25/2022] [Indexed: 01/18/2023] Open
Abstract
AIM To evaluate short-term changes in tricuspid regurgitation (TR) after transcatheter edge-to-edge mitral valve repair (M-TEER) in secondary mitral regurgitation (SMR), their predictors and impact on mortality. METHODS AND RESULTS This is a retrospective analysis of SMR patients undergoing successful M-TEER (post-procedural mitral regurgitation ≤2+) at 13 European centres. Among 503 patients evaluated 79 (interquartile range [IQR] 40-152) days after M-TEER, 173 (35%) showed ≥1 degree of TR improvement, 97 (19%) had worsening of TR, and 233 (46%) remained unchanged. Smaller baseline left atrial diameter and residual mitral regurgitation 0/1+ were independent predictors of TR ≤2+ after M-TEER. There was a significant association between TR changes and New York Heart Association class and pulmonary artery systolic pressure decrease at echocardiographic re-assessment. At a median follow-up of 590 (IQR 209-1103) days from short-term echocardiographic re-assessment, all-cause mortality was lower in patients with improved compared to those with unchanged/worsened TR (29.6% vs. 42.3% at 3 years; log-rank p = 0.034). Baseline TR severity was not associated with mortality, whereas TR 0/1+ and 2+ at short-term follow-up was associated with lower all-cause mortality compared to TR 3/4+ (30.6% and 35.6% vs. 55.6% at 3 years; p < 0.001). A TR ≤2+ after M-TEER was independently associated with a 42% decreased risk of mortality (p = 0.011). CONCLUSION More than one third of patients with SMR undergoing successful M-TEER experienced an improvement in TR. Pre-procedural TR was not associated with outcome, but a TR ≤2+ at short-term follow-up was independently associated with long-term mortality. Optimal M-TEER result and a small left atrium were associated with a higher likelihood of TR ≤2+ after M-TEER.
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Affiliation(s)
- Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Matteo Pagnesi
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Giulia Ghizzoni
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | | | - Daniela Tomasoni
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Stolfo
- Department of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Univeristy Hospital of Trieste, Trieste, Italy.,Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gianfranco Sinagra
- Department of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Univeristy Hospital of Trieste, Trieste, Italy
| | | | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Laura Stazzoni
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | | | | | - Cosmo Godino
- Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy
| | - Eustachio Agricola
- Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy
| | - Andrea Munafò
- Division of Cardiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Victor Léon
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Antonio Montefusco
- Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Torino, Italy
| | - Paolo Boretto
- Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Torino, Italy
| | - Stefano Pidello
- Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Torino, Italy
| | | | - Maria Del Trigo
- Cardiology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Elena Biagini
- Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandra Berardini
- Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Saia
- Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | - Alberto De Augustin
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | - Antonio De Luca
- Department of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Univeristy Hospital of Trieste, Trieste, Italy
| | - Luca Branca
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Gregorio Zaccone
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Laura Lupi
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Erik Lipsic
- University Medical Center Groningen, Groningen, The Netherlands
| | - Adriaan Voors
- University Medical Center Groningen, Groningen, The Netherlands
| | - Marco Metra
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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10
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Stolz L, Doldi PM, Weckbach LT, Stocker TJ, Braun D, Orban M, Wild MG, Hagl C, Massberg S, Näbauer M, Hausleiter J, Orban M. Right ventricular function in transcatheter mitral and tricuspid valve edge-to-edge repair. Front Cardiovasc Med 2022; 9:993618. [PMID: 36312295 PMCID: PMC9596758 DOI: 10.3389/fcvm.2022.993618] [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: 07/13/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
Since transcatheter edge-to-edge repair (TEER) has become a valuable therapy in the treatment of both, mitral (MR) and tricuspid regurgitation (TR), the question of optimized patient selection has gained growing importance. After years of attributing rather little attention to the right ventricle (RV) and its function in the setting of valvular heart failure, this neglect has recently changed. The present review sought to summarize anatomy and function of the RV in a clinical context and aimed at presenting the current knowledge on how the RV influences outcomes after TEER for atrioventricular regurgitation. The anatomy of the RV is determined by its unique shape, which necessitates to use three-dimensional imaging methods for detailed and comprehensive characterization. Complex parameters such as RV to pulmonary artery coupling (RVPAc) have been developed to combine information of RV function and afterload which is primary determined by the pulmonary vasculature and LV filling pressure. Beyond that, TR, which is closely related to RV function also plays an important role in the setting of TEER. While mitral valve transcatheter edge-to-edge repair (M-TEER) leads to reduction of concomitant TR in some patients, the prognostic value of TR in the setting of M-TEER remains unclear. Overall, this review summarizes the current state of knowledge of the outstanding role of RV function and associated TR in the setting of TEER and outlines the unsolved questions associated with right-sided heart failure.
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Affiliation(s)
- Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,*Correspondence: Lukas Stolz,
| | - Philipp M. Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ludwig T. Weckbach
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Thomas J. Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mirjam G. Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Christian Hagl
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany,Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mathias Orban
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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11
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Blitzer D, Bouhout I, Al Haddad E, Lewis M, Farooqi K, Shah A, Zemer-Wassercug N, Singh H, Anderson B, Bacha E, Kalfa D. Outcomes and risk analysis after tricuspid valve surgery for non-Ebstein 2-ventricle congenital tricuspid valve diseases. JTCVS OPEN 2022; 11:351-362. [PMID: 36172453 PMCID: PMC9510886 DOI: 10.1016/j.xjon.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 04/25/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- David Blitzer
- Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Ismail Bouhout
- Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Eliana Al Haddad
- Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Matthew Lewis
- Department of Pediatric Cardiology, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Kanwal Farooqi
- Department of Pediatric Cardiology, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Amee Shah
- Department of Pediatric Cardiology, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Noa Zemer-Wassercug
- Department of Pediatric Cardiology, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Harsimran Singh
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Brett Anderson
- Department of Pediatric Cardiology, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Emile Bacha
- Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - David Kalfa
- Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
- Address for reprints: David Kalfa, MD, PhD, Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, CHN-274, New York, NY 10032.
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12
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Zaid S, Denti P, Tang GHL, Nazif TN, Bapat VN, Kaneko T, Modine T. Impact of Tricuspid Regurgitation on Outcomes of Mitral Valve Surgery after Transcatheter Edge-to-Edge Repair. Semin Thorac Cardiovasc Surg 2022; 36:11-25. [PMID: 35931346 DOI: 10.1053/j.semtcvs.2022.06.021] [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: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 11/11/2022]
Abstract
Tricuspid regurgitation (TR) severity after mitral transcatheter edge-to-edge repair (TEER) has been shown to impact outcomes but unknown in patients requiring mitral valve (MV) surgery after TEER. We sought to determine the impact of preoperative TR severity and right ventricular (RV) dysfunction on MV surgery after TEER. From 7/2009 to 7/2020, 260/332 patients in the CUTTING-EDGE registry who underwent MV surgery after TEER had paired echocardiographic evaluation on TR severity, and ≥moderate (2+) vs <2+ TR at the time of index TEER were compared. Median follow-up post-MV surgery was 9.1 months, 96.5% complete at 30 days and 81.9% complete at 1 year. Mean age was 73.8 ± 10.3; with primary/mixed and secondary MR present in 65.6% and 32.0%, respectively. Proportion of ≥2+ TR increased from TEER to MV surgery (40% vs 57%, P < 0.001). Compared to <2+ TR group, ≥2+ pre-TEER TR patients were older, had higher STS risk score at TEER, higher RVSP, more RV dysfunction, more MR post-TEER, and a shorter median interval from TEER to MV surgery (1.9 vs 4.9 months, P = 0.023). Mortality was higher in the ≥2+ pre-TEER TR group at 30 days(24.2% vs 13.8%, P = 0.043) and 1 year (45.3% vs 22.3%, P = 0.003). On Kaplan-Meier analysis, cumulative mortality was 23.8% at 1 year and 31.6% at 3 years after MV surgery overall, and was associated with preoperative RV dysfunction (P = 0.023), ≥2+ TR at pre-TEER (P = 0.001) and presurgery (P = 0.004), but not concomitant tricuspid surgery. Moderate or greater pre-TEER TR was associated with worse outcomes, and pre-TEER TR worsened significantly at MV surgery. Concomitant tricuspid surgery did not increase overall mortality.
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Affiliation(s)
- Syed Zaid
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | | | - Tamim N Nazif
- Columbia University Irving Medical Center, New York, New York. https://twitter.com/https://twitter.com/tnazifMD
| | - Vinayak N Bapat
- Abbott Northwestern Hospital, Minneapolis, Minnesota. https://twitter.com/https://twitter.com/bapat_savrtavr
| | - Tsuyoshi Kaneko
- Brigham & Women's Hospital, Boston, Massachusetts. https://twitter.com/https://twitter.com/TsuyoshiKaneko1
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13
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Bhardwaj B, Cigarroa JE, Zahr F. Tricuspid Valve Percutaneous Therapies. Curr Cardiol Rep 2022; 24:1209-1226. [PMID: 35767178 DOI: 10.1007/s11886-022-01739-9] [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] [Accepted: 06/13/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW In this review, we have focused on the currently available transcatheter tricuspid valve therapies, device selection, as well as role and management of tricuspid regurgitation (TR) in the setting of other transcatheter valvular procedures. RECENT FINDINGS In this review, we have enlisted the recently finished as well as ongoing trials in the percutaneous tricuspid valve therapies. TR is highly prevalent yet remains underrecognized and is often untreated. TR has traditionally been managed conservatively with medical therapies including diuretics for volume management, whereas surgical therapies are reserved for those undergoing left-sided valvular surgery. Although the transcatheter devices for tricuspid repair and replacement are in clinical trials, the experience to date for their effectiveness and safety has been reassuring.
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Affiliation(s)
- Bhaskar Bhardwaj
- Division of Cardiology, Knight Cardiovascular Institute, OHSU, Portland, OR, United States
| | - Joaquin E Cigarroa
- Division of Cardiology, Knight Cardiovascular Institute, OHSU, Portland, OR, United States
| | - Firas Zahr
- Division of Cardiology, Knight Cardiovascular Institute, OHSU, Portland, OR, United States.
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14
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Gill H, Adams HSL, Chehab O, Allen C, Hancock J, Lamata P, Lucchese G, Prendergast B, Redwood S, Patterson T, Rajani R. Anatomy of a Transcatheter Mitral Valve Service. Front Cardiovasc Med 2022; 9:862471. [PMID: 35497993 PMCID: PMC9051038 DOI: 10.3389/fcvm.2022.862471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Transcatheter mitral therapies offer treatment options to selected patients who are unable to undergo open procedures due to prohibitive surgical risk. Data detailing the design and structure of transcatheter mitral services to ensure appropriate patient selection and tailored management strategies is lacking. We report our initial experience of developing and running a purpose-built transcatheter mitral service. The nature and number of referral sources, the multi-disciplinary make-up of the dedicated Mitral Heart Team and the use of integrative imaging assessment with incorporation of computational solutions are discussed. In addition, a summary of the clinical decision-making process is presented. This report sets out a framework from which future clinics can evolve to improve and streamline the delivery of transcatheter mitral therapies.
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Affiliation(s)
- Harminder Gill
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences Engineering, King's College London, London, United Kingdom
| | - Heath S. L. Adams
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Omar Chehab
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Christopher Allen
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Jane Hancock
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Pablo Lamata
- School of Biomedical Engineering and Imaging Sciences Engineering, King's College London, London, United Kingdom
| | - Gianluca Lucchese
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Bernard Prendergast
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Simon Redwood
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Tiffany Patterson
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Ronak Rajani
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences Engineering, King's College London, London, United Kingdom
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15
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Chitturi KR, Bhardwaj B, Murtaza G, Karuparthi PR, Faza NN, Goel SS, Reardon MJ, Kleiman NS, Aggarwal K. Clinical impact of tricuspid regurgitation on transcatheter edge-to-edge mitral valve repair for mitral regurgitation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 41:1-9. [DOI: 10.1016/j.carrev.2022.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/31/2021] [Accepted: 01/27/2022] [Indexed: 11/17/2022]
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16
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Praz F, Muraru D, Kreidel F, Lurz P, Hahn RT, Delgado V, Senni M, von Bardeleben R, Nickenig G, Hausleiter J, Mangieri A, Zamorano J, Prendergast BD, Maisano F. Transcatheter treatment for tricuspid valve disease. EUROINTERVENTION 2021; 17:791-808. [PMID: 34796878 PMCID: PMC9724890 DOI: 10.4244/eij-d-21-00695] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Approximately 4% of subjects aged 75 years or more have clinically relevant tricuspid regurgitation (TR). Primary TR results from anatomical abnormality of the tricuspid valve apparatus and is observed in only 8-10% of the patients with tricuspid valve disease. Secondary TR is more common and arises as a result of annular dilation caused by right ventricular enlargement and dysfunction as a consequence of pulmonary hypertension, often caused by left-sided heart disease or atrial fibrillation. Irrespective of its aetiology, TR leads to volume overload and increased wall stress, both of which negatively contribute to detrimental remodelling and worsening TR. This vicious circle translates into impaired survival and increased heart failure symptoms in patients with and without reduced left ventricular ejection fraction. Interventions to correct TR are underutilised in daily clinical practice owing to increased surgical risk and late patient presentation. The recently introduced transcatheter tricuspid valve interventions aim to address this unmet need. Dedicated expertise and an interdisciplinary Heart Team evaluation are essential to integrate these new techniques successfully and select patients. The present article proposes a standardised approach to evaluate patients with TR who may be candidates for transcatheter interventions. In addition, a state-of-the-art review of the available transcatheter therapies, the main criteria for patient and device selection, and information concerning the remaining uncertainties are provided.
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Affiliation(s)
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, and Istituto Auxologico Italiano, IRCCS, Department of Cardiological, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | | | | | | | | | | | | | - Georg Nickenig
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Jörg Hausleiter
- Department of Cardiology, University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
| | - Antonio Mangieri
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Jose Zamorano
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Bernard D. Prendergast
- Department of Cardiology, St Thomas' Hospital and Cleveland Clinic, London, United Kingdom
| | - Francesco Maisano
- Department of Cardiothoracic Surgery, IRCCS Ospedale San Raffaele, Milan, Italy
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17
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Burke L, Hassanin M, Ong G, Fam N. A Practical Approach to Combined Transcatheter Mitral and Tricuspid Valve Intervention. Front Cardiovasc Med 2021; 8:706123. [PMID: 34722653 PMCID: PMC8548370 DOI: 10.3389/fcvm.2021.706123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/12/2021] [Indexed: 12/27/2022] Open
Abstract
Concomitant tricuspid regurgitation (TR) is common in patients with mitral regurgitation (MR). While current guidelines recommend repair of both valves at the time of surgery when feasible, high risk patients are often undertreated, leading to significant morbidity and mortality. With advances in transcatheter edge-to-edge repair (TEER) devices and technique, combined TEER for treating significant MR and TR has emerged as a new tool for heart failure management. Recent evidence has shed light on which patients with severe TR should be targeted for transcatheter intervention either in isolation or in combination with a MV TEER procedure and allows for expanded treatment options in patients who otherwise would be limited to medical management. Technological advancements remain ahead of robust clinical data, and thus randomized clinical studies in patients with severe MR and TR will be instrumental in determining the best approach in treating these patients with transcatheter therapies.
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Affiliation(s)
| | | | | | - Neil Fam
- St. Michael's Hospital, Toronto, ON, Canada
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18
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Tanaka T, Kavsur R, Spieker M, Iliadis C, Metze C, Horn P, Sugiura A, Kelm M, Baldus S, Nickenig G, Westenfeld R, Pfister R, Becher MU. Periprocedural changes in natriuretic peptide levels and clinical outcome after transcatheter mitral valve repair. ESC Heart Fail 2021; 8:5237-5247. [PMID: 34519444 PMCID: PMC8712850 DOI: 10.1002/ehf2.13603] [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: 06/23/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 11/06/2022] Open
Abstract
Aims This multicentre study investigated the association of periprocedural changes in the levels of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) with clinical outcomes after transcatheter edge‐to‐edge mitral valve repair (TMVR). Methods and results Patients were retrospectively analysed who underwent TMVR with the MitraClip system (Abbott Vascular, Santa Clara, CA, USA) and had available sequential NT‐proBNP testing at baseline and 2 months after TMVR. Periprocedural changes in NT‐proBNP following TMVR were assessed as the percent change in NT‐proBNP between baseline and the 2 month follow‐up, and the significant reduction in NT‐proBNP was defined as a decrease of >30% in the follow‐up NT‐proBNP compared with the pre‐procedural NT‐proBNP level. Primary outcome was defined as a composite outcome consisting of all‐cause mortality and hospitalization due to heart failure from 2 months to 2 years after TMVR. Additionally, we identified the cut‐off value of pre‐procedural NT‐proBNP to predict the composite outcome using a receiver operating characteristic analysis (cut‐off: 2485 pg/mL). Of 485 patients undergoing TMVR (age: 76.2 ± 9.2 years, female: 42.1%, secondary mitral regurgitation: 67.2%), 150 patients (30.9%) had the significant reduction in NT‐proBNP (>30%) following the procedure. Patients with the NT‐proBNP reduction had a lower incidence of the composite outcome, compared with those without the reduction in NT‐proBNP (31.4% vs. 40.2%; log‐rank P = 0.03). The significant reduction in NT‐proBNP was also associated with a lower risk of the composite outcome [adjusted hazard ratio (HR): 0.67; 95% confidence interval (CI): 0.45–0.97; P = 0.04], independently of pre‐procedural NT‐proBNP levels and other clinical parameters. The percent change in NT‐proBNP was associated with a linear trend of the incidence of the composite outcome (adjusted HR per 10% decrease: 0.96; 95% CI: 0.94–0.98; P < 0.001). A stratified analysis revealed that the prognostic impact of the significant reduction in NT‐proBNP was consistent among clinical subgroups, including aetiology of mitral regurgitation (P for interaction = 0.99). Higher pre‐procedural NT‐proBNP level (>2485 pg/mL) was associated with the increased risk of the composite outcome (adjusted HR: 1.50; 95% CI: 1.03–2.17; P = 0.03); however, patients with a higher pre‐procedural NT‐proBNP who achieved the significant reduction in NT‐proBNP had a similar risk of the composite outcome to those with a lower pre‐procedural NT‐proBNP. Conclusions Changes in sequential NT‐proBNP measurements were associated with clinical outcomes within 2 years after TMVR. The assessment of NT‐proBNP dynamics may be valuable to assess the residual risk for patients undergoing TMVR and could assist with post‐procedural management after TMVR.
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Affiliation(s)
- Tetsu Tanaka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127, Germany
| | - Refik Kavsur
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127, Germany
| | - Maximilian Spieker
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christos Iliadis
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Clemens Metze
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Patrick Horn
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127, Germany
| | - Malte Kelm
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephan Baldus
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127, Germany
| | - Ralf Westenfeld
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Roman Pfister
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127, Germany
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