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Atluri P, Iyengar A, Rekhtman D. Risks and Benefits of Concomitant Tricuspid Surgery at the Time of Mitral Intervention. J Am Coll Cardiol 2024; 83:1669-1670. [PMID: 38658106 DOI: 10.1016/j.jacc.2024.03.378] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Pavan Atluri
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Amit Iyengar
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. https://twitter.com/iyengaramit
| | - David Rekhtman
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kassab J, Harb SC, Desai MY, Gillinov AM, Layoun H, El Dahdah J, Chedid El Helou M, Nakhla S, Elgharably H, Kapadia SR, Cremer PC, Mentias A. Incidence, Risk Factors, and Outcomes Associated With Permanent Pacemaker Implantation Following Tricuspid Valve Surgery. J Am Heart Assoc 2024; 13:e032760. [PMID: 38293932 PMCID: PMC11056159 DOI: 10.1161/jaha.123.032760] [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: 10/16/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Data regarding permanent pacemaker (PPM) implantation following tricuspid valve surgery (TVS) are limited. We sought to evaluate its incidence, risk factors, and outcomes. METHODS AND RESULTS Medicare beneficiaries who underwent TVS from 2013 to 2020 were identified. Patients who underwent TVS for endocarditis were excluded. The primary exposure of interest was new PPM after TVS. Outcomes included all-cause mortality and readmission with endocarditis or heart failure on follow-up. Among the 13 294 patients who underwent TVS, 2518 (18.9%) required PPM placement. Risk factors included female sex (relative risk [RR], 1.26 [95% CI, 1.17-1.36], P<0.0001), prior sternotomy (RR, 1.12 [95% CI, 1.02-1.23], P=0.02), preoperative second-degree heart block (RR, 2.20 [95% CI, 1.81-2.69], P<0.0001), right bundle-branch block (RR, 1.21 [95% CI, 1.03-1.41], P=0.019), bifascicular block (RR, 1.43 [95% CI, 1.06-1.93], P=0.02), and prior malignancy (RR, 1.23 [95% CI, 1.01-1.49], P=0.04). Tricuspid valve (TV) replacement was associated with a significantly higher risk of PPM implantation when compared with TV repair (RR, 3.20 [95% CI, 2.16-4.75], P<0.0001). After a median follow-up of 3.1 years, mortality was not different in patients who received PPM compared with patients who did not (hazard ratio [HR], 1.02 [95% CI, 0.93-1.12], P=0.7). PPM placement was not associated with a higher risk of endocarditis but was associated with a higher risk of heart failure readmission (HR, 1.28 [95% CI, 1.14-1.43], P<0.001). CONCLUSIONS PPM implantation frequently occurs after TVS, notably in female patients and patients undergoing TV replacement. Although mortality is not increased, it is associated with higher rates of heart failure rehospitalization.
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Affiliation(s)
- Joseph Kassab
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Serge C. Harb
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Milind Y. Desai
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - A. Marc Gillinov
- Department of Cardiovascular SurgeryHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Habib Layoun
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Joseph El Dahdah
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Michel Chedid El Helou
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Shady Nakhla
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Haytham Elgharably
- Department of Cardiovascular SurgeryHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Samir R. Kapadia
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Paul C. Cremer
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Amgad Mentias
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
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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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Furuta A, Shinkawa T, Okugi S, Yoshida H, Niinami H. Tricuspid valve replacement provides better long-term survival and tricuspid valve function than repair in patients with systemic right ventricle. JTCVS Open 2023; 15:382-393. [PMID: 37808018 PMCID: PMC10556944 DOI: 10.1016/j.xjon.2023.06.013] [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: 03/29/2023] [Revised: 05/16/2023] [Accepted: 06/20/2023] [Indexed: 10/10/2023]
Abstract
Objective The purpose of this study is to compare the long-term outcomes of 2 different tricuspid surgeries including valvuloplasty and replacement for significant tricuspid regurgitation in patients with systemic right ventricle. Method This is a retrospective study of 34 patients with dextro-transposition of the great arteries or levo-transposition of the great arteries with biventricular circulation and systemic right ventricle undergoing tricuspid valve surgery between April 1979 and April 2022. Patients were divided into 2 groups based on the procedure: tricuspid valvuloplasty (n = 11) and tricuspid valve replacement (n = 23). These groups were compared in terms of survival, tricuspid valve dysfunction, and tricuspid valve-related reoperation. Results There was no significant difference between the groups in operative age, body weight, the proportion of dextro-transposition of the great arteries, Ebstein-like tricuspid dysplasia, and preoperative right ventricular volume/function. During the median follow-up of 9.7 years, there was 1 early death (tricuspid valvuloplasty group) and 4 late deaths (3 in tricuspid valvuloplasty group and 1 in tricuspid valve replacement group). There were 7 tricuspid valve dysfunctions, including 6 significant tricuspid regurgitations in the tricuspid valvuloplasty group and 1 prosthetic valve dysfunction in the tricuspid valve replacement group, and 4 tricuspid valve-related reoperations (3 in the tricuspid valvuloplasty group and 1 in the tricuspid valve replacement group) were performed. There were significant differences between the groups in survival (tricuspid valvuloplasty vs tricuspid valve replacement: 72.7 vs 94.7% at 10 years after surgery, P = .0328) and cumulative incidence of tricuspid valve dysfunction at 10 years after tricuspid surgery (tricuspid valvuloplasty vs tricuspid valve replacement: 27.3% vs 0%, P = .0121). Conclusions Tricuspid valve replacement provided better long-term survival and tricuspid function in patients with systemic right ventricle compared with tricuspid valvuloplasty.
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Affiliation(s)
- Akihisa Furuta
- Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Takeshi Shinkawa
- Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Satoshi Okugi
- Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Hisashi Yoshida
- Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
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Kaneyuki D, Villarraga HR, Gallego-Navarro CA, Todd A, Pislaru SV, Crestanello JA, Dearani JA, Greason KL, Schaff HV, Arghami A. Fate of concomitant tricuspid regurgitation in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00649-9. [PMID: 37541574 DOI: 10.1016/j.jtcvs.2023.07.044] [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: 03/01/2023] [Revised: 07/09/2023] [Accepted: 07/26/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE Owing to a lack of supportive data, tricuspid regurgitation (TR) is usually not addressed in patients undergoing coronary artery bypass grafting (CABG). Here we evaluated changes in TR degrees over time and its impact on survival in patients undergoing CABG. METHODS We reviewed the data of 9726 patients who underwent isolated CABG between January 2000 and January 2021. According to preoperative TR severity, patients were stratified into nonsignificant (none to trivial, mild) and significant (moderate to severe) TR groups. We excluded patients who had undergone previous tricuspid valve surgery, pacemaker placement, and concomitant valve or ablative surgery. Propensity score matching and Cox proportional hazards models were used to identify associations between TR grade and the primary outcome of all-cause mortality. The secondary outcome was change in TR severity on the last echocardiogram. RESULTS After propensity score matching, 380 patients in each group were identified. At baseline, 359 patients had moderate TR (94.5%) and 21 (5.5%) had severe TR. On the last follow-up echocardiogram, TR had improved in 40.5% of the patients in the significant TR group. Kaplan-Meier survival curves showed significantly lower survival in patients with significant preoperative TR compared to those with nonsignificant TR (P < .001). After adjusting for other confounders, survival was no worse in the patients with significant TR group (hazard ratio, 1.05; 95% confidence interval, 0.80-1.38; P = .70). CONCLUSIONS Significant preoperative TR improved in 40.5% of patients after isolated CABG. After adjusting for other factors, significant TR did not affect long-term survival.
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Affiliation(s)
- Daisuke Kaneyuki
- Department of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | | | | | - Austin Todd
- Department of Biostatistics, Mayo Clinic, Rochester, Minn
| | - Sorin V Pislaru
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minn
| | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
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Lim MH, Lee CH, Ju MH, Je HG. Influence of hepatic dysfunction in patients who underwent tricuspid valve surgery. J Thorac Dis 2023; 15:1614-1626. [PMID: 37197498 PMCID: PMC10183499 DOI: 10.21037/jtd-22-1741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
Background Hepatic dysfunction (HD) is frequently associated with chronic tricuspid regurgitation (TR), and is a risk factor for TR surgery. Late referral of patients with TR is associated with the progression of TR and HD, as well as an increase in surgical morbidity and mortality. Many patients with severe TR suffer from HD; however, their clinical impact is not well documented. Methods This retrospective review was conducted between October 2008 and July 2017. In total, 159 consecutive patients underwent surgery for TR; 101 with moderate to severe TR were included. We divided patients into N (normal liver function; n=56) and HD (HD; n=45) groups. HD was defined as clinically or radiologically diagnosed liver cirrhosis, or a preoperative Model for End-Stage Liver Disease (MELD)-XI score ≥13. Perioperative data were compared between groups, and changes in the MELD score following TR surgery were estimated in the HD group. Long-term survival rates were analyzed, and analyses were performed to obtain the assessment tool and cutoff value to determine the degree of HD affecting late mortality. Results The preoperative demographics of both groups were similar, excluding the presence of HD. The EuroSCORE II, MELD score, and prothrombin time international normalization ratio were significantly higher in the HD group, and although early mortality was comparable between groups [N group: 0%, HD group: 2.2% (n=1); P=0.446], intensive care unit and hospital stays were significantly longer in the HD group. The MELD score in the HD group temporarily increased immediately after surgery, and then decreased. The long-term survival rates were significantly lower in the HD group. The most suitable tool for predicting late mortality was the MELD-XI score, with a cutoff value of 13 points. Conclusions Surgery for patients with severe TR can be performed with relatively low morbidity and operative mortality, regardless of associated HD. MELD scores significantly improved after TR surgery in patients with HD. Even with favorable early outcomes, compromised long-term survival with HD suggests the need to develop an assessment tool that can evaluate the appropriate timing for TR surgery.
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Laghlam D, Touboul O, Herry M, Estagnasié P, Dib JC, Baccouche M, Brusset A, Nguyen LS, Squara P. Takotsubo cardiomyopathy after cardiac surgery: A case-series and systematic review of literature. Front Cardiovasc Med 2023; 9:1067444. [PMID: 36704455 PMCID: PMC9871635 DOI: 10.3389/fcvm.2022.1067444] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Abstract
Background Takotsubo cardiomyopathy (TTC) is a rare entity after cardiac surgery. Aims To describe patients' profile who developed postoperative TTC after cardiac surgery, management, and outcomes. Methods We performed a systematic literature search to extract cases of TTC after adult cardiac surgery (from 1990 to 2021). Additionally, we extracted all cases of TTC in a prospective single-center cohort database of 10,000+ patients (from 2007 to 2019). We then combined all cases in a single cohort to describe its clinical features. Results From 694 screened articles, we retained 71 individual cases published in 20 distinct articles (19 cases reports and 1 case-series). We combined these to 10 cases extracted from our cohort [among 10,682 patients (0.09%)]. Overall, we included 81 cases. Patients were aged 68 ± 10 years-old and 64/81 (79%) were women. Surgery procedures included mitral valve and/or tricuspid valve surgery in 70/81, 86%. TTC was diagnosed in the first days after surgery [median 4 (1-4) days]. Incidence of cardiogenic shock, defined as requirement of vasopressor and/or inotropic support was 24/29, 83% (data available on 29/81 patients). Refractory cardiogenic appeared in 5/81, 6% who required implantation of arterio-venous extra-corporeal membrane oxygenation, and 6/81, 7%, intra-aortic balloon pump. In-hospital mortality was 5/81, 6%. Conclusion This systematic review, based on case reports and case series, showed that postoperative TTC appears as a rare complication after cardiac surgery and mainly occurred after mitral and/or tricuspid valve repair procedures. In this population, TTC is associated with high rate of cardiogenic shock.
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Olsthoorn JR, Heuts S, Houterman S, Roefs M, Maessen JG, Nia PS. Does concomitant tricuspid valve surgery increase the risks of minimally invasive mitral valve surgery? A multicentre comparison based on data from The Netherlands Heart Registration. J Card Surg 2022; 37:4362-4370. [PMID: 36229944 PMCID: PMC10091696 DOI: 10.1111/jocs.17004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 04/27/2022] [Accepted: 08/29/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Mitral valve (MV) disease is often accompanied by tricuspid valve (TV) disease. The indication for concomitant TV surgery during primary MV surgery is expected to increase, especially through a minimally invasive surgical (MIS) approach. The aim of the current study is to investigate the safety of the addition of TV surgery to MV surgery in MIMVS in a nationwide registry. METHODS Patients undergoing atrioventricular valve surgery through sternotomy or MIS between 2013 and 2018 were included. Patients undergoing MV surgery only through sternotomy or MIS were used as comparison. Primary outcomes were short-term morbidity and mortality and long-term survival. Propensity score matching was used to correct for potential confounders. RESULTS The whole cohort consisted of 2698 patients. A total of 558 patients had atrioventricular double valve surgery through sternotomy and 86 through MIS. As a comparison, 1365 patients underwent MV surgery through sternotomy and 689 patients through MIS. No differences in 30- and 120-day mortality were observed between the groups, both unmatched and matched. 5-year survival did not differ for double atrioventricular valve surgery through either sternotomy or MIS in the matched population (90.1% vs. 95.3%, Log-Rank p = .12). A higher incidence of re-exploration for bleeding (n = 12 [15.2%] vs. n = 3 [3.8%], p = .02) and new onset arrhythmia (n = 35 [44.3%] vs. n = 13 [16.5%], p < .001) was observed in double valve surgery through MIS. Median length of hospital stay (LOHS) was longer in the minimally invasive double valve group (9 days [6-13]) compared with sternotomy (7 days [6-11]; p = .04). CONCLUSION No differences in short-term mortality and 5-year survival were observed when tricuspid valve was added to MV surgery in MIS or sternotomy. The addition of tricuspid valve surgery is associated with higher incidence of re-exploration for bleeding, new onset arrhythmia. A longer LOHS was observed for MIS compared to sternotomy.
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Affiliation(s)
- Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Maaike Roefs
- Netherlands Heart Registration, Utrecht, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Peyman S Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Affiliation(s)
- Rebecca T Hahn
- Department of Medicine, Columbia University Medical Center/NY Presbyterian Hospital, New York, NY
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10
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Henning RJ. Tricuspid valve regurgitation: current diagnosis and treatment. Am J Cardiovasc Dis 2022; 12:1-18. [PMID: 35291509 PMCID: PMC8918740] [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] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/10/2021] [Indexed: 06/14/2023]
Abstract
Tricuspid regurgitation (TR) is present in 1.6 million individuals in the United States and 3.0 million people in Europe. Functional TR, the most common form of TR, is caused by cardiomyopathies, LV valve disease, or pulmonary disease. The five-year survival with severe TR and HFrEF is 34%. Echocardiography can assess the TR etiology/severity, measure RA and RV size and function, estimate pulmonary pressure, and characterize LV disease. Management includes diuretics, ACE inhibitors, and aldosterone antagonists. Surgical annuloplasty or valve replacement should be considered in patients with progressive RV dilatation without severe LV dysfunction and pulmonary hypertension. Transcatheter repair/replacement is possible in patients with a LVEF <40%, dilated annuli, and impaired RV function. The diagnosis and treatment of TR, including coaptation, annuloplasty devices and prosthetic valves, success rates, morbidity/mortality, and trials are discussed. Transcatheter tricuspid valve repair/replacement is an emerging therapy for high-risk patients with TR who would otherwise have a dismal clinical prognosis.
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Huang Y, Dearani JA, Lahr BD, Stephens EH, Madhavan M, Cannon BC, Schaff HV. Surgical management of transvenous lead-induced tricuspid regurgitation in adult and pediatric patients with congenital heart disease. J Thorac Cardiovasc Surg 2021; 163:2185-2193.e4. [PMID: 34753592 DOI: 10.1016/j.jtcvs.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/20/2021] [Revised: 09/22/2021] [Accepted: 10/01/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate outcomes of surgical management of lead-induced tricuspid regurgitation (TR) in patients with congenital heart disease. METHODS We analyzed data of 54 consecutive patients who underwent tricuspid valve (TV) surgery from 1998 to 2015 for lead-induced TR. Primary end points, including mortality, TV reinterventions, and longitudinal TR measurements, were analyzed with the Kaplan-Meier method or with repeated measures proportional odds modeling. RESULTS The median age of patients was 48.2 years (interquartile range, 37.3-59.0 years); 31 (57.4%) were female; 2 (3.7%) were children. Thirty patients (55.6%) underwent TV repair and 24 (44.4%) had replacement, and 52 underwent concomitant cardiac procedures. Thirty-day mortality was 1.9% (repair: 3.3%, replacement: 0.0%). Five-year survival was 80.4% overall and 79.7% and 81.4% for the repair and replacement groups, respectively. In response to surgery, TR improved in both groups (each P < .001) but more with replacement than repair (P < .001); longitudinal analysis showed that TR trends observed early on favoring replacement were sustained across follow-up (P < .001). The model-estimated risk of moderate or severe TR at 5-year follow-up, conditional on having severe preoperative TR, was 74.4% for the repair and 10.7% for the replacement group. Five-year cumulative risk of TV reintervention was comparable for valve repair and replacement. CONCLUSIONS Despite the need for concomitant cardiac procedures in most of the patients, early mortality was low after TV surgery. Survival and rate of TV reintervention were comparable for the repair and replacement groups. However, TV repair was associated with progressive TR during intermediate follow-up, especially in patients with severe preoperative TR.
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Affiliation(s)
- Ying Huang
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
| | - Brian D Lahr
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minn
| | | | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Bryan C Cannon
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn
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Vieitez JM, Monteagudo JM, Mahia P, Perez L, Lopez T, Marco I, Perone F, González T, Sitges M, Bouzas A, González-Salvado V, Li CH, Alonso D, Carrasco F, Adeba A, de la Hera JM, Fernandez-Golfin C, Zamorano JL. New insights of tricuspid regurgitation: a large-scale prospective cohort study. Eur Heart J Cardiovasc Imaging 2021; 22:196-202. [PMID: 32783057 DOI: 10.1093/ehjci/jeaa205] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [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: 12/13/2019] [Accepted: 07/01/2020] [Indexed: 01/01/2023] Open
Abstract
AIMS To evaluate the burden of tricuspid regurgitation (TR) in a large cohort, determine the right ventricle involvement of patients with TR and determine the characteristics of isolated TR. METHODS AND RESULTS Prospective study where consecutive patients undergoing an echocardiographic study in 10 centres were included. All studies with significant TR (at least moderate) were selected. We considered that patients with one of pulmonary systolic hypertension >50 mmHg, left ventricular ejection fraction <35%, New York Heart Association III-IV, or older than 85 years, had a high surgical risk. A total of 35 088 echocardiograms were performed. Significant TR was detected in 6% of studies. Moderate TR was found in 69.6%, severe in 25.5%, massive in 3.9%, and torrential in 1.0% of patients. Right ventricle was dilated in 81.7% of patients with massive/torrential TR, in 55.9% with severe TR, and in 29.3% with moderate TR (P < 0.001). Primary TR was present in 7.4% of patients whereas secondary TR was present in 92.6%. Mitral or aortic valve disease was the most common aetiology (54.6%), following by isolated TR (16%). Up to 51.9% of patients with severe, massive, or torrential primary TR and 57% of patients with severe, massive, or torrential secondary TR had a high surgical risk. CONCLUSION Significant TR is a prevalent condition and a high proportion of these patients have an indication for valve intervention. More than a half of patients with severe, massive, or torrential TR had a high surgical risk. Massive/torrential TR may have implications regarding selection and monitoring patients for percutaneous treatment.
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Affiliation(s)
- José María Vieitez
- Department of Cardiology, CIBERCV University Hospital Ramon y Cajal, Carretera de Colmenar Km 9.100, Madrid 28034, Spain
| | - Juan Manuel Monteagudo
- Department of Cardiology, CIBERCV University Hospital Ramon y Cajal, Carretera de Colmenar Km 9.100, Madrid 28034, Spain
| | - Patricia Mahia
- Department of Cardiology, Hospital Clinic San Carlos, calle Prof Martín Lagos, Madrid 28040, Spain
| | - Leopoldo Perez
- Department of Cardiology, Hospital Clinic San Carlos, calle Prof Martín Lagos, Madrid 28040, Spain
| | - Teresa Lopez
- Department of Cardiology, University Hospital La Paz, Paseo de la Castellana, 261, Madrid 28046, Spain
| | - Irene Marco
- Department of Cardiology, University Hospital La Paz, Paseo de la Castellana, 261, Madrid 28046, Spain
| | - Francesco Perone
- Department of Cardiology, University Hospital La Paz, Paseo de la Castellana, 261, Madrid 28046, Spain
| | - Teresa González
- Department of Cardiology, Hospital Vall d`Hebron, Passeig de la Vall d'Hebron, 119, 129, Barcelona, Spain
| | - Marta Sitges
- Barcelona Hospital Clinic de Barcelona, Carrer de Villarroel 170, Barcelona 08036, Spain
| | - Alberto Bouzas
- Department of Cardiology, University Hospital Complex A Coruña, As Xubias 84, A Coruña 15006, Spain
| | | | - Chi-Hion Li
- Department of Cardiology, Hospital of Santa Creu I Sant Pau, Carrer de Sant Quintí, 89, Barcelona 08041, Spain
| | - David Alonso
- Department of Cardiology, Hospital of Leon, Altos de Nava, León 24008, Spain
| | - Fernando Carrasco
- Department of Cardiology, University Hospital Virgen de la Victoria, Campus de Teatinos, Málaga 29010, Spain
| | - Antonio Adeba
- Department of Cardiology, University Hospital Central de Asturias, Avenida de Roma s/n, Oviedo 33011, Spain
| | - Jesus Maria de la Hera
- Department of Cardiology, University Hospital Central de Asturias, Avenida de Roma s/n, Oviedo 33011, Spain
| | - Covadonga Fernandez-Golfin
- Department of Cardiology, CIBERCV University Hospital Ramon y Cajal, Carretera de Colmenar Km 9.100, Madrid 28034, Spain
| | - José Luis Zamorano
- Department of Cardiology, CIBERCV University Hospital Ramon y Cajal, Carretera de Colmenar Km 9.100, Madrid 28034, Spain
- Department of Cardiology, La Zarzuela Hospital, Calle de Pleyades, 25, Madrid 28023, Spain
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13
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Okabe T, Afzal MR, Houmsse M, Makary MS, Elliot ED, Daoud EG, Augostini RS, Hummel JD. Tine-Based Leadless Pacemaker: Strategies for Safe Implantation in Unconventional Clinical Scenarios. JACC Clin Electrophysiol 2021; 6:1318-1331. [PMID: 33092762 DOI: 10.1016/j.jacep.2020.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/06/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 12/28/2022]
Abstract
Leadless pacemakers (LPs) have emerged as a meaningful alternative to transvenous pacemakers for single-ventricular pacing. LPs eliminate many of lead- and pocket-associated complications observed with transvenous pacemakers. Owing to the lack of atrioventricular synchronous pacing until recently, the use of LP was generally reserved for those patients who either required minimal ventricular pacing or had permanent atrial fibrillation. The only commercially available LP is the Micra transcatheter pacing system (Micra-TPS, Medtronic Inc. Fridley, Minnesota), which requires insertion of a 27-F (outer diameter) introducer sheath in the femoral vein. The LP is delivered to the right ventricle using a 23-F delivery catheter. Owing to the need for a large-bore sheath, the pivotal studies for the Micra transcatheter pacing system excluded patients with indwelling inferior vena cava filters and included only a few patients with bioprosthetic or repaired tricuspid valve. Subsequent real-world experience has demonstrated the overall safety and feasibility of LP placement, and use in various unconventional clinical settings has been validated, albeit with specific precautions. Additionally, incorporation of adjunctive techniques and strategies can improve the safety of the procedure in routine clinical settings as well. The objective of this state-of-the-art review is to highlight the key procedural elements to facilitate safe and efficient implantation of LP in routine as well as in unique clinical settings.
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Affiliation(s)
- Toshimasa Okabe
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | - Muhammad R Afzal
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mina S Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Eric D Elliot
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Emile G Daoud
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ralph S Augostini
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John D Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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14
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O'Neill BP, Negrotto S, Yu D, Lakhter V, Depta J, McCabe JM, Dube S, Vaikom M, Wang DD, Patil P, Lindman B, Iglessis-Azuaje I, Fredi J, Lu X, O'Neill WW. Caval Valve Implantation for Tricuspid Regurgitation: Insights From the United States Caval Valve Registry. J Invasive Cardiol 2020; 32:470-475. [PMID: 33087585] [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: 06/11/2023]
Abstract
BACKGROUND We sought to describe the outcomes of patients who underwent caval valve implantation (CAVI) for treatment of severe tricuspid regurgitation (TR) in the United States. Previous studies on CAVI have used a variety of techniques and transcatheter valves. We present our findings from CAVI with inferior vena cava (IVC) implant only using a single valve. METHODS Patients who were determined to be poor candidates for tricuspid valve surgery and underwent CAVI in the United States from March 1, 2013 through March 1, 2018 were included in this study. Data during hospitalizations and interim outpatient follow-up from each individual site were collected and entered into a central password-protected database. RESULTS A total of 24 patients were treated. The median age was 79.5 years, 63% were women, and 96% were white. Twenty-three of 24 patients underwent valve implantation with a 29 mm Sapien 3 valve (Edwards Lifesciences). There was a 100% rate of successful valve implantation. There were no cases requiring emergency surgery. Thirty-day mortality rate was 25%. The median survival as of last follow-up of all patients was 350 days. Pre- and postprocedure New York Heart Association (NYHA) class data were available in 11 of 24 patients; of these 11 patients, 72.7% improved at least 1 NYHA class from baseline. CONCLUSION CAVI may be performed safely in a high surgical risk population with severe tricuspid regurgitation. Dedicated studies with longer-term follow-up are needed.
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Affiliation(s)
- Brian P O'Neill
- Henry Ford Hospital, Clara Ford Pavilion #440, 2799 W. Grand Blvd, Detroit, MI 48202 USA.
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15
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Michaelis A, Wagner F, Riede FT, Schroeter T, Daehnert I, Pfannmueller B, Gebauer RA, Paech C. Performance of pacemaker leads in alternative lead positions after tricuspid valve replacement. Pacing Clin Electrophysiol 2020; 43:1382-1389. [PMID: 33058294 DOI: 10.1111/pace.14093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 09/30/2020] [Accepted: 10/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bradycardic arrhythmias requiring pacemaker (PM) implantation are still common in patients in need of tricuspid valve replacement (TVR). Leaving an existing PM lead in an extravalvular position may represent a helpful alternative in special situations like the implantation of a mechanical TV. This study aimed to examine the short- to mid-term outcome of paravalvular leads concerning lead survival and prosthesis dysfunction in patients after TVR. METHODS A retrospective case-control study of patients with TVR and ventricular pacing was conducted. Patients from the database of the Leipzig Heart Center were included. Data of the paravalvular lead group (PVG) and coronary sinus lead group (CSG) were compared to a control group with conventional transvalvular leads (TVG). RESULTS Eighty patients with TVR and cardiac PM (TVG [n = 13], PVG [n = 40], and CSG [n = 27]) were included. The mean follow-up was 2.8 years. The rate of lead revisions (TVG 15.4%, PVG 2.5%, and CSG 7.5%) was lower in PVG but without significance (P = .286). The CSG demonstrated significantly higher pacing thresholds (1.4 V/0.8 ms) than TVG (0.5 V/0.4 ms), P = .004. However, the deterioration of threshold amplitudes during follow-up was similar in CSG (7.4%) and PVG (7.5%) compared with controls (7.7%). Function of TV prosthesis regarding development of stenosis or regurgitation showed a similarity between the groups (regurgitation PVG P = .692, CSG P = 1; stenosis PVG P = .586, CSG P = 0.69). CONCLUSION Paravalvular positioning of PM leads seems to represent a reasonable alternative to the conventional transvalvular lead positioning concerning the lead and Tricuspid Valve prosthesis's function and durability in selected patients.
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Affiliation(s)
- Anna Michaelis
- Department for Pediatric Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Franziska Wagner
- Department for Pediatric Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Frank-Thomas Riede
- Department for Pediatric Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Thomas Schroeter
- Department for Cardiac Surgery, University of Leipzig-Heart Center, Leipzig, Germany
| | - Ingo Daehnert
- Department for Pediatric Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Bettina Pfannmueller
- Department for Cardiac Surgery, University of Leipzig-Heart Center, Leipzig, Germany
| | - Roman Antonin Gebauer
- Department for Pediatric Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Christian Paech
- Department for Pediatric Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
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16
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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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Wong WK, Chen SW, Chou AH, Lee HA, Cheng YT, Tsai FC, Lee KT, Wu VCC, Wang CL, Chang SH, Chu PH. Late Outcomes of Valve Repair Versus Replacement in Isolated and Concomitant Tricuspid Valve Surgery: A Nationwide Cohort Study. J Am Heart Assoc 2020; 9:e015637. [PMID: 32301369 PMCID: PMC7428522 DOI: 10.1161/jaha.119.015637] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Surgery for tricuspid valve (TV) diseases is associated with poor prognosis, but few studies have described the long‐term outcomes by comparing TV repair and replacement in isolated and concomitant TV surgeries separately. Methods and Results Between 2000 and 2013, adult patients who underwent TV repair or replacement surgeries were identified from the Taiwan National Health Insurance Research Database. Outcomes of interest included all‐cause mortality, composite outcome, and readmission attributable to any cause. Inverse probability of treatment weighting was used to reduce confounding effects. A total of 2644 patients with a mean follow‐up of 4.9 years were included. Of them, 12.6% and 87.4% underwent isolated and concomitant TV surgery, respectively. The in‐hospital mortality rates for isolated and concomitant TV surgery were 8.7% and 8.6%, respectively, whereas all‐cause mortality rates were 41.7% and 36.8%, respectively. Compared with TV replacement, TV repair demonstrated significantly lower risks of all‐cause mortality (concomitant: hazard ratio [HR], 0.76; 95% CI, 0.59–0.99), composite outcome (isolated: subdistribution HR, 0.55; 95% CI, 0.35–0.89; concomitant: subdistribution HR, 0.63; 95% CI, 0.46–0.86), and readmission (isolated: subdistribution HR, 0.64; 95% CI, 0.46–0.91; concomitant: subdistribution HR, 0.72; 95% CI, 0.60–0.86), except insignificant difference in all‐cause mortality in isolated surgery. Conclusions Compared with replacement, TV repair is associated with better short‐ and long‐term outcomes in both isolated and concomitant TV surgery. However, further prospective clinical trials are warranted.
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Affiliation(s)
- Wang-Kin Wong
- School of Medicine Chang Gung University Taoyuan City Taiwan.,Division of Cardiac Surgery Department of Surgery Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan
| | - Shao-Wei Chen
- Division of Cardiac Surgery Department of Surgery Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan.,Center for Big Data Analytics and Statistics Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology Chang Gung Memorial Hospital Linkou Medical Center Chang Gung University Taoyuan City Taiwan
| | - Hsiu-An Lee
- Division of Cardiac Surgery Department of Surgery Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan
| | - Yu-Ting Cheng
- Division of Cardiac Surgery Department of Surgery Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan
| | - Feng-Chun Tsai
- Division of Cardiac Surgery Department of Surgery Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan
| | - Kuang-Tso Lee
- Department of Cardiology Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan
| | - Chun-Li Wang
- Department of Cardiology Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan
| | - Shang-Hung Chang
- Center for Big Data Analytics and Statistics Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan.,Department of Cardiology Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan
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18
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Borer JS. Application of Transcatheter Repair to Tricuspid Regurgitation: Still Looking Through a Dark Glass. J Am Coll Cardiol 2019; 73:1916-1918. [PMID: 30999994 DOI: 10.1016/j.jacc.2019.02.026] [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: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Jeffrey S Borer
- College of Medicine, School of Public Health, SUNY Downstate Medical Center, Brooklyn, New York; Weill Cornell Medicine, New York, New York.
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19
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Paech C, Wagner F, Karthe B, Bakthiary F, Gebauer RA. A novel technique for lead sparing tricuspid valve replacement in the case of a transvenous ICD lead. Clin Case Rep 2018; 6:1588-1591. [PMID: 30147910 PMCID: PMC6099035 DOI: 10.1002/ccr3.1648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/22/2018] [Revised: 05/18/2018] [Accepted: 05/23/2018] [Indexed: 11/29/2022] Open
Abstract
Tricuspid valve (TV) surgery represents a complex consideration regarding lead management in patients with a transvenous ICD. The presented case shows favorable short-term results after lead sparing TV replacement, leaving an ICD lead in a paravalvular position. The described technique can be used in challenging cases of TV replacement.
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Affiliation(s)
- Christian Paech
- Department for Pediatric CardiologyUniversity of Leipzig ‐ Heart CenterLeipzigGermany
| | - Franziska Wagner
- Department for Pediatric CardiologyUniversity of Leipzig ‐ Heart CenterLeipzigGermany
| | - Bianca Karthe
- Department for Pediatric CardiologyUniversity of Leipzig ‐ Heart CenterLeipzigGermany
| | - Farhad Bakthiary
- Department for cardiac surgeryHELIOS Heart Center SiegburgSiegburgGermany
| | - Roman Antonin Gebauer
- Department for Pediatric CardiologyUniversity of Leipzig ‐ Heart CenterLeipzigGermany
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20
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Çakıcı M, Özçınar E, Baran Ç, Gümüş F, Durdu MS, İnan MB, Eryılmaz S, Akar AR. Tricuspid valve surgery in implantable cardiac electronic device-related endocarditis: Repair or replace? Turk Gogus Kalp Damar Cerrahisi Derg 2018; 26:183-91. [PMID: 32082733 DOI: 10.5606/tgkdc.dergisi.2018.14790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/30/2017] [Indexed: 11/21/2022]
Abstract
Background The aim of this study was to investigate lead endocarditis-related tricuspid valve regurgitation, to identify underlying causes, and to report our surgical approaches to tricuspid valve endocarditis. Methods Between March 2010 and August 2016, medical records of a total of 43 patients (23 males, 20 females; mean age: 63.2±13.6 years; range 48 to 72 years) who underwent tricuspid valve surgery for severe tricuspid regurgitation caused by lead endocarditis, which was previously placed as an implantable cardiac electronic device were reviewed. We removed all systems including infected leads and generators, revised infected wounds and tissues, performed tricuspid valve surgery for lead endocarditis, and applied long-term intravenous antibiotic regimen for the culprit agent, as confirmed by the culture. Results Of 43 patients, 18 underwent tricuspid valve repair and 25 underwent tricuspid valve replacement for lead endocarditisrelated severe tricuspid valve regurgitation. During followup (range, 2 to 62 months), two patients required temporary mechanical support due to postoperative acute right heart failure, while eight patients died due to sepsis (n=6; 14%) and stroke (n=2; 4.6%) in the early postoperative period. The remaining patients showed significant improvement in signs and symptoms of heart failure. Conclusion Our study results suggest that incompetent experience and inaccurate decision for valve repair may result in delayed valve replacement and prolonged operation time.
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Lucchese G, Rossetti L, Faggian G, Luciani GB. Long-Term Follow-Up Study of Temporary Tricuspid Valve Detachment as Approach to VSD Repair without Consequent Tricuspid Dysfunction. Tex Heart Inst J 2016; 43:392-396. [PMID: 27777518 DOI: 10.14503/thij-14-4797] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Temporary tricuspid valve detachment improves the operative view of certain congenital ventricular septal defects (VSDs), but its long-term effects on tricuspid valve function are still debated. From 2002 through 2012, we performed a prospective study of 68 children (mean age, 1.28 ± 1.01 yr) who underwent transatrial closure of VSDs following temporary tricuspid valve detachment. Sixty patients had conoventricular and 8 had mid-muscular VSDs. All were in sinus rhythm. Seventeen patients had systemic pulmonary artery pressures. Preoperative echocardiograms showed trivial-to-mild tricuspid regurgitation in 62 patients and tricuspid dysplasia with severe regurgitation in 6 patients. Patients were clinically and echocardiographically monitored at 30 postoperative days, 3 months, 6 months, every 6 months thereafter for the first 2 years, and then once a year. No in-hospital or late death was observed at the median follow-up evaluation of 5.9 years. Mean intensive care unit and hospital stays were 1.6 ± 1.1 and 7.3 ± 2.7 days, respectively. Residual small VSDs occurred in 3 patients, and temporary atrioventricular block in one. After VSD repair, 62 patients (91%) had trivial or mild tricuspid regurgitation, and 6 moderate. Five of these last had severe tricuspid regurgitation preoperatively and had undergone additional tricuspid valve repair during the procedure. The grade of residual tricuspid regurgitation remained stable postoperatively, and no tricuspid stenosis was documented. All patients were in New York Heart Association class I at follow-up. Temporary tricuspid valve detachment is a simple and useful method for a complete visualization of certain VSDs without incurring substantial tricuspid dysfunction.
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