Tricuspid Valve Repair Research Articles

"Beyond 2D Echocardiography: A Novel Multiparametric Assessment of Right Ventricular Dysfunction in Transcatheter Tricuspid Valve Repair".

Right ventricular (RV) heart failure as assessed by RV to pulmonary artery coupling (RVPAc) is a prognostic marker in transcatheter tricuspid valve repair (T-TEER). However, quantification of RVPAc components by 2D echocardiography in patients with severe tricuspid regurgitation (TR) has significant limitations, and the traditional RVPAc parameter neglects the degree of volume overload/dilatation of the RV, which is another key clinical indicator for right ventricular dysfunction (RVD).Therefore, we aimed to assess RVD by a novel RVPAc parameter, including the three important drivers of RVD, for an improved prediction of 1-year mortality after T-TEER. We analyzed 262 patients undergoing T-TEER with complete 3D RV echocardiography and 1-year follow-up. Increased 3D-RV enddiastolic volume (3D-RVEDV: HR 1.85; 1.10-3.12; p=0.020) and impaired RV free wall longitudinal strain (RVFWLS: hazard ratio (HR) 1.73, 1.02-2.92, p=0.042) predicted 1-year mortality. A novel RVPAc parameter [RVFWLS/(3D-RVEDV*sPAPinvasive)] including all 3 important drivers for RVD was developed, associating RVPA-uncoupling with a tripled risk for 1-year mortality (HR 3.19, 1.7-6.0, p<0.001). The novel RVPAc parameter significantly outperformed the traditional non-invasive RVPAc parameter in 1-year mortality prediction (c-index: 0.68 vs. 0.57 for novel vs. traditional non-invasive RVPAc; p=0.027). The novel RVPAc parameter, integrating RV function, volume stress, and pressure stress is a powerful metric for RV failure and a superior predictor for survival post-T-TEER.

Pressure-strain-volume analysis-derived wasted work predicts clinical outcomes after transcatheter tricuspid valve intervention

Abstract Background The pressure-strain loop is a non-invasive alternative to the traditional pressure-volume analysis for calculating myocardial work. Incorporating volume into work calculations may be particularly beneficial in evaluating patients with tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve intervention (TTVI), who often present with highly varied load conditions. Purpose The study aimed to test the hypothesis that pressure-strain-volume analysis-derived right ventricular (RV) work will predict the composite clinical outcome of heart failure hospitalization (HFH) and death within 12 months after the TTVI. Methods Patients undergoing TTVI at two tertiary centers were included between June 2021 and November 2023. The pre-procedural three-dimensional echocardiographic acquisitions of the RV (to obtain RV volumes and global longitudinal strain) and RV pressures obtained from same day, pre-procedural right heart catheterization or calculated from TR maximal velocity and right atrial pressure were integrated into pressure-strain-volume loops using dedicated software (ReVISION, Argus Cognitive, USA). The pressure-strain-volume derived myocardial work was quantified as the volume under the three-dimensional curve and characterized by the following metrics: global work index (GWIV), global constructive work (GCWV), global wasted work (GWWV), and global work efficiency (GWEV). Conventional pressure-strain analysis-derived metrics were also calculated as previously described (1). The composite outcome was HFH or death within 12 months after TTVI. Cox regression analysis was performed to investigate the possible associations with the composite outcome and included all baseline clinical, echocardiographic, hemodynamic and RV work parameters. Variables were considered for multivariate analysis when they were related to composite endpoint on univariate analysis with a p value &amp;lt;0.05. Results Of 76 patients included, 52.6% were female. The mean age was 79.3 ± 7.5 years and median TRI-Score 5 [4-7] points. Transcatheter interventions included transcatheter tricuspid valve repair (61.8%) and tricuspid valve replacement (38.2%). TR at discharge was trace/mild, moderate, severe or massive in 60.6%, 26.3%, 13.2% and 0% cases respectively. At 12-month follow-up, 26 (34.2%) patients met the composite endpoint. After adjustment for number of HFH 12 months prior to TTVI, atrial fibrillation, glomerular filtration rate and NT-proBNP, GWWV remained the only baseline parameter significantly associated with increased risk of HFH and death at 12-month follow-up in the multivariate analysis with an adjusted OR of 1.079 (95% confidence interval 1.020 - 1.143; p = 0.009). Conclusion Results of this analysis show that baseline pressure-strain-volume analysis-derived wasted work identifies patients at higher risk for HFH or death following TTVI. Thus, the GWWV calculation may help identify individuals who are more likely to benefit from TTVI.

Posterior Chordae Rupture of the Tricuspid Valve due to Myocardial Infarction: A Rare Entity Among Tricuspid Valve Pathologies

The tricuspid valve is rarely affected by myocardial infarction. The right ventricle has a lower systolic pressure compared to the left ventricle making the papillary muscles of the tricuspid valve more resistant to ischemia. The right coronary artery is the main blood supply to tricuspid papillary muscles, chordae rupture of the tricuspid valve may occur following myocardial infarction. Here, we present a rare case of a 70-year-old male with severe tricuspid regurgitation, a completely occluded right coronary artery (RCA), 70% stenosis of the left main coronary artery (LMCA), and 100% occlusion of the left anterior descending artery (LAD). The patient’s ejection fraction (EF) was reduced to 30%. Treatment included tricuspid valve repair using the bicuspidization technique and a five-vessel coronary artery bypass graft (CABG). This case demonstrates that, although rare, myocardial infarction can involve the tricuspid valve and that the surgery of the valve with full revascularization proved to be an effective treatment strategy in our patient.

Anesthesia Considerations for Transcatheter Tricuspid Valve Repair and Replacement

Anesthesia Considerations for Transcatheter Tricuspid Valve Repair and Replacement

Real-World Experience in Tricuspid Transcatheter Edge-to-Edge Repair: Transcatheter Tricuspid Valve Repair in Spain Registry.

Significant tricuspid regurgitation (TR) is associated with increased morbidity and mortality. The development of transcatheter valve repair therapies has opened a wide range of opportunities for treatment of patients with high surgical risk. Real-world data might improve patient selection and outcome. The authors sought to investigate acute and short-term cardiovascular outcomes of tricuspid transcatheter edge-to-edge repair (T-TEER) with dedicated devices in a real-world setting. This is a retrospective, single-arm, multicenter registry conducted at 15 sites in Spain. The primary end point was a composite of all-cause death, rehospitalization for heart failure, and tricuspid valve re-intervention. Patients included (n=283) were older (76±9 years, 70% female), and showed significant comorbidities. Massive or torrential TR was present in 55% of subjects, with secondary cause being the main mechanism of regurgitation in ≈80% of individuals. Intraprocedural success was achieved in 79% of patients. At 1-year follow-up, significant improvements in TR grade (≥3+, 100% to 25%, P <0.001) and New York Heart Association functional class (I/II, 33%-86%, P <0.001) were observed. Lead-induced cause and single leaflet device attachment emerged as independent predictors of at least severe predischarge residual TR. In-hospital mortality occurred in 4 (1.4%) patients, whereas the Kaplan-Meier estimated 1-year primary end point occurrence rate was 21%. Intraprocedural success (hazard ratio, 0.353 [95% CI, 0.156-0.798]; P=0.012), was found to be an independent predictor of primary end point. In a real-world contemporary setting, tricuspid transcatheter edge-to-edge repair with dedicated devices emerged as effective therapeutic option for patients with severe TR.

Heart Transplantation Outcomes for Fontan Patients When Using Contemporary Strategies: Heart-Liver Transplantation and Ventricular Assist Device Therapy.

With an increasing number of Fontan patients surviving into adulthood, the burden of end-stage heart failure is increasing. Prior studies have reported suboptimal heart transplantation (HTx) outcomes. Therefore, the authors describe their institutional experience of HTx in patients with Fontan circulation failure, including en-bloc heart-liver transplantation (HLTx) and pretransplant systemic ventricular assist device (SVAD) therapies. All consecutive Fontan-palliated patients undergoing HTx or HLTx between 2013 and 2022 at the authors' institution were included. Pretransplant characteristics and posttransplant outcomes were recorded. Twenty-six transplant recipients, including 5 (19%) HLTx recipients, were identified. The majority (n = 16, 62%) of patients had a cardiac diagnosis of hypoplastic left heart syndrome. Seven (26%) patients were bridged to transplant on an SVAD; the median duration of support was 104 [IQR 39-543] days. Transplantation occurred at a median of 10.6 [IQR 6.8-15.6] years post-Fontan. Fourteen (54%) patients had ≥1 in-hospital complication and 4 (15%) patients required an in-hospital reoperation. Postdischarge reinterventions included tricuspid valve repair (n = 1, 4%) and retransplantation (n = 1, 4%). Two (8%) in-hospital mortalities [22 days (post-HLTx), 2.9 months (post-HTx] and 4 (15%) postdischarge mortalities [5.4 months, 3.1 years, 5.7 years, 7.1 years (all post-HTx)] occurred. Overall survival was excellent, with in-hospital, one-year, and five-year actuarial survival being 92%, 89%, and 80%, respectively. The current series demonstrates that excellent posttransplant outcomes are achievable for patients with Fontan circulation failure using a comprehensive approach including SVAD and HLTx therapies. Pretransplant optimization, sometimes including SVAD implantation, and meticulous operative planning are imperative strategies for successful patient outcomes.

Predictive value of CT-based and AI-reconstructed 3D-TAPSE in patients undergoing transcatheter tricuspid valve repair.

The tricuspid annular plane systolic excursion (TAPSE) assessed by echocardiography has failed in predicting outcomes in patients with severe tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve intervention (TTVI). Considering the complex shape of the tricuspid annulus and right ventricle, as well as the difficult echocardiographic image acquisition of the right heart, cardiac computed tomography (CT) might be superior for the analysis of the annular excursion. Thus, this study aimed to analyze whether CT-captured TAPSE provides additional value in predicting outcomes after TTVI. For TTVI procedure planning, 75 patients (mean age, 77 ± 8 years; 61% female) with severe TR underwent full cardiac cycle CT. Septal, lateral, anterior, and posterior TAPSE, as well as TAPSE- volume, were analyzed. Indexed anterior and posterior (iTAPSE) and TAPSE volume were reduced in patients with right ventricular ejection fraction <45%. At 1 year after TTVI (mean follow-up, 193 ± 146days), the combined endpoint of death and rehospitalization occurred in significantly fewer patients with posterior iTAPSE >4.5 mm/m2 (17.2% vs. 63.6%; HR 0.225, CI 0.087-0.581; P < 0.001) and in patients with iTAPSE volume >9 ml/m2 (16.4% vs. 57.1%; HR: 0.269 CI 0.105-0.686; P = 0.003). Echocardiographic TAPSE correlated best with lateral CT-based TAPSE, although both failed in predicting outcomes after TTVI. In multivariate Cox regression, posterior iTAPSE was found to be a significant predictor of outcome 1 year after TTVI. Posterior iTAPSE is an independent predictor of cardiovascular outcomes among patients undergoing TTVI. Furthermore, CT-measured TAPSE has incremental value and refines risk stratification for clinical outcomes in patients undergoing TTVI.

Minimally invasive trans-axillary approach and ultra-fast-track management: a new paradigm for mitral valve disease treatment

The introduction of transcatheter procedures has focused on patient expectations for treatments with a less invasive approach and faster recovery. The aim of this study was to assess the short- and medium-term results in patients who underwent trans-axillary mitral valve repair with application of the ultra-fast-track protocol. Data from 431 patients undergoing isolated trans-axillary mitral valve repair or associated with tricuspid valve treatment between January 2018 and December 2023 were prospectively collected. The mean age of the population was 63 ± 11 years and the average EuroSCORE II was 1.21 ± 1%. Mitral valve repair for degenerative mitral regurgitation was performed in 93.3% of cases. In 52 cases (12.6%) concomitant tricuspid valve repair was performed. The 30-day mortality rate was 0.2% (n=1), the postoperative stroke rate was 0.2% (n=1). A total of 351 patients (81.4%) were extubated within 6 h of the procedure; in 218 cases (50.6%) extubation occurred in the operating room, at the end of the surgical treatment. Overall, 70.8% (n=305) of patients left the intensive care unit on the first postoperative day; 222 patients (51.6%) were discharged home without the need for any further rehabilitation. Postoperative mitral regurgitation was absent/negligible in 97% of cases (n=418). Survival at 1 year and 5 years was 98.9% and 97.9%, respectively. The trans-axillary approach for mitral valve repair was associated with low rates of in-hospital mortality and postoperative complications. The application of our ultra-fast-track protocol in more than 80% of cases allowed early extubation, short intensive care unit stay and reduced hospitalization with a high rate of patients able to be discharged home with no need of any further period of rehabilitation. The medium-term outcomes support the safety and efficacy profile of the trans-axillary approach.

The multi-center mid-term clinical outcomes of combined complete preservation of chordal structure mitral valve replacement with total anatomic complete arterial myocardial revascularization for coronary patients with moderate-to-severe or severe ischemic mitral regurgitation

Objective: To evaluate the clinical outcomes of combined complete preservation of chordal structure mitral valve replacement (C-MVR) with total anatomical arterial myocardial revascularization (TACR) in coronary patients with moderate-to-severe or severe ischemic mitral regurgitation (IMR). Methods: This is a retrospective multi-center case series study. Data were retrospectively collected from 127 patients with coronary artery disease with moderate to severe or severe IMR who received TACR with C-MVR from July 2015 to April 2024 in 13 hospitals in China. There were 90 males and 37 females, aged (56.5±10.7) years (range: 33 to 74 years). Perioperative data and follow-up data including left ventricular ejection fraction, left ventricular end-diastolic diameter, and patency rate of arterial grafts of patients were collected. Comparisons were made using paired sample t-test or χ2 test. Results: In this cohort of 127 patients, 67 underwent concurrent tricuspid valve repair. During surgery, 113 grafts of the left internal mammary artery (LIMA), 127 grafts of the left radial artery, 80 grafts of the right radial artery, and 110 grafts of the right internal mammary artery (RIMA) were harvested. The number of the distal anastomosis was 4.2±0.4 (range: 3 to 5). The aortic cross-clamp time and cardiopulmonary bypass time were (97.5±23.4) minutes (range: 90 to 161 minutes) and (145.4±19.2) minutes (range: 101 to 210 minutes), respectively. There was one operative death. Intraoperative placement of an intra-aortic balloon pump was performed in 21 patients to improve the left ventricular ejection. No sternal ischemic occurred. All patients completed follow-up, with a mean follow-up period of (64.3±7.5) months (range: 4 to 110 months). No major cerebrovascular events occurred during the follow-up period, and all patients survived. Left ventricular ejection fraction improved postoperatively (55.0%±5.3% vs. 41.0%±15.3%, t=17.23, P<0.01). The proportion of patients with New York Heart Association functional class ≤2 increased postoperatively (23.6% (30/127) vs. 87.3% (110/126), χ²=103.77, P<0.01). The proportion of patients with Canadian Cardiovascular Society Angina Classification ≤3 decreased postoperatively (4.8% (6/126) vs. 78.7% (100/127), χ²=142.19, P<0.01). The left ventricular end-diastolic diameter decreased postoperatively ((5.70±4.50) cm vs. (6.10±0.23) cm, t=12.15, P<0.01). Coronary multi-detector computed tomography angiography (MDCTA) follow-up was conducted for (60.5±11.7) months (range: 6 to 109 months) postoperatively. MDCTA confirmed the patency rates of the grafts: 96.4% (108/112) for the LIMA grafts, 88.9% (112/126) for the left radial artery grafts, 93.7% (74/79) for the right radial artery grafts, and 90.9% (100/110) for the free RIMA grafts. No significant differences in graft patency rates were observed between the arterial grafts (χ²=5.24, P=0.155). Conclusion: The results of this multi-centre study demonstrate satisfactory mid-term results of C-MVR with TACR for the treatment of coronary artery disease with moderate to severe or severe IMR.

Advancements in the Diagnosis and Surgical Management of Ebstein’s Anomaly: A Comprehensive Review

Ebstein’s anomaly is a rare congenital heart defect characterized by the apical displacement of the septal and posterior leaflets of the tricuspid valve, resulting in atrialization of the right ventricle and significant hemodynamic disturbances. This anomaly often presents with a spectrum of clinical manifestations, ranging from asymptomatic cases to severe heart failure and cyanosis in neonatal life. The diagnostic process has been significantly enhanced by advancements in echocardiography, magnetic resonance imaging (MRI), and electrocardiographic techniques, enabling early detection and detailed assessment of structural abnormalities. Treatment strategies for Ebstein’s anomaly are tailored according to the severity of the condition and patient age. While mild cases may be managed conservatively, severe forms necessitate surgical interventions, including tricuspid valve repair or replacement, bidirectional Glenn shunt, and occasionally the Fontan procedure. Novel approaches, such as cone repair, have shown promising outcomes in improving valve function and overall cardiac performance. This review article provides a detailed exploration of the pathophysiology, clinical manifestations, diagnostic advancements, and therapeutic options for Ebstein’s anomaly, with an emphasis on surgical innovations.

ECMO in the Management of Noncardiogenic Pulmonary Edema with Increased Inflammatory Reaction After Cardiac Surgery: A Case Report and Literature Review.

Noncardiogenic pulmonary edema after cardiac surgery is a rare but severe complication. The etiology remains poorly understood; however, the issue may arise from multiple sources. Possible causes include a significant inflammatory response or an autoimmune process. Pulmonary edema resulting from noncardiac etiologies can necessitate extracorporeal membrane oxygenation (ECMO) because most of the cases present a substantial volume of fluid expelled from the lungs and the medical team must manage the inability to achieve effective ventilation. A 64-year-old patient with known heart disease was admitted to our clinic with acute pulmonary edema. His medical history included Barlow's disease, severe mitral regurgitation (IIP2), moderate-severe tricuspid regurgitation, and moderate pulmonary hypertension. The patient had a coronary angiography performed in a prior hospitalization before the surgical intervention which indicated the absence of coronary lesions. Preoperative screening (nasal, pharyngeal exudate, inguinal pouch culture, and urine culture) was negative, with no active dental infections. The patient was stabilized, and 14 days post-admission, mitral and tricuspid valve repair was performed via a thoracoscopic approach. After being admitted to intensive care post-surgery, the patient quickly developed pulmonary edema, producing a large volume (4.5 L) of yellow secretions through the intubation tube followed by hemodynamic instability necessitating high doses of medications to support circulation but no cardiorespiratory arrest. Due to his worsening condition, the patient was urgently taken back to the operating room, where veno-venous extracorporeal membrane oxygenation (VV-ECMO) was initiated to support oxygenation and stabilize the patient.

Long-term outcomes with medical therapy, transcatheter repair, or surgery for isolated tricuspid regurgitation: a systematic review and network meta-analysis.

Several transcatheter tricuspid valve (TV) repair devices for tricuspid regurgitation (TR) have emerged. However, few studies have compared transcatheter TV repair with medical therapy (MT) alone or isolated TV surgery. PubMed and EMBASE were searched in February 2024. Studies comparing at least any of the following 2 were included: MT, surgical TV repair, surgical TV replacement, or transcatheter TV repair. The primary outcome was long-term mortality (≧ 1year). The secondary outcomes were short-term mortality (30-day or in-hospital mortality) and periprocedural complications. We performed a network meta-analysis using a random effects model. A total of 25,831 patients from 22 studies (one randomized trial and 21 observational studies) were included. MT alone was associated with higher long-term mortality compared to surgical TV repair (HR [95% CI] 1.72 [1.34-2.23]), surgical TV replacement (HR [95% CI] 1.49 [1.14-1.96]), and transcatheter TV repair (HR [95% CI] 1.52 [1.30-1.78]). Long-term mortality was comparable between transcatheter and surgical interventions. Transcatheter TV repair had a lower risk of short-term mortality (versus surgical TV repair; RR [95% CI] 0.40 [0.22-0.72], versus surgical TV replacement; RR [95% CI] 0.35 [0.19-0.66]) and lower rates of periprocedural complications, including new pacemaker implantation, renal complications, cardiogenic shock than surgical interventions. MT alone for TR was associated with higher long-term mortality compared to surgical or transcatheter TV interventions. Transcatheter TV repair had better periprocedural outcomes compared to surgical interventions with similar long-term mortality. Despite the possibility of selection bias, transcatheter TV repair appears to be an attractive option for TR treatment.

A Comparison of Early and Medium-term Results of De Vega Annuloplasty and Ring Annuloplasty Techniques for the Tricuspid Valve Repair in Patients Undergoing Mitral Valve Replacement

Objectives: Tricuspid regurgitation is a pathology that usually occurs secondary to left heart pathologies and affects the daily activities of the patients. The long-term results of tricuspid valve replacement are not very encouraging. Therefore, the primary treatment for tricuspid valve regurgitation is repair. Therefore, which repair method should be used is very critical. The aim of our study is to compare tricuspid valve De Vega annuloplasty (TDVA) and tricuspid valve ring annuloplasty (TRA) methods, which are frequently used in tricuspid regurgitation (TR). Methods: Patients who underwent TDVA or TRA in addition to mitral valve replacement at our hospital between January 01, 2017, and December 31, 2019 were included in the study. The study was designed retrospectively and was based on hospital database, patient files, and archive records. A total of 125 patients were included in the study. The pre-operative, intraoperative, and post-operative clinical features of the patients were investigated, and their cardiac status at the last follow-up visit to the hospital was investigated. Results: In the early post-operative and mid-term evaluation, TR was similar in both groups. Conclusion: There is no difference between TRA and TDVA techniques in terms of the recurrence of tricuspid valve insufficiency in the early and mid-term post-operative period. Both techniques are not perfect, and there is a need for the development of new strategies and techniques.

Early results of female patients who underwent mitral valve surgery through periareolar incision approach.

Approaches that require less invasive procedures, offer heal in a shorter time and provide better cosmetic results have gained importance with the technological and modern developments in cardiac surgery. Esthetically preferred results can be achieved after heart valve surgery using a periareolar incision, especially in female patients. In the present study, we aimed to present our results after surgery using periareolar incision in female patients. We retrospectively evaluated the 1-year follow-up results in the postoperative period of isolated mitral valve replacement and tricuspid valve repair with mitral valve replacement using a periareolar incision with direct observation in 32 patients between 2020 and 2023. At the end of 1-year follow-up, we evaluated the patients' visual satisfaction with the incision site using a visual analog scale. According to the postoperative follow-up results, no prosthetic mitral valve dysfunction was detected in any of the patients at the 1st year echocardiography controls. Mild tricuspid valve insufficiency was detected in 3 patients who underwent tricuspid valve repair. Besides, a high level of satisfaction was observed in the patients' incision site evaluations with a visual analog scale at the end of the first year, and no numbness was reported in the periareolar region in any of the patients. Our study shows that surgical results similar to conventional methods can be achieved with the periareolar approach, and patient satisfaction and recovery times are shorter and more satisfying. We also think that the periareolar incision can be made without videoassisted equipment and this may reduce the surgical cost.

Sex Differences Among Patients Undergoing Transcatheter Tricuspid Valve Repair Using the Edge-to-Edge Technique.

Tricuspid valve regurgitation (TR) is more prevalent among females. Transcatheter tricuspid valve repair (TTVR) using the edge-to-edge technique represents an alternative to surgery in patients with severe TR and high surgical risk. This study aims to investigate sex differences among patients undergoing TTVR. All patients who underwent TTVR at our center were retrospectively included. We compared baseline characteristics, intra-hospital, and one-year outcomes between males and females. A total of 105 consecutive patients underwent TTVR. Females were more prevalent in the study cohort (n = 63, 60%). Coronary artery disease (CAD) was more evident in males than females (71.4% vs. 47.6%, p = 0.016). Left ventricular ejection fraction (LVEF) was also worse in males (48.8 ± 13.4 vs. 58 ± 6.8, p < 0.001). Other clinical characteristics were similar between both groups. The Success of the procedure (88.1% vs. 95.2%, p = 0.177) and intra-hospital mortality (4.8% vs. 11.1%, p = 0.255) were similar among males and females. At one-year follow-up, mortality was similar between both groups (24.3% vs. 25.9%, p = 0.863). Furthermore, hospitalization due to acute heart failure was also similar between both groups (40.5% vs. 37.5%, p = 0.768), as was a composite endpoint of death or hospitalization. In patients with successful procedures and who survived one year, TR severity was comparable between both groups. In our real-world cohort, more females underwent TTVR than males. No difference was observed in outcomes between males and females at one-year follow-up.

Transcatheter Tricuspid Regurgitation Repair-An Overview of Techniques and Eligible Patient Selection.

Tricuspid regurgitation (TR) is frequently encountered in clinical practice. It is classified into primary TR (organic), which accounts for a minority of cases; and into secondary TR (functional), which has a higher prevalence. Although it can be asymptomatic for a long time, TR causes right ventricle dysfunction and increases hospitalizations for heart failure and mortality. In most patients with severe, isolated TR, surgery is not indicated due to the high surgical risk. In the last 10 years, transcatheter tricuspid valve repair became feasible with the following good results: reduction in TR severity, reverse remodeling of the right heart chambers, improvement in symptoms and reduction in hospitalization time. This paper presents the main transcatheter techniques and data from relevant trials that used these techniques, focusing on patient characteristics that define eligibility and high probability of repair. Information is provided regarding the observed benefits and the complications.

Abstract 4125497: Diagnostic Discrepancies Revealed by Explant Pathology at the Time of Cardiac Transplant in Patients Clinically Diagnosed with Nonischemic Cardiomyopathy: Role of Cardiac Magnetic Resonance Imaging

Background: Differentiating between causes of non-ischemic cardiomyopathy is important for disease-directed treatment. Cardiac MRI (CMR) and the use of late gadolinium enhancement (LGE) have proven useful for enhancing diagnostic accuracy. Definitive assessment of cardiomyopathy etiology by explant pathology facilitates direct evaluation of CMR utility. Hypothesis: We hypothesized direct comparison between pre-transplant (Tx) CMR and explant pathology will improve the characterization of undifferentiated cardiomyopathy through examination of cases where pre- and post-Tx diagnoses were discordant. Aims: To evaluate discrepant cases to describe imaging patterns in relation to post-Tx diagnosis. Methods: Institutional Tx recipients between 2000 and June 2023 were queried for pre-Tx MRI (n=122). Discrepant cases were identified (n=8). Pre-Tx diagnostic modalities, including CMR, were reviewed, and CMR patterns were evaluated in association with ultimate explant diagnosis. Results: Of the eight patients with discrepant diagnoses, five carried clinical diagnosis of dilated cardiomyopathy, one hypertrophic cardiomyopathy, one peripartum cardiomyopathy, and one congenital heart disease having undergone tricuspid valve and ASD repair. Pathologic evaluation most frequently identified biventricular or left ventricular arrhythmogenic cardiomyopathy (ARVC) (n=6), where CMR disclosed a diffuse pattern of subepicardial LGE and pre-Tx diagnosis of DCM was most common. Two of these pathologic descriptions represented a different disease on genetic evaluation: one patient had Danon disease, another had a LMNA pathogenic variant. The presumed peripartum cardiomyopathy was identified as Fabry’s disease on pathology (however, genetic testing consistent with Danon disease). Both Danon disease patients had primarily subendocardial LGE on CMR. One patient with a DCM phenotype had HCM pathologically. Results summarized in Table 1. Conclusions: Cardiac MRI can be a useful modality for the evaluation of underlying cardiomyopathy and should prompt appropriate genetic testing. Diffuse subepicardial LGE frequently accompanied the diagnosis of ARVC whereas a non-subepicardial pattern reflected alternative etiologies identified only through genetic testing.

Preoperative Predictors of Recurrent Tricuspid Regurgitation After Annuloplasty: Insights into the Role of 3D Echocardiography.

While tricuspid annuloplasty (TAP) is an effective treatment option for tricuspid regurgitation (TR), understanding the echocardiographic factors contributing to recurrent TR can help in developing more effective preventive measures to reduce the rate of recurrent TR after TAP. This study was designed as a prospective observational cohort study to investigate factors contributing to recurrent TR following surgical tricuspid valve (TV) repair in patients with moderate or severe functional TR caused by left heart valvular disease, with severe mitral regurgitation as the dominant pathology. The study included 66 patients who underwent preoperative two-dimensional (2D) and three-dimensional (3D) echocardiographic assessments. Patients were divided into two groups based on TAP outcomes: the effective TAP group and the recurrent TR group. The analysis revealed that 3D-derived both septal-lateral diastolic and systolic tricuspid annulus (TA) diameter (odds ratio (OR) 1.77; 95% confidence interval (CI) 1.17-2.68 and OR 1.62; 95% CI 1.14-2.29, respectively), and major axis diastolic TA diameter (OR 1.59; 95% CI 1.15-2.2) had the highest OR among all echocardiographic parameters. The further univariate analysis of predefined echocardiographic values unveiled that the combined effect of heightened 3D-measured TA major axis diastolic diameter and increased right ventricle (RV) basal diameter exhibited the highest OR at 12.8 (95% CI 2.3-72.8) for a recurrent TR. Using ROC analysis, diastolic major axis (area under the curve (AUC) 0.848; cut-off 48.5 mm), septal-lateral systolic (AUC 0.840; cut-off 43.5 mm) and diastolic (AUC 0.840; cut-off 46.5 mm) TA diameter demonstrated the highest predictive value for recurrent TR from all TV parameters. Recurrent moderate or severe TR after TAP is associated with preoperative TA size, right atrium and RV geometry, but not with changes of RV function. The predictive capacity of 2D-assessed echocardiographic parameters was found to be lower when compared to their corresponding 3D parameters.

Contemporary Outcomes of Degenerative Mitral Valve Surgery in a Regional Tertiary Care Center.

Objective: As percutaneous mitral valve techniques become more prevalent, it is important to evaluate the contemporary outcomes of surgical mitral valve interventions. This study assessed the current results and procedural trends of mitral valve surgery for degenerative mitral regurgitation (DMR) at a regional tertiary care center. Methods: Data were analyzed from 693 consecutive DMR patients who underwent isolated mitral valve operations, with or without tricuspid valve repair and atrial fibrillation ablation between 2017 and 2024. The outcomes were defined according to MVARC criteria. The study endpoints included successful mitral valve repair, in-hospital results, and operative and long-term mortality. Logistic regression was applied to assess the impact of valve lesions and patient risk factors on the probability of valve repair. Survival was analyzed using Kaplan-Meier methodology. The follow up was 100% complete. Results: Mitral valve repair was performed in 90.9% of cases, with only 0.9% requiring the conversion to replacement due to unsuccessful repair. Posterior leaflet lesions had the highest success rate (93.4%), while anterior leaflet lesions had a lower rate (86.2%), with anterior pathology being a negative predictor of repair (OR 2.57, p = 0.02). The type of lesion (prolapse vs. flail), the commissural involvement, and the increased risk for SAM had no statistically significant impact on valve repair outcome. Less invasive transaxillary access was used in 63.2% of patients, and its adoption increased significantly (from 50.9% to 67.4% p = 0.03) over time, resulting in more frequent fast-track extubation and home discharges. The rate of in-hospital mortality was 0.6%, while the rate of 5-year survival was 95.5%. Conclusions: Contemporary surgical techniques for DMR lead to high repair rates and excellent recovery outcomes. Despite the rise in transcatheter options, our findings confirm that surgery remains the gold standard for most DMR patients.

Impact of Optimal Procedural Result After Transcatheter Edge-to-Edge Tricuspid Valve Repair: Results From TRI-SPA Registry

BackgroundProcedural success following tricuspid transcatheter edge-to-edge repair (TEER) has been defined variably over time; however, the consequences of achieving a tricuspid regurgitation (TR) grade of 0/1+ are still unclear. ObjectivesThis study aimed to assess the predictors and prognostic impact of achieving TR 0/1+ after TEER and its role in clinical events. MethodsThis multicenter registry included patients undergoing tricuspid TEER in 15 Spanish centers from June 2020 and May 2023. Patients were categorized into the following groups based on the TR grade after procedure: optimal (0/1+), acceptable (2+), and not acceptable (≥3+). The primary endpoint was the 1-year composite of all-cause death, heart failure hospitalization, and tricuspid reintervention. Secondary endpoints included each component of the primary endpoint assessed separately, NYHA functional class, and TR grade at follow-up. ResultsAmong 280 enrolled patients, 120 (42.9%) had residual TR 0/1+, 111 (39.6%) had residual TR 2+, and 49 (17.5%) had residual TR ≥3+. Patients with TR 0/1+ experienced lower rates of the primary endpoint (13% vs 20% vs 31%; log-rank P = 0.036). Residual TR ≥3+ was an independent predictor of primary endpoint (HR: 2.277; P = 0.044). Higher rates of NYHA functional class I or II and sustained TR reduction were seen in the TR 0/1+ group (P < 0.001 for both). A small coaptation gap and absence of septal leaflet tethering were independent predictors of achieving TR 0/1+. ConclusionsAn optimal procedural result after TEER might be associated with improved outcomes. TR coaptation gap and leaflet restriction may aid in assessing suitability for TEER.