Treatment Of Severe Tricuspid Regurgitation Research Articles

Lancisi’s Sign After Implantation of a Pacemaker

Summary Tricuspid regurgitation is a common finding following implantation of a pacemaker or defibrillator lead in the right ventricle. Occasionally this may result in severe tricuspid regurgitation with clinical findings including C-V waves in the JVP known as Lancisi’s sign. It is important to be aware of the relationship, mechanism and treatment of severe tricuspid regurgitation as a result of a lead in the right ventricle.

Transcatheter tricuspid valve intervention: a practical algorithm for patient selection.

Worldwide experience in transcatheter tricuspid valve intervention is increasing as more options become available for the treatment of severe tricuspid regurgitation. These devices can be categorized by their primary mechanism of action, including edge-to-edge leaflet devices, space occupying devices, annuloplasty devices, complete valve replacement and caval valve implantation. This review summarizes the current technologies in use, early clinical results and factors that may affect procedural success. Almost all transcatheter devices for tricuspid regurgitation are investigational with very limited evidence. The most commonly used device is the MitraClip (Abbott, Santa Clara, CA, USA) edge-to-edge leaflet device, which is often more effective when the leaflet coaptation gap is not too large (ideally under 7 mm). The Tricuspid Cardioband (Edwards Lifesciences, Irvine, CA, USA) annuloplasty device has CE mark approval with promising short-term procedural results. Guideline-based assessment of disease severity and medication optimization is crucial during heart team evaluation of eligibility for intervention. Although important lessons have been learned thus far regarding patient and device selection for transcatheter tricuspid regurgitation interventions, the field remains young and further research is needed to optimize treatment in terms of who, when and with what device. Our proposed algorithm for patient selection based on current knowledge incorporates both clinical and anatomic factors.

Short- and long-term outcomes of surgery for severe tricuspid regurgitation: Algerian experience

There is little data available for Algeria on the outcomes of surgical treatment for severe tricuspid regurgitation. The aim of this study was to analyze clinical and echocardiographic outcomes in a series of patients who received surgical treatment for severe tricuspid regurgitation and to compare outcomes according to the operative approach to valve repair or replacement. Retrospective study in 239 consecutive patients with severe tricuspid regurgitation undergoing valve surgery between April 2006 and February 2014 in military hospitals of Algeria and Constantine. A total of 112 ringless and 85 ring annuloplasties were performed and 9 bioprostheses and 33 mechanical prostheses were implanted. Perioperative mortality was 18.5% and was associated with age and cardiopulmonary bypass time. During clinical follow-up (median, 41 [interquartile range, 24–89] months), 2 reoperations were required in the ring annuloplasty and mechanical prosthesis groups; prosthetic thrombosis was diagnosed in 4 patients in the latter group. Total mortality after follow-up was 29.9% and was associated with age >70 years and extracorporeal circulation time. The emergence of new severe tricuspid regurgitation was associated with age and ringless annuloplasty ( P = 0.04). Ringless repair was significantly associated with recurrence of severe tricuspid regurgitation. The use of mechanical prostheses was associated with a high rate of thrombosis. No significant differences in perioperative or total mortality were found between the different methods used for repair or valve replacement.

Clinical outcomes after tricuspid surgery : The role of previous cardiac surgery.

The aim of our study was to assess the outcomes of surgical treatment for severe tricuspid regurgitation according to whether cardiac surgery had been performed before the tricuspid valve intervention. Between 1996 and 2013, 201 consecutive patients with severe tricuspid regurgitation underwent tricuspid surgery at our center. Patients were classified according to whether or not they had undergone previous cardiac surgery, which 33% of the sample had. Perioperative as well as long-term morbidity and mortality were analyzed. Mean patient age was 62.3years. 32.8% underwent suture annuloplasty, 41.3% underwent ring annuloplasty, 15.4% received a bioprosthesis, and 10.4% received a mechanical prosthesis. There were no significant differences in perioperative mortality between the group that had not undergone previous cardiac surgery and the group that had (12.7% vs. 17.9%, respectively; p= 0.32). The long-term mortality rate (median follow-up time: 53months) was 43.3%. Long-term survival curves showed no significant differences between the two groups (p= 0.884), and previous cardiac surgery was not a predictive factor for long-term mortality (hazard ratio= 1.211; p= 0.521). In a series of patients who underwent tricuspid valve surgery, no significant differences were observed in perioperative mortality or in long-term survival according to whether or not subjects had undergone previous cardiac surgery.

TCT-73 Treatment of Severe TRIcuspid Regurgitation in Patients with Advanced Heart Failure with CAval Vein Implantation of the Edwards Sapien XT VALve (TRICAVAL): a controlled prospective randomized trial

Tricuspid regurgitation (TR) is a frequent comorbidity in patients with advanced heart failure and associated with high morbidity and mortality. Surgical repair carries a high risk for postoperative complications in these patients. Therefore, innovative interventional therapies of TR are an unmet

P1590Percutaneous systemic av-valve repair for the treatment of severe tricuspid regurgitation in patients with congenitally corrected transposition of the great arteries

P1590Percutaneous systemic av-valve repair for the treatment of severe tricuspid regurgitation in patients with congenitally corrected transposition of the great arteries

P1592Acute and short-term results of transcatheter treatment of severe tricuspid regurgitation using the Edge-to-Edge-repair system

P1592Acute and short-term results of transcatheter treatment of severe tricuspid regurgitation using the Edge-to-Edge-repair system

P1591Novel transcatheter repair system for the treatment of severe tricuspid regurgitation

P1591Novel transcatheter repair system for the treatment of severe tricuspid regurgitation

One-year results of transcatheter treatment of severe tricuspid regurgitation using the edge-to-edge repair technique.

One-year results of transcatheter treatment of severe tricuspid regurgitation using the edge-to-edge repair technique.

O2-5 - Surgical Outcome of Severe Tricuspid Valve Regurgitation Developed Long after Left-sided Valvular Surgeries

Background: Early surgical treatment for severe tricuspid regurgitation (TR) is recommended before right or left heart failure develops, however those who have developed severe TR late after left-sided valvular surgery are prone to be treated noninvasively because the risk of repeated surgery is concerned. Methods: Nine patients with severe symptomatic TR treated surgically in our hospital long after left-sided valvular disease were reviewed retrospectively. Results: Average age of the patients were 67 ± 4 years. Prior surgeries had been performed at their age of 37 ± 11 years, and heart failure symptoms had appeared 11 ± 8 years before subsequent surgeries. The second surgeries were performed with aortic valve replacement in 3, with mitral valve replacement in 4, and without left-sided valve surgery were in 2. None of the nine patients died perioperatively, however 4 patients died during a mean follow up period of 2.3 ± 1.7 years. Right heart catheterization was performed after surgery in 6 patients. Systolic regurgitant pressure of right atrium were prone to decrease (P = .66) and cardiac index increased significantly (P = .033), however mean pressure of right atrium and pulmonary artery wedge pressure increased considerably in some patients. Conclusion: Operative risk of surgical treatment for TR late after left-sided valvular surgery is not high, however long-term prognosis is poor with incomplete hemodynamic improvement in some patients.

Transcatheter Tricuspid Valve Repair With a New Transcatheter Coaptation System for the Treatment of Severe Tricuspid Regurgitation: 1-Year Clinical and Echocardiographic Results

ObjectivesThis study sought to describe the 1-year experience with the transcatheter FORMA system for severe tricuspid regurgitation (TR). BackgroundSevere TR is associated with significant morbidity and mortality. Novel transcatheter therapies have been recently developed. MethodsEighteen patients underwent device implantation at 3 centers in Canada and Switzerland. Baseline characteristics, procedural, 30-day, and 1-year outcomes were prospectively evaluated using multimodality imaging and hemodynamic and clinical assessments. ResultsProcedural success was achieved in 16 (89%) patients. Unsuccessful procedures were because of right ventricular perforation requiring open surgery and device dislocation. At 1 year there were no deaths, significant arrhythmias, device infections, or dislocations. Thrombus was observed on 1 device at 4 months and there was 1 rehospitalization for heart failure. Among the 14 patients with successful device implantation and 1-year follow-up, 79% were in New York Heart Association functional class I/II (p < 0.001), the average 6-min walk test increased by 84 m (p = 0.03), and the Kansas City Cardiomyopathy Questionnaire heart failure score improved by 18 points (p = 0.02) compared with baseline. Echocardiography showed a reduction of TR from severe in 17 of 18 (94%) patients at baseline to moderate-severe or less in 11 of 16 patients (69%) by 30 days (p = 0.001) and 6 of 13 patients (46%) by 1 year (p = 0.01). The diameters of the tricuspid annulus and the right ventricle were reduced at 1 year (45.7 ± 4.8 mm to 42.1 ± 4.4 mm, p = 0.004; 54 ± 5.3 mm to 49.9 ± 4.3 mm, p = 0.02, respectively). ConclusionsImplantation of the FORMA system in high-risk patients with severe TR shows feasibility with a good mid-term safety profile. At 1 year, despite variable success in reducing echocardiographic TR grade, there were significant clinical improvements and reductions in right ventricular dimensions.

P5429Prognostic value of pulmonary hypertension in patients who receive surgical treatment for severe tricuspid regurgitation

P5429Prognostic value of pulmonary hypertension in patients who receive surgical treatment for severe tricuspid regurgitation

4109Transcatheter treatment of severe tricuspid regurgitation with the edge-to-edge MitraClip technique

4109Transcatheter treatment of severe tricuspid regurgitation with the edge-to-edge MitraClip technique

Transcatheter treatment of severe tricuspid regurgitation using the edge-to-edge repair technique.

The aim of this study was to investigate the procedural feasibility and short-term durability of the transcatheter tricuspid valve edge-to-edge repair technique in highly symptomatic patients with severe tricuspid regurgitation (TR). Eighteen consecutive patients suffering from severe right-sided heart failure (NYHA Class III-IV), primarily due to moderate to severe tricuspid regurgitation, were included in the study. Applying a modified steering technique for the clip delivery system, six patients were treated for isolated severe TR, while 12 patients were treated for moderate to severe TR and concomitant severe mitral regurgitation. The primary objectives were procedural success, defined as reduction of at least one TR grade, and 30-day echocardiographic and clinical outcomes. A total of 41 clips (2.3±0.7 per patient) were placed into the tricuspid valve of high surgical risk patients (EuroSCORE II: 10±8%). Procedural success was achieved in all patients; no MACCE occurred in hospital. The presence of a TR grade ≥3 was reduced from 94% (17 patients) before the procedure to 33% (six patients) at 30-day follow-up (p<0.001). Sixteen patients (89%) reported an improvement in NYHA functional class at 30 days. Applying a modified steering technique, the edge-to-edge repair technique can be successfully used for the treatment of TR. At 30-day follow-up, the short-term durability of TR reduction appeared promising and the majority of patients improved clinically. Further studies with larger patient populations and longer follow-up have to define the role of this novel treatment option for patients with right-sided heart failure and severe TR.

TCT-87 Transcatheter treatment of severe tricuspid regurgitation using the MitraClip® system: 30-day clinical results in 13 consecutive patients.

The aim of this study was to investigate the procedural feasibility and 30-day results of transcatheter tricuspid valve repair using the MitraClip® system in selected, highly symptomatic patients with severe tricuspid regurgitation. Thirteen consecutive patients were treated for severe symptomatic

Erratum to: Surgical indication for functional tricuspid regurgitation at initial operation: judging from long term outcomes.

The assessment and management of tricuspid valve disease have evolved substantially during the past several years. Whereas tricuspid stenosis is uncommon, tricuspid regurgitation is frequently encountered and it is most often secondary due to annular dilatation and leaflet tethering from right ventricular remodelling. The indications for tricuspid valve surgery to treat tricuspid regurgitation are several and mainly related to the underlying disease, to the severity of insufficiency and to the right ventricular function. Surgical tricuspid repair has been avoided for years, because of the misleading concept that tricuspid regurgitation should disappear once the primary left-sided problem has been eliminated. Instead, during the last decade, many investigators have reported evidence in favor of a more aggressive surgical approach to functional tricuspid regurgitation, recognising the risk of progressive tricuspid insufficiency in patients with moderate or lesser degrees of tricuspid regurgitation and tricuspid annular dilatation. This concept, along with the long-term outcomes of principal surgical repair techniques are reported and discussed. Last, novel transcatheter therapies have begun to emerge for the treatment of severe tricuspid regurgitation in high-risk patients. Hence, very preliminary pre-clinical and clinical experiences are illustrated. The scope of this review is to explore the anatomic basis, the pathophysiology, the outcomes and the new insights in the management of functional tricuspid regurgitation.

Surgical indication for functional tricuspid regurgitation at initial operation: judging from long term outcomes.

The assessment and management of tricuspid valve disease have evolved substantially during the past several years. Whereas tricuspid stenosis is uncommon, tricuspid regurgitation is frequently encountered and it is most often secondary due to annular dilatation and leaflet tethering from right ventricular remodelling. The indications for tricuspid valve surgery to treat tricuspid regurgitation are several and mainly related to the underlying disease, to the severity of insufficiency and to the right ventricular function. Surgical tricuspid repair has been avoided for years, because of the misleading concept that tricuspid regurgitation should disappear once the primary left-sided problem has been eliminated. Instead, during the last decade, many investigators have reported evidence in favor of a more aggressive surgical approach to functional tricuspid regurgitation, recognising the risk of progressive tricuspid insufficiency in patients with moderate or lesser degrees of tricuspid regurgitation and tricuspid annular dilatation. This concept, along with the long-term outcomes of principal surgical repair techniques are reported and discussed. Last, novel transcatheter therapies have begun to emerge for the treatment of severe tricuspid regurgitation in high-risk patients. Hence, very preliminary pre-clinical and clinical experiences are illustrated. The scope of this review is to explore the anatomic basis, the pathophysiology, the outcomes and the new insights in the management of functional tricuspid regurgitation.

0263: Short- and long-term outcomes of surgery for severe tricuspid regurgitation: Algerian experience

There is little data available for Algeria on the outcomes of surgical treatment for severe tricuspid regurgitation. The aim of this study was to analyze clinical and echocardiographic outcomes in a series of patients who received surgical treatment for severe tricuspid regurgitation and to compare outcomes according to the operative approach to valve repair or replacement. Retrospective study in 239 consecutive patients with severe tricuspid regurgitation undergoing valve surgery between April 2006 and February 2014 in military hospitals of Algeria and Constantine. A total of 112 ringless and 85 ring annuloplasties were performed and 9 bioprostheses and 33 mechanical prostheses were implanted. Perioperative mortality was 18.5% and was associated with age and cardiopulmonary bypass time. During clinical follow-up (median, 41 [interquartile range, 24-89] months), 2 reoperations were required in the ring annuloplasty and mechanical prosthesis groups; prosthetic thrombosis was diagnosed in 4 patients in the latter group. Total mortality after follow-up was 29.9% and was associated with age>70 years and extra-corporeal circulation time. The emergence of new severe tricuspid regurgitation was associated with age and ringless annuloplasty (P=.04). Ringless repair was significantly associated with recurrence of severe tricuspid regurgitation. The use of mechanical prostheses was associated with a high rate of thrombosis. No significant differences in perioperative or total mortality were found between the different methods used for repair or valve replacement.

Transcatheter treatment of tricuspid regurgitation by caval valve implantation—experimental evaluation of decellularized tissue valves in central venous position

Caval valve implantation has been suggested for transcatheter treatment of severe tricuspid regurgitation (TR). Combining the interventional technique with the promising surgical experience with decellularized valves, we sought to evaluate the functional and structural outcome of decellularized pericardial tissue valves (dTVs) in the low-pressure venous circulation in a chronic model of TR. Sixteen pericardial tissue valves were heterotopically implanted in the inferior and superior vena cava in a sheep model (54-98 kg; median 74.5 kg, n = 8) of severe TR. The devices were assembled using self-expanding nitinol stents and bovine pericardia decellularized by a detergent-based protocol (group dTV; n = 8). Glutaraldehyde-fixed pericardial tissue valves served as control (GaTV, n = 8). After 6 months, device function and structural maturation were analyzed using echocardiographic, histologic, immunohistologic, and electron microscopic approaches. After implantation, cardiac output increased significantly from 3.7 ± 1.1 l/min to 4.8 ± 1.1 l/min (P < 0.05) and competent valve function was verified by angiography. At 6 months, angiographic and echocardiographic evaluation revealed moderate to severe regurgitation in all GaTV. In contrast, five of the eight dTVs functioned well with only minor regurgitation. In these animals, autopsy revealed preserved valve structure with tender leaflets without signs of thrombosis or calcification. Conversely, GaTV showed severe degeneration with large calcification areas. Microscopic and histologic analysis confirmed endothelial repopulation in both valve types. However, additional interstitial reseeding was observed in decellularized valves. In the venous circulation in severe TR, decellularized valves show superior functional performance compared to Ga-fixed tissue valves. Macroscopic and microscopic analyses suggest preserved structural integrity and advanced endothelial and interstitial repopulation with evidence of less degradation in dTV. © 2014 Wiley Periodicals, Inc.

Cirugía de la regurgitación tricuspídea grave: resultados a corto y largo plazo

Introduction and objectivesThere is little data available for Spain on the outcomes of surgical treatment for severe tricuspid regurgitation. The aim of this study was to analyze clinical and echocardiographic outcomes in a series of patients who received surgical treatment for severe tricuspid regurgitation and to compare outcomes according to the operative approach to valve repair or replacement. MethodsRetrospective study in 119 consecutive patients with severe tricuspid regurgitation undergoing valve surgery between April 1996 and February 2010. ResultsA total of 61 ringless and 23 ring annuloplasties were performed and 11 bioprostheses and 24 mechanical prostheses were implanted. Perioperative mortality was 18.5% and was associated with age and cardiopulmonary bypass time. During clinical follow-up (median, 41 [interquartile range, 24-89] months), 2 reoperations were required in the ring annuloplasty and mechanical prosthesis groups; prosthetic thrombosis was diagnosed in 4 patients in the latter group. Total mortality after follow-up was 29.9% and was associated with age>70 years and extracorporeal circulation time. The emergence of new severe tricuspid regurgitation was associated with age and ringless annuloplasty (P=.04). ConclusionsRingless repair was significantly associated with recurrence of severe tricuspid regurgitation. The use of mechanical prostheses was associated with a high rate of thrombosis. No significant differences in perioperative or total mortality were found between the different methods used for repair or valve replacement.Full English text available from:www.revespcardiol.org/en.