1
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Lurz P, Rommel KP, Schmitz T, Bekeredjian R, Nickenig G, Möllmann H, von Bardeleben RS, Schmeisser A, Atmowihardjo I, Estevez-Loureiro R, Lubos E, Heitkemper M, Peterman K, Lapp H, Donal E. Real-world 1-Year Results of Tricuspid Edge-to-Edge Repair from the bRIGHT Study. J Am Coll Cardiol 2024:S0735-1097(24)07207-3. [PMID: 38759905 DOI: 10.1016/j.jacc.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/29/2024] [Accepted: 05/08/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Severe tricuspid regurgitation (TR) is known to be associated with poor quality of life and increased risk of death when left untreated. OBJECTIVES To report the 1-year clinical outcomes of subjects treated by tricuspid transcatheter edge-to-edge repair (TEER) with the TriClip system in a contemporary, real-world setting. METHODS The bRIGHT post-approval study is a prospective, single-arm, open-label, multicenter, post-market registry conducted at 26 sites in Europe with central event adjudication and echocardiographic core-lab assessment. RESULTS Enrolled subjects were elderly (79±7 years) with significant comorbidities. Eighty-eight percent had baseline massive or torrential TR and 80% percent of subjects were in NYHA class III/ IV. TR was reduced to moderate or less in 81% at 1 year. Significant improvements in NYHA class (21% to 75% I/II, P<0.0001) and KCCQ score (19±26-point improvement, P<0.0001) were observed at 1 year. One-year mortality was significantly lower in subjects who achieved moderate or lower TR at 30 days; however, there was no difference in mortality among subjects that achieved moderate, mild, or trace TR at 30 days. In addition to TR reduction at 30 days, baseline serum creatinine and baseline RV TAPSE were independently associated with mortality at 1 year (OR: 2.169, 95% CI: [1.494, 3.147], P<0.0001; OR: 0.636, 95% CI: [0.415, 0.974], P=0.0375). Mortality was not associated with baseline TR grade, nor with center volume. CONCLUSIONS Tricuspid TEER using the TriClip system was safe and effective through 1 year for subjects with significant TR and advanced disease in a diverse, real-world population.
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Affiliation(s)
- Philipp Lurz
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany;.
| | | | | | | | | | | | | | | | | | | | - Edith Lubos
- Katholisches Marienkrankenhaus GmbH, Hamburg, Germany
| | | | | | - Harald Lapp
- Zentralklinik Bad Berka GmbH, Bad Berka, Germany
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2
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Faerber G, Berretta P, Nguyen TC, Wilbring M, Lamelas J, Stefano P, Kempfert J, Rinaldi M, Pacini D, Pitsis A, Gerdisch M, Dinh NH, Van Praet F, Salvador L, Yan T, Bonaros N, Fiore A, Doenst T, Di Eusanio M. Pacemaker implantation after concomitant tricuspid valve repair in patients undergoing minimally invasive mitral valve surgery: Results from the Mini-Mitral International Registry. JTCVS Open 2024; 17:64-71. [PMID: 38420545 PMCID: PMC10897665 DOI: 10.1016/j.xjon.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/22/2023] [Accepted: 09/11/2023] [Indexed: 03/02/2024]
Abstract
Objective Randomized evidence suggests a high risk of pacemaker implantation for patients undergoing mitral valve (MV) surgery with concomitant tricuspid valve repair (cTVR). We investigated the impact of cTVR on outcomes in the Mini-Mitral International Registry. Methods From 2015 to 2021, 7513 patients underwent minimally invasive MV with or without cTVR in 17 international centers (MV: n = 5609, cTVR: n = 1113). Propensity matching generated 1110 well-balanced pairs. Multivariable analysis was applied. Results Patients with cTVR were older and had more comorbidities. Propensity matching eliminated most differences except for more TR in patients who underwent cTVR (77.2% vs 22.1% MV, P < .001). Mean matched age was 71 years, and 45% were male. European System for Cardiac Operative Risk Evaluation II was still 2.68% (interquartile range [IQR], 0.80-2.63) vs 1.9% (IQR, 1.12-3.9) in matched MV (P < .001). MV replacement (30%) and atrial fibrillation surgery (32%) were similar in both groups. Cardiopulmonary bypass (161 minutes [IQR, 133-203] vs MV: 130 minutes [IQR, 103-166]; P < .001) and crossclamp times (93 minutes [IQR, 66-123] vs MV: 83 minutes [IQR, 64-107]; P < .001) were longer with cTVR. Although in-hospital mortality was similar (cTVR: 3.3% vs MV: 2.2%; P = .5), postoperative pacemaker implantations (9% vs MV: 5.8%; P = .02), low cardiac output syndrome (7.7% vs MV: 4.4%; P = .02), and acute kidney injury (13.8% vs MV: 10%; P = .01) were more frequent with cTVR. cTVR eliminated relevant TR in most patients (greater-than-moderate TR: 6.8%). Multivariable analysis identified MV replacement, atrial fibrillation, and cTVR as risk factors of postoperative pacemaker implantation. Conclusions cTVR in minimally invasive MV surgery is an independent risk factor for pacemaker implantation in this international registry. It is also associated with more bleeding, low output syndrome, and acute kidney injury. It remains unclear whether technical or patient factors (or both) explain these differences.
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Affiliation(s)
- Gloria Faerber
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Tom C. Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, Tex
| | - Manuel Wilbring
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Joseph Lamelas
- Division of Cardiothoracic Surgery, University of Miami, Miami, Fla
| | | | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Mauro Rinaldi
- Cardiac Surgery Unit, University of Turin, Turin, Italy
| | - Davide Pacini
- Cardiac Surgery Department, Sant’Orsola Malpighi Hospital, University of Bologna, Italy
| | - Antonios Pitsis
- Cardiac Surgery Department, European Interbalkan Medical Center, Thessaloniki, Greece
| | | | | | - Frank Van Praet
- Cardiac Surgery Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Loris Salvador
- Division of Cardiac Surgery, S. Bortolo Hospital, Vicenza, Italy
| | - Tristan Yan
- Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Antonio Fiore
- Henri Mondor Hospital, University of Paris, Paris, France
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
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3
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Actis Dato GM, Calia C, Lodo V, Fadde M, Cappuccio G, Italiano E, Addonizio M, Stefan AB, Centofanti P. A rare case of papillary fibroelastoma involving the tricuspid valve. A single center experience over a period of 22 years (1999-2021). Acta Chir Belg 2023; 123:563-565. [PMID: 35395925 DOI: 10.1080/00015458.2022.2064625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/31/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIM Papillary fibroelastoma (PFE) represents only 16% of the benign cardiac tumor and approximately 15% of these are located on the tricuspid valve. MATERIALS AND METHODS Over a period of 22 years (1999-2021) we observed 75 pts with cardiac tumors at our Center over 9650 pts operated on but only one case of a tricuspid valve PFE in a 69-year-old patient. Trans-thoracic echocardiography demonstrated a mobile mass (20 × 10 mm), adhering to the atrial side of the septal leaflet of the tricuspid valve of unknown origin. In consideration of the mobility of the mass and the consequent high embolic risk, surgical removal was made. The patient underwent surgery through a median sternotomy on CPBP. A 'gelatinous' mass adhering to the tricuspid leaflet was found and completely removed. The postoperative course was uneventful. The pathological diagnosis was PFE. CONCLUSIONS PFEs of the tricuspid valve are rare entities being in most cases found incidentally. In our experience, the incidence of this tumor in this location is 1/10,000 cases of cardiac surgery. Although most patients are asymptomatic, surgical treatment is nevertheless recommended in consideration of the high embolic risk.
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Affiliation(s)
- Guglielmo Mario Actis Dato
- Department of Cardiac Surgery and Cardiovascular Anaestesia, Ospedale Mauriziano "Umberto I", Torino, Italy
| | - Claudia Calia
- Department of Cardiac Surgery and Cardiovascular Anaestesia, Ospedale Mauriziano "Umberto I", Torino, Italy
| | - Vittoria Lodo
- Department of Cardiac Surgery and Cardiovascular Anaestesia, Ospedale Mauriziano "Umberto I", Torino, Italy
| | - Marco Fadde
- Department of Cardiac Surgery and Cardiovascular Anaestesia, Ospedale Mauriziano "Umberto I", Torino, Italy
| | - Gianfranco Cappuccio
- Department of Cardiac Surgery and Cardiovascular Anaestesia, Ospedale Mauriziano "Umberto I", Torino, Italy
| | - Enrico Italiano
- Department of Cardiac Surgery and Cardiovascular Anaestesia, Ospedale Mauriziano "Umberto I", Torino, Italy
| | - Mariangela Addonizio
- Department of Cardiac Surgery and Cardiovascular Anaestesia, Ospedale Mauriziano "Umberto I", Torino, Italy
| | - Andreea Beatrice Stefan
- Department of Cardiac Surgery and Cardiovascular Anaestesia, Ospedale Mauriziano "Umberto I", Torino, Italy
| | - Paolo Centofanti
- Department of Cardiac Surgery and Cardiovascular Anaestesia, Ospedale Mauriziano "Umberto I", Torino, Italy
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Schumer EM, Kotkar KD, Masood MF, Kaneko T, Damiano RJ, Pawale A. Management of severe tricuspid valve regurgitation due to ruptured papillary muscle in a patient with mediastinitis early after heart transplant. JTCVS Tech 2023; 21:106-108. [PMID: 37854829 PMCID: PMC10580097 DOI: 10.1016/j.xjtc.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/08/2023] [Accepted: 07/11/2023] [Indexed: 10/20/2023] Open
Abstract
Objective Even though severe tricuspid regurgitation is not uncommon after cardiac transplantation, primary severe tricuspid regurgitation is rare. We present such a case with additional complexities. Methods The patient was 44-year-old man with a HeartWare durable left ventricular assist device (Heartware Inc) who received a temporary right ventricular assist device (RVAD) with a ProtekDuo cannula (LivaNova Inc USA) for refractory ventricular fibrillation and underwent a heart transplant as United Network for Organ Sharing Status 1, in the presence of partially compensated cardiogenic shock, renal failure. Given complex re-operative surgery in a volume-overloaded patient with unknown pulmonary vascular resistance, an RVAD cannula was preserved and re- inserted during cardiac transplant. Postoperatively he required hemodialysis, had severe primary tricuspid regurgitation discovered after RVAD removal and developed Enterobacter mediastinitis. He underwent complex tricuspid valve repair for flail tricuspid leaflet due to ruptured papillary muscle likely due to RVAD cannula injury, after multiple mediastinal washouts and was followed by delayed chest reconstruction. Results The patient is doing well, 6 months after discharge to home, asymptomatic, without re-admissions, on renal recovery path, with no tricuspid regurgitation and good biventricular function. Conclusions Replacing the tricuspid valve in presence of hemodialysis catheter, immunosuppression and mediastinitis could be high risk for endocarditis. Even though we have short-term follow-up, tricuspid valve repair can be an effective way of managing primary severe regurgitation especially when there is a desire or need to avoid valve replacement.
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Affiliation(s)
- Erin M. Schumer
- Division of Cardiothoracic Surgery, Washington University, St Louis, Mo
| | - Kunal D. Kotkar
- Division of Cardiothoracic Surgery, Washington University, St Louis, Mo
| | - M. Faraz Masood
- Division of Cardiothoracic Surgery, Washington University, St Louis, Mo
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Washington University, St Louis, Mo
| | - Ralph J. Damiano
- Division of Cardiothoracic Surgery, Washington University, St Louis, Mo
| | - Amit Pawale
- Division of Cardiothoracic Surgery, Washington University, St Louis, Mo
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Xu R, Cai Z, Ding J, Ma G. Insight into tricuspid transcatheter edge-to-edge repair: no longer the forgotten valve. Expert Rev Cardiovasc Ther 2023; 21:877-885. [PMID: 37983042 DOI: 10.1080/14779072.2023.2286010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/16/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Tricuspid regurgitation (TR) is one of the most prevalent types of valvular heart disease linked to poor prognosis in patients with heart failure and is usually ignored. TR has received considerable attention due to the progressive advancements in transcatheter therapies in recent years. AREAS COVERED With relatively solid data and rapid technological advancements, tricuspid transcatheter edge-to-edge repair (T-TEER) is the most frequently employed in a series of tricuspid transcatheter interventional treatments for TR. However, the efficacy and technical benefits of T-TEER are limited because of the unique anatomical characteristics and pathological mechanisms of the tricuspid valve. The aim of this review is to summarize reported data on current status of T-TEER and to provide an expert opinion regarding the challenges it is now experiencing and future development direction and approach. EXPERT OPINION T-TEER is a significant treatment for TR, but its effectiveness and technical promotion are limited due to the tricuspid valve unique anatomical characteristics and pathological mechanisms. The selection criteria for suitable patients, the choice of when to intervene, device innovation, the advancement of ultrasound technology, and the volume of evidence in evidence-based medicine all indicate that the disorder of TR will eventually be better treated and understood.
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Affiliation(s)
- Rongfeng Xu
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, P.R.China
| | - Zhenyu Cai
- Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, P.R. China
| | - Jiandong Ding
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, P.R.China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, P.R.China
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6
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Hirji SA, Kewalramani D, Cangut B, Brown A. Suture Bicuspidization Repair for Mild or Moderate Tricuspid Regurgitation at the Time of Mitral Valve Surgery: Success or Bust? Eur J Cardiothorac Surg 2023:ezad237. [PMID: 37335875 DOI: 10.1093/ejcts/ezad237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 06/21/2023] Open
Affiliation(s)
- Sameer A Hirji
- Division of Cardiac Surgery, Department of Surgery, Brigham and Womeńs Hospital, Harvard Medical School, Boston, MA, USA
| | - Divya Kewalramani
- Division of Cardiac Surgery, Department of Surgery, Brigham and Womeńs Hospital, Harvard Medical School, Boston, MA, USA
| | - Busra Cangut
- Division of Cardiac Surgery, Department of Surgery, Brigham and Womeńs Hospital, Harvard Medical School, Boston, MA, USA
| | - Amy Brown
- Libin Cardiovascular Institute, Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Calgary, Alberta, Canada
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7
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Lurz P, Besler C, Schmitz T, Bekeredjian R, Nickenig G, Möllmann H, Stephan von Bardeleben R, Schmeisser A, Atmowihardjo I, Estevez-Loureiro R, Lubos E, Heitkemper M, Huang D, Lapp H, Donal E. Short-term Outcomes of Tricuspid Edge-to-Edge Repair in Clinical Practice. J Am Coll Cardiol 2023:S0735-1097(23)05585-7. [PMID: 37207923 DOI: 10.1016/j.jacc.2023.05.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Severe tricuspid regurgitation (TR) is known to be associated with substantial morbidity and mortality. OBJECTIVES To study the acute outcomes of subjects treated by tricuspid transcatheter edge-to-edge repair with the TriClip system in a contemporary, real-world setting. METHODS The bRIGHT post-approval study is a prospective, single-arm, open-label, multicenter, post-market registry conducted at 26 sites in Europe. Echocardiographic assessment was performed at a core laboratory. RESULTS Enrolled subjects were elderly (79 ± 7 years) with significant comorbidities. Eighty-eight percent had baseline massive or torrential TR and 80% percent of subjects were in NYHA class III or IV. Successful device implantation occurred in 99% of subjects and TR was reduced to ≤moderate at 30 days in 77%. Associated significant improvements in NYHA class (20% to 79% I/II, p < 0.0001) and KCCQ score (19 ± 23 points improvement, p < 0.0001) were observed at 30 days. With baseline TR grade removed as a variable, smaller RAV and smaller tethering distance at baseline were independent predictors of TR reduction to ≤ moderate at discharge (OR:0.679, CI: [0.537, 0.858], p = 0.0012; OR: 0.722, CI: [0.564, 0.924], p=0.0097). Fourteen (2.5%) subjects experienced a major adverse event at 30 days. CONCLUSIONS Transcatheter tricuspid valve repair was found to be safe and effective in treating significant TR in a diverse, real-world population.
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Affiliation(s)
- Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany;.
| | | | | | | | | | | | | | | | | | | | - Edith Lubos
- Katholisches Marienkrankenhaus GmbH, Hamburg, Germany
| | | | - Dina Huang
- Abbott Structural Heart, California, USA
| | - Harald Lapp
- Zentralklinik Bad Berka GmbH, Bad Berka, Germany
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8
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Chevalier B, Neylon A. Isolated Transcatheter Tricuspid Repair for Functional Regurgitation: Are We Selecting the Right Patients? JACC Cardiovasc Interv 2021; 14:2296-2297. [PMID: 34674868 DOI: 10.1016/j.jcin.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Bernard Chevalier
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France.
| | - Antoinette Neylon
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
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9
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Sala A, Lorusso R, Bargagna M, Ruggeri S, Buzzatti N, Scandroglio M, Monaco F, Agricola E, Giacomini A, Carino D, Meneghin R, Schiavi D, Lapenna E, Denti P, Blasio A, Alfieri O, Castiglioni A, De Bonis M. Complicated postoperative course in isolated tricuspid valve surgery: Looking for predictors. J Card Surg 2021; 36:3092-3099. [PMID: 34131952 DOI: 10.1111/jocs.15739] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study aims at better defining the profile of patients with a complicated versus noncomplicated postoperative course following isolated tricuspid valve (TV) surgery to identify predictors of a favorable/unfavorable hospital outcome. METHODS All patients treated with isolated tricuspid surgery from March 1997 to January 2020 at our institution were retrospectively reviewed. Considering the complexity of most of these patients, a regular postoperative course was arbitrarily defined as a length-of-stay in intensive care unit less than 4 days and/or postoperative length-of-stay less than 10days. Patients were therefore divided accordingly in two groups. RESULTS One hundred and seventy-two patients were considered, among whom 97 (56.3%) had a regular (REG) and 75 (43.6%) a non-regular (NEG) postoperative course. The latter had worse baseline clinical and echocardiographic characteristics, with higher rate of renal insufficiency, previous heart failure hospitalizations, cardiac operations, and right ventricular dysfunction. NEG patients more frequently needed tricuspid replacement and experienced a greater number of complications (p < .001) and higher in-hospital mortality (13% vs. 0%, p < .001). The majority of these complications were related to more advanced stage of the tricuspid disease. Among most important predictors of a negative outcome univariate analysis identified chronic kidney disease, ascites, previous right heart failure hospitalizations, right ventricular dysfunction, previous cardiac surgeries, TV replacement and higher MELD scores. At multivariate analysis, liver enzymes and diuretics' dose were predictors of complicated postoperative course. CONCLUSION In isolated TV surgery a complicated postoperative course is observed in patients with more advanced right heart failure and organ damage. Earlier surgical referral is associated to excellent outcomes and should be recommended.
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Affiliation(s)
- Alessandra Sala
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Center, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Marta Bargagna
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefania Ruggeri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Buzzatti
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Mara Scandroglio
- Department of Anesthesiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Fabrizio Monaco
- Department of Anesthesiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Eustachio Agricola
- Department of Cardiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Giacomini
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Davide Carino
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberta Meneghin
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Davide Schiavi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Lapenna
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Denti
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Blasio
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Castiglioni
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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10
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Mestres CA, Sromicki J, Vogt PR. In the operating room, do not leave important things unattended. J Card Surg 2021; 36:990-991. [PMID: 33491246 DOI: 10.1111/jocs.15338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Carlos A Mestres
- Clinic of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland.,Department of Cardiothoracic Surgery, The University of the Free State, Bloemfontein, South Africa
| | - Juri Sromicki
- Clinic of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Paul R Vogt
- Clinic of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
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11
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Mullan C, Caraballo C, Ravindra NG, Miller PE, Mori M, McCullough M, Clarke JRD, Anwer M, Velazquez EJ, Geirsson A, Desai NR, Ahmad T. Clinical impact of concomitant tricuspid valve procedures during left ventricular assist device implantation. J Heart Lung Transplant 2020; 39:926-933. [PMID: 32593561 DOI: 10.1016/j.healun.2020.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/29/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Tricuspid regurgitation (TR) is common in patients with end-stage heart failure receiving left ventricular assist devices (LVADs), but the benefit of concomitant tricuspid valve procedures (TVPs) remains uncertain. This study examined the impact of TVP at the time of LVAD implantation on clinical outcomes and quality of life (QOL) metrics. METHODS We included adult patients in the Interagency Registry for Mechanical Circulatory Support database with various degrees of TR who received continuous-flow LVADs from 2008 to 2017. Patients undergoing concomitant TVP were compared with those without the intervention in a stratified analysis. Descriptive analyses, survival analyses, and Andersen‒Gill hazard models were used as appropriate to examine associations with clinical and patient-centered QOL outcomes. RESULTS Our analysis included 8,263 (53.1%) mild, 4,252 (33.3%) moderate, and 2,100 (13.5%) severe TR cases. TVP rate increased with severity: 8.6% of mild, 18.0% of moderate, and 43.9% of severe cases. TVP was not associated with survival benefit in cases of mild (adjusted hazard ratio [aHR]: 0.97, 95% CI: 0.79-1.19, p = 0.75), moderate (aHR: 1.03, 95% CI: 0.88-1.20, p = 0.72), or severe (aHR: 1.20, 95% CI: 0.98-1.48, p = 0.08) TR. For patients with combined moderate or severe TR, TVP was associated with increased mortality (log-rank p < 0.01, aHR: 1.13, 95% CI: 1.00-1.27, p = 0.04). After adjusting for TR severity, TVP was associated with increased risk of bleeding, arrhythmia, and stroke (p < 0.01 each) and no improvements in QOL (p > 0.05). CONCLUSIONS TVP at the time of LVAD implantation was not associated with either improved survival or QOL, and there were associations with increased risk of adverse events among patients with moderate and severe TR.
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Affiliation(s)
- Clancy Mullan
- Division of Cardiac Surgery, Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut
| | - Cesar Caraballo
- Center for Outcomes Research & Evaluation (CORE), Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut
| | - Neal G Ravindra
- Cardiovascular Research Center and Department of Computer Science, Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut
| | - P Elliott Miller
- Section of Cardiovascular Medicine, Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut; Yale National Clinician Scholars Program, Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut
| | - Makoto Mori
- Division of Cardiac Surgery, Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut
| | - Megan McCullough
- Section of Cardiovascular Medicine, Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut
| | - John-Ross D Clarke
- Department of Internal Medicine (Bridgeport Hospital), Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut
| | - Muhammad Anwer
- Division of Cardiac Surgery, Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut
| | - Eric J Velazquez
- Section of Cardiovascular Medicine, Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut
| | - Nihar R Desai
- Center for Outcomes Research & Evaluation (CORE), Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut; Section of Cardiovascular Medicine, Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut
| | - Tariq Ahmad
- Center for Outcomes Research & Evaluation (CORE), Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut; Section of Cardiovascular Medicine, Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut.
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12
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Abdul Khader A, Khan H, Stowell C, Liu G, Sameh M, Punjabi P. Retrospective analysis of tricuspid valve repair using a novel surgical technique: A 7-year single-surgeon experience. Perfusion 2020; 35:795-801. [PMID: 32339067 PMCID: PMC7686925 DOI: 10.1177/0267659120910373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Tricuspid annuloplasty is the optimal surgical repair technique for tricuspid regurgitation which improves mortality and morbidity. Ring annuloplasties is the techniques of choice. Here, we evaluate the efficacy and durability of a new method of interrupted pledgeted suture annuloplasty. Methods: Between 2011 and 2018, 39 eligible patients underwent tricuspid valve repair using this novel technique. Indication for repair was a grade of regurgitation at moderate or greater, or an annular diameter >40 mm. Patients were assessed both preoperatively and postoperatively by echocardiogram. Follow-up results were split into the first postoperative echocardiogram and most recent postoperative echocardiogram undertaken. Results: There were two in-hospital mortalities and two patients required permanent pacemaker implantation following surgery. At the time of the first postoperative echocardiogram undertaken (median 3 months postoperatively), freedom from moderate-severe regurgitation was 92.3%. At the time of the most recent postoperative echocardiogram undertaken (median 11 months postoperatively); none or mild regurgitation was detected in 24 patients (61.5%), mild-moderate in 11 (28.2%) and moderate-severe in 4 (10.3%) patients. Freedom from moderate-severe regurgitation was 89.7%. Postoperative grade of regurgitation was significantly reduced from preoperative grades (p < 0.001). Conclusion: Initial and midterm results of our technique show a good durability of repair. We have demonstrated recurrence rates of regurgitation equal and superior to current forms of suture annuloplasty published in the literature. This novel method of suture annuloplasty can be considered in the surgical repertoire of tricuspid valve repair techniques.
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Affiliation(s)
- Ashiq Abdul Khader
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Habib Khan
- Cardiothoracic Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Catherine Stowell
- Department of Echocardiography, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Guiqing Liu
- Cardiothoracic Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Mohamed Sameh
- Cardiothoracic Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Prakash Punjabi
- Imperial College Faculty of Medicine, National Heart and Lung Institute, Hammersmith Hospital, London, UK
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13
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Maisano F. All Roads Lead to Rome?: Out-of-the-Box Thinking in the Quest of Tricuspid Interventions. JACC Cardiovasc Interv 2019; 12:1448-1450. [PMID: 31395214 DOI: 10.1016/j.jcin.2019.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Francesco Maisano
- University Hospital Zurich, University Heart Center, Zurich, Switzerland.
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14
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Arellano-Serrano C, Moñivas V, Estévez-Loureiro R. Combined Percutaneous Treatment of Severe Triscuspid Regurgitation and Left Atrial Appendage Closure. J Invasive Cardiol 2019; 31:E4-E5. [PMID: 30611127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
LAA closure and MitraClip implantation in the tricuspid position in the same procedure is a feasible and safe option in patients with a high surgical risk suffering from severe symptomatic tricuspid regurgitation and bleeding complications under anticoagulant therapy.
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Affiliation(s)
| | | | - Rodrigo Estévez-Loureiro
- Interventional Cardiology Unit, University Hospital Puerta de Hierro, c/ Manuel de Falla 1, 28220 Majadahonda, Madrid, Spain.
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