Worsening tricuspid regurgitation after mitral valve surgery: a meta-analysis and meta-regression.

One-stop pulmonary artery denervation and transcatheter tricuspid annuloplasty in combined pre- and post-capillary pulmonary hypertension with severe tricuspid regurgitation.

BackgroundPatients who suffer from severe tricuspid regurgitation (TR) do not undergo standard care therapy because of the high surgical risk. As a result, safer and less invasive techniques are being sought after internationally. The objective of this study was to investigate the feasibility and safety of the K-Clip™ device, a novel interventional tricuspid annuloplasty system designed for transcatheter tricuspid repair that is positioned using ultrasound technology and fluoroscopy.MethodsFour patients with severe symptomatic TR (3 with massive and 1 with torrential TR) and high surgical risk [STS score of 6.7 (5.6–11.1)] underwent tricuspid annular repair with the K-Clip™ device guided by echocardiography and fluoroscopy. Echocardiographic measurements [vena contracta width, regurgitant volume, effective regurgitant orifice area (EROA)], quality-of-life (QoL) measurements [NYHA functional class, Kansas City Cardiomyopathy Questionnaire score (KCCQ), and the 6-min walk test (6MWT)] were performed before the procedure and at the 30-day follow-up assessment.ResultsThe K-Clip™ device was successfully implanted in all four patients (2 patients with 2 clips each and 2 patients with 1 clip each). No procedural or 30-day major adverse events occurred. The TR was reduced by at least 1 grade in all patients. EROA (0.93 ± 0.40 mm2 VS 0.42 ± 0.11 mm2, p < 0.05), vena contracta width (17.95 ± 8.19 mm VS 7.48 ± 1.87 mm, p < 0.05) and regurgitant volume (97.00 ± 46.41 ml VS 43.50 ± 17.13 ml, p < 0.05) were obviously reduced at 30 days after the procedure. Significant improvements in the NYHA functional class, KCCQ score (37.58 ± 6.48 VS 58.55 ± 5.13, p < 0.01), and 6MWT (239.67 ± 31.64 m VS 402.67 ± 41.53 m, p < 0.05) outcome were observed at the 30-day follow-up visit.ConclusionsThis report on the early experience of transcatheter tricuspid repair with the K-Clip™ in China revealed notable clinical improvement, acceptable safety, and high procedural success. Larger prospective trials with extended follow-up periods are required to validate these encouraging preliminary findings and to clarify the effects of the K-Clip™ on clinical outcomes.

A 74-year-old man was implanted with a permanent pacemaker for sick sinus syndrome ten years earlier and permanent atrial fibrillation( AF). Echocardiography indicated progressive severe tricuspid regurgitation (TR) and right ventricular systolic dysfunction with tricuspid annular dilatation and tricuspid valve tethering. The pacemaker lead passing through the tricuspid valve may have contributed to TR, therefore we decided to perform tricuspid valve surgery, pacemaker lead removal, and leadless pacemaker implantation simultaneously during open heart surgery. Tricuspid annuloplasty was performed with the spiral suspension technique. The leadless pacemaker was anchored to the apical septum of the right ventricle through the tricuspid valve with endoscopic guidance, and left atrial appendage closure was performed for permanent AF. The patient was discharged on postoperative day 18 without major complications. He has been doing well with mild TR on transthoracic echocardiography as of three years post-operation.

We report two cases of intraoperative transcatheter embolization for pulmonary artery injury caused by a pulmonary artery catheter( PAC). The 1st case who had severe mitral regurgitation and tricuspid regurgitation with giant left and right atrium underwent mitral and tricuspid annuloplasty. The 2nd case woman underwent aortic valve replacement and coronary artery bypass grafting. Sudden massive hemoptysis occurred during weaning from cardiopulmonary bypass in both cases, and pulmonary artery injury due to PAC was diagnosed. Both cases underwent pulmonary arteriography via the main pulmonary artery trunk and transcatheter embolization, and successful hemostasis was obtained. During intraoperative endovascular treatment, an approach via the main pulmonary artery trunk is very useful for diagnosis and treatment.

We present the case of a 68-year-old patient who underwent secondary thoracotomy, implantation of a continuous-flow ventricular assist device (VAD) in a biventricular configuration, and aortic valve replacement (AVR) 2 years after receiving a continuous-flow left ventricular assist device (LVAD) and coronary artery bypass grafting (CABG), due to right ventricular failure, moderate aortic insufficiency, and damage to the original LVAD device cable. The patient initially received a Corheart 6 LVAD, CABG, and tricuspid annuloplasty due to end-stage heart failure resulting from ischemic cardiomyopathy and severe tricuspid regurgitation. Following the surgery, the patient was discharged with favorable outcomes. However, 2 years later, the patient was readmitted with severe right heart failure. Given the current shortage of heart donors, the decision was made to implant a Corheart 6 biventricular VAD (BiVAD) as destination therapy. Severe right ventricular failure is a well-recognized complication following continuous-flow LVAD implantation. In this case, it was successfully managed with BiVADs as destination therapy for this high-risk patient.

BackgroundCardiac involvement by Echinococcus granulosus is extremely rare, accounting for less than 2% of all hydatid disease cases. When it occurs, it commonly affects the left ventricle, while valvular involvement is exceedingly unusual.Case PresentationWe present the case of a 74-year-old woman from rural Georgia who developed progressive exertional dyspnoea and fatigue. Physical examination revealed multiple murmurs, and transthoracic echocardiography identified a mobile, hyperechoic mass attached to the posterior mitral valve leaflet. Transoesophageal echocardiography raised suspicion for a myxoma or vegetation, and surgical excision was pursued due to embolic risk. Intraoperatively, a teardrop-shaped cystic mass containing multiple daughter cysts was found on the P2 segment of the mitral valve. Histopathology confirmed a hydatid cyst, consistent with cardiac echinococcosis. The patient underwent successful segmental excision of the cyst with mitral valve repair and tricuspid annuloplasty. Her postoperative course was complicated by atrial fibrillation and new-onset type 2 diabetes mellitus. She was treated with albendazole and discharged in stable condition.ConclusionThis report highlights a rare instance of isolated mitral valve echinococcosis, initially misdiagnosed as a myxoma. It underscores the importance of considering parasitic aetiologies in the differential diagnosis of intracardiac masses, particularly in patients with rural backgrounds.LEARNING POINTSMitral valve involvement in cardiac echinococcosis is exceedingly rare and may clinically and radiographically mimic myxomas or vegetations.Hydatid disease should be considered in the differential diagnosis of intracardiac masses, especially in patients with epidemiologic exposure to livestock or dogs.Early recognition and surgical intervention, coupled with antiparasitic therapy, are essential for optimal outcomes in rare valvular hydatid disease.

Evoque Tricuspid Replacement in a Patient With Failed Cardioband Transcatheter Tricuspid Annuloplasty.

Highlights This paper presents the long-term results of complex tricuspid valve reconstructions in severe secondary tricuspid insufficiency, such as the extension of the anterior tricuspid valve flap, the “clover” technique, as well as the immediate results of the convergence of the papillary muscles of the right ventricle. This generalized material has no analogues in the Russian-language literature and familiarization with it will expand the indications, durability and safety of tricuspid valve reconstructions. AbstractAim. Tricuspid annuloplasty of the tricuspid valve is the most common and, in the vast majority of cases, the only intervention on the tricuspid valve performed for tricuspid regurgitation. However, there are a number of problems that cause dissatisfaction with a single-component treatment of the tricuspid valve, such as: the risk of recurrence of TR 2, varying from 10 to 32% depending on the annuloplasty method; high mortality during reoperation on the tricuspid valve due to the return of TR.Methods. From 2010 to 2017, anterior leaflet augmentation of the tricuspid valve was performed in 18 patients with severe TR. According to the etiology of TR, the patients were divided into 2 groups: Group 1 – patients with organic disease of the tricuspid valve (rheumatism – 10 patients, congenital heart disease – 2 patients); Group 2 – with functional TR (6 patients). For the period from 2004 to 2019. The “clover” technique was used in TR correction in 28 patients. Myxomatosis was the predominant etiology of TR in 16 cases, functional disease of the tricuspid valve – 7 patients, rheumatism – 3 patients, infective endocarditis – 2 patients.Results. Freedom from recurrence of TR ≥ grade 2 in the long-term period in the “clover” group was 75% (with myxomatosis – 85,7%), in the “augmentation” group – 100% with functional defect and 60% with organic valve disease. Freedom from recurrence of TR ≥ grade 3 in the “edge to edge” group was 87.5% (with myxomatosis – 100%), in the “augmentation” group – 100% with functional disease and 81.8% with organic valve disease. In the edge-to-edge group, a correlation was found between the degree of TR in the late period and the implementation of additional maneuvers on the tricuspid valve (excision of secondary chords and anterior leaflet augmentation r = 0.5, p = 0.037 and r = 0.5, p = 0.048, respectively).Conclusion. The results of anterior leaflet augmentation of the tricuspid valve in case of functional TR, the edge-to-edge suture in case of valve myxomatosis are satisfactory and allow to expand the indications for reconstructive surgery, the techniques are reproducible, safe and durability.

Pulmonary arterial hypertension (PAH) is a life-threatening progressive disorder caused by increased resistance in the pulmonary vasculature. The condition may lead to right-sided heart failure and death. A 56-year-old woman was referred for pulmonary arterial hypertension (PAH) with atrial septal defect, mitral regurgitation, and tricuspid regurgitation. Hemodynamic parameters were obtained by right heart catheterization. She underwent transthoracic pulmonary artery radiofrequency denervation (TPARFD), to relieve the pulmonary artery pressure, while concomitantly undergoing mitral valvuloplasty with 28 # Sorin ring, patch closure of atrial septal defect, and tricuspid annuloplasty with 28 # Edwards MC3 ring. Her hemodynamic parameters and functional capacity showed marked improvement after TPARFD.

There is a paucity of data on factors contributing to post-operative tricuspid regurgitation among patients with pre-operative moderate functional tricuspid regurgitation undergoing mitral valve replacement for rheumatic heart disease, the most common cause of mitral valve disease in the developing world. Between January 2013 and December 2018, 476 patients underwent mitral valve replacement in our institution, of which 135 fulfilled the exclusion criteria. Of the remaining 341 patients, 142 had moderate functional tricuspid regurgitation. Our primary objective was to estimate the number of patients with of post-operative moderate to severe tricuspid regurgitation. Secondary outcomes were to determine the factors associated with it. Among the 142 patients who had pre-operative moderate functional tricuspid regurgitation (TR), mitral stenosis (46.4%) was the predominant lesion. Concomitant tricuspid annuloplasty (TAP) was done in 41 patients (28.9%). The median duration of follow-up was 35 (11, 79.5) months. Post-operative moderate to severe TR was recorded in 41.5%. Atrial fibrillation was significantly associated with post-operative moderate to severe TR (p = 0.006). Among the patients who did not undergo TAP, post-operative moderate to severe TR (85%, 50/59) compared to post-operative mild TR (61%, 51/83) with a p-value of 0.003. Our data show that concomitant tricuspid annuloplasty during mitral valve replacement can be considered even in patients with pre-operative moderate TR and that pre-operative atrial fibrillation is significantly associated with post-operative TR. The online version contains supplementary material available at 10.1007/s12055-025-01965-0.

71119 | The GLIDE Score Predicts Procedural Success Not Only in Patients Undergoing Transcatheter Edge-to-Edge Repair but Also Tricuspid Annuloplasty

Abstract Background:Cor triatriatum sinister is a rare congenital cardiac anomaly, occurring in approximately 1 in 1,000 congenital cases. Although typically diagnosed in infancy because of significant haemodynamic consequences, cases in adulthood are uncommon and may present with nonspecific symptoms.Case presentation:A 31-year-old male presented with progressive dyspnoea and haemoptysis. Transthoracic echocardiography revealed a fibrous membrane dividing the left atrium, with a 5-mm fenestration permitting communication between an accessory chamber and the main left atrial cavity; four pulmonary veins drained into the accessory chamber. In addition, an atrial septal defect and pulmonary hypertension were identified. The patient underwent surgical correction, which included resection of the membrane, closure of the atrial septal defect using a Dacron patch, and DeVega tricuspid annuloplasty. Intraoperative transesophageal echocardiography confirmed absence of residual shunt and tricuspid regurgitation with improved pulmonary artery pressures.Conclusion:This case underscores the necessity for early recognition and timely surgical intervention in adult cor triatriatum sinister cases to prevent complications such as right ventricular failure and severe pulmonary hypertension.

Transcatheter tricuspid valve-in-ring implantation (TVIRI) has emerged as a viable therapy for high-risk patients with symptomatic severe tricuspid regurgitation after failure of tricuspid annuloplasty. However, there are potential complications associated with this minimally invasive procedure, including the rare but life-threatening occurrence of valve embolization during TVIRI. This report describes a rare case of atrial embolization of a balloon-expandable valve during TVIRI in a 67-year-old female patient. The embolized valve was successfully retrieved and repositioned with a balloon catheter, avoiding emergent surgery. This case illustrates a novel management strategy for valve embolization and provides valuable insight into the expanding field of structural heart interventions.

Abstract We present the case of a patient with a history of valvulopathy. In 2016, she underwent aortic valve replacement with a bioprosthetic valve (MitroFlow 21mm). One year later, she required replacement of the previously implanted bioprosthetic valve due to prosthetic endocarditis, with an Edwards Magna 21mm aortic bioprosthesis. She remained clinically stable until August 2024, when she presented with effort–induced dyspnea. Echocardiography revealed severe mitral regurgitation and moderate–to–severe tricuspid regurgitation. Left ventricular systolic function was normal, and the aortic bioprosthesis was functioning well. In October, the patient underwent mitral valve replacement and tricuspid annuloplasty. The procedure was complicated by atrial fibrillation and paroxysmal AV block, necessitating the implantation of a permanent pacemaker (PM). During the pacemaker implantation, angiography revealed stenosis of the superior vena cava, leading to abandonment of the transvenous approach (fig 1). A subsequent CT scan confirmed luminal narrowing of the distal segment of the superior vena cava at its junction with the right atrium, with minimal tissue thickening and small extra–luminal radiopaque images (approximately 60% stenosis, without endoluminal filling defects suggestive of thrombosis) (fig 2). This finding, likely related to prior cardiac surgeries, contraindicated the implantation of endocavitary electrode catheters. Consequently, a leadless pacemaker (AVEIR) was implanted in the septal region of the right ventricle, with excellent electrical parameters (fig 3). The procedure was well tolerated, though complicated by a hematoma at the access site, requiring a blood transfusion and resolved with suturing.Figure 1 Figure 2 Figure 3

We elucidated the impact of concomitant tricuspid annuloplasty (TAP) on postoperative tricuspid regurgitation (TR), pulmonary hypertension (PH) and survival in patients with ischemic cardiomyopathy undergoing restrictive mitral annuloplasty (RMA). This study included 234 patients with ischemic cardiomyopathy (LV ejection fraction ≤40%) who underwent RMA. Of them, 114 (49%) underwent concomitant TAP for secondary TR. The primary endpoint was freedom from significant recurrence (i.e., moderate or greater) and progression (≥2+ grades) in TR. The secondary endpoints were postoperative pulmonary artery systolic pressure (sPAP) and overall survival. The 30-day mortality was not different (0.9% vs. 0.8%, P = 0.97), despite higher EuroSCORE II score (median, 9.3% vs. 7.2%, P = 0.016) for TAP group. At baseline, TAP group had higher TR grades (2.4 ± 0.8 vs. 1.4 ± 0.6, P < 0.001) and sPAP (51 ± 16 vs. 44 ± 12 mmHg, P < 0.001). At 5-year post-surgery, RMA with TAP demonstrated higher freedom from recurrence or progression of TR (91 ± 3% vs. 81 ± 4%, log-rank P = 0.036), yielding nearly identical sPAP (42 ± 18 vs. 40 ± 16 mmHg, P = 0.54). Multivariable analysis demonstrated concomitant TAP was independently associated with freedom from significant recurrence in TR. Overall survival were not different between the groups (P = 0.74). In patients with ischemic cardiomyopathy, concomitant TAP did not increase operative mortality and better reduced TR, resulting in comparable PH severity and long-term survival, compared to RMA alone.

Various surgical techniques have been reported for repairing Ebstein anomaly. Cone repair provides nearly anatomical tricuspid valve (TV) reconstruction with promising outcomes. We reviewed our experience with cone repair to evaluate biventricular remodeling and the outcomes of the annular support procedure. Between January 2008 and December 2021, cone repair was performed in 33 consecutive patients with Ebstein anomaly. Mean age was 32.0±16.8 years (range, 1.1-66.8 years). Previous TV repair had been performed in two patients with the Hetzer and the Carpentier techniques (6%). Severe tricuspid regurgitation (TR) was observed in 32 patients (97%). Twenty patients had preoperative magnetic resonance imaging (MRI) data; 15 patients had postoperative MRI data. Modifications included the addition of an annuloplasty band (21 patients with pericardial strips, two patients with prosthetic rings) in 23 patients (69.7%) and papillary muscle repositioning in one patient (3%). Bidirectional cavopulmonary anastomosis was performed in two patients (6%), with one of them undergoing a Fontan operation in the third postoperative years. No mortality was observed. The mean follow-up duration was 7.5±4.6 years. Two patients (6%) required late TV re-repair in the first and sixth postoperative years. At follow-up, five patients (16.1%) reported no or trivial TR, 16 (51.6%) had mild TR, and 5 (16.1%) had mild to moderate TR. Freedom from late TV reoperation was 78.8%±13.4% at 5 years. The TV reoperation rate was significantly low in the patients who underwent tricuspid annuloplasty with a band (P=0.02). Preoperative and postoperative MRI data demonstrated a significant right ventricular (RV) volume decrease after cone repair [RV end-diastolic volume index (mL/m2): preoperative/postoperative =207.4±40.2/105.5±41.3, P=0.001]. Left ventricular ejection fraction (LVEF) remained unchanged after cone repair, while left ventricular stroke volume (LVSV) significantly increased [LVEF (%): preoperative/postoperative =60.8±5.3/61.2±5.4, P=0.10; LVSV (mL): preoperative/postoperative =64.0±1.8/71.4±12.7, P=0.041]. Cone repair for Ebstein anomaly has low mortality and morbidity rates. The addition of an annuloplasty band was associated with a low incidence of the TV reoperation. Moreover, cone repair might impact left ventricular function due to ventricular interdependency. Longer follow-up is essential to determine the late durability of cone repair and both ventricular functional changes.

We describe a novel variation of hybrid TPVR using a tricuspid annuloplasty ring which can be considered for patients with very large RVOT, short pulmonary artery, and limited vascular access and to avoid the risk of cardiopulmonary bypass. The utilization of Carpentier-Edwards Physio Tricuspid annuloplasty ring can reduce the size of the RVOT and at the same time the ring served as an effective docking site for the implantation of the SAPIEN S3 (Edwards Lifesciences). All three reported cases showed satisfactory immediate hemodynamic and clinical outcomes as well as at mid-term follow up.

Transesophageal echocardiographic guidance in tricuspid transcatheter edge-to-edge repair may face limitations in imaging, which are sometimes difficult to overcome and lead to an increased risk of periprocedural complications. We present an imaging vignette describing the usefulness of multiplanar reconstructions by 3-dimensional transesophageal echocardiography in a patient with previously implanted surgical tricuspid annuloplasty ring impeding imaging quality. The procedure was conducted successfully by implanting a single device and reducing tricuspid regurgitation from massive to moderate. Multiplanar reconstructions represent a valuable tool with the possibility for improving safety in tricuspid transcatheter edge-to-edge repair by ameliorated visualization of leaflet insertion and grasping.

PO-06-166 IMPACT OF TRICUSPID ANNULOPLASTY ON ATRIAL MECHANICAL SENSING IN SINGLE CHAMBER LEADLESS PACEMAKERS WITH ACCELEROMETER-BASED AV SYNCHRONIZATION