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1. Natural History of Isolated Functional Tricuspid Regurgitation

Author

Christophe Tribouilloy, Pierre Vanhaecke, Julien Dreyfus, Thierry Le Tourneau, Yoan Lavie‐Badie, Christine Selton‐Suty, Augustin Coisne, Erwan Donal, Maurice Enriquez‐Sarano, and Yohann Bohbot

Subjects
isolated tricuspid regurgitation, natural history, outcome, survival, Diseases of the circulatory (Cardiovascular) system, RC666-701
Published
2024
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2. Isolated functional tricuspid regurgitation: how to define patients at risk for event?

Author

Guillaume L'Official, Mathilde Vely, Wojciech Kosmala, Elena Galli, Anne Guerin, Elisabeth Chen, Catherine Sportouch, Julien Dreyfus, Emmanuel Oger, and Erwan Donal

Subjects
Functional tricuspid regurgitation, Echocardiography, Prognosis, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Aims Functional tricuspid regurgitation (TR) is a turning point in cardiac diseases. Symptoms typically appear late. The optimal timing for proposing a valve repair remains a challenge. We sought to analyse the characteristics of right heart remodelling in patients with significant functional TR to identify the parameters that could be used in a simple prognostic model predicting clinical events. Methods and results We designed a prospective observational French multicentre study including 160 patients with significant functional TR (effective regurgitant orifice area > 30 mm2) and left ventricular ejection fraction > 40%. Clinical, echocardiographic, and electrocardiogram data were collected at baseline and at the 1 and 2 year follow‐up. The primary outcome was all‐cause death or hospitalization for heart failure. At 2 years, 56 patients (35%) achieved the primary outcome. The subset with events showed more advanced right heart remodelling at baseline, but similar TR severity. Right atrial volume index (RAVI) and the tricuspid annular plane systolic excursion to systolic pulmonary arterial pressure (TAPSE/sPAP) ratio, reflecting right ventricular–pulmonary arterial coupling, were 73 mL/m2 and 0.40 vs. 64.7 mL/m2 and 0.50 in the event vs. event‐free groups, respectively (both P 0.4 (odds ratio = 0.41, 95% confidence limit 0.2 to 0.82) and RAVI > 60 mL/m2 (odds ratio = 2.13, 95% confidence limit 0.96 to 4.75), providing a clinically valid prognostic evaluation. Conclusions RAVI and TAPSE/sPAP are relevant for predicting the risk for event at 2 year follow‐up in patients with an isolated functional TR.

Published
2023
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3. Permanent Pacemaker Implantation After Tricuspid Valve Surgery

Author

Baptiste Bazire, MD, Vincent Algalarrondo, MD, PhD, and Julien Dreyfus, MD

Subjects
atrioventicular block, pacing, tricuspid valve surgery, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Tricuspid valve (TV) surgery carries a high risk of atrioventricular block. In this report, we illustrate several options for managing conduction disorders after TV surgery. The choice of cardiac implantable devices must take account of several parameters such as surgical procedure, patient’s rhythm and history, and etiology of TV disease. (Level of Difficulty: Intermediate.)

Published
2023
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4. Comparison of effective regurgitant orifice area by the PISA method and tricuspid coaptation gap measurement to identify very severe tricuspid regurgitation and stratify mortality risk

Author

Yohann Bohbot, Léa Tordjman, Julien Dreyfus, Thierry Le Tourneau, Yoan Lavie-Badie, Christine Selton-Suty, Benjamin Elegamandji, Guillaume L’official, Antoine Fraix, Samy Aghezzaf, Pierre Yves Turgeon, David Messika Zeitoun, Maurice Enriquez-Sarano, Augustin Coisne, Erwan Donal, and Christophe Tribouilloy

Subjects
very severe tricuspid regurgitation, survival, coaptation gap, effective regurgitant orifice area, mortality, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

IntroductionVarious definitions of very severe (VS) tricuspid regurgitation (TR) have been proposed based on the effective regurgitant orifice area (EROA) or tricuspid coaptation gap (TCG). Because of the inherent limitations associated with the EROA, we hypothesized that the TCG would be more suitable for defining VSTR and predicting outcomes.Materials and methodsIn this French multicentre retrospective study, we included 606 patients with ≥moderate-to-severe isolated functional TR (without structural valve disease or an overt cardiac cause) according to the recommendations of the European Association of Cardiovascular Imaging. Patients were further stratified into VSTR according to the EROA (≥60 mm2) and then according to the TCG (≥10 mm). The primary endpoint was all-cause mortality and the secondary endpoint was cardiovascular mortality.ResultsThe relationship between the EROA and TCG was poor (R2 = 0.22), especially when the size of the defect was large. Four-year survival was comparable between patients with an EROA

Published
2023
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5. Predictive value of the TRI-SCORE for in-hospital mortality after redo isolated tricuspid valve surgery

Author

Julien Dreyfus, Yohann Bohbot, Augustin Coisne, Yoan Lavie-Badie, Michele Flagiello, Baptiste Bazire, Florian Eggenspieler, Florence Viau, Elisabeth Riant, Yannick Mbaki, Damien Eyharts, Thomas Sénage, Thomas Modine, Martin Nicol, Fabien Doguet, Thierry Le Tourneau, Christophe Tribouilloy, Erwan Donal, Jacques Tomasi, Gilbert Habib, Christine Selton-Suty, Costin Radu, Pascal Lim, Richard Raffoul, Bernard Iung, Jean-Francois Obadia, Etienne Audureau, David Messika-Zeitoun, Centre cardiologique du Nord (CCN), CHU Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, CHU Lille, Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U1011 (RNMCD), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Assistance Publique - Hôpitaux de Marseille (APHM), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre hospitalier universitaire de Nantes (CHU Nantes), Pole Cardio-vasculaire et pulmonaire [CHU Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Lariboisière-Fernand-Widal [APHP], CHU Rouen, Normandie Université (NU), Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Service de cardiologie, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Département de Cardiologie [Hôpital de la Timone - APHM], and Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE)

Subjects
tricuspid valve insufficiency, Cardiology and Cardiovascular Medicine, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

ObjectivesThe TRI-SCORE reliably predicts in-hospital mortality after isolated tricuspid valve surgery (ITVS) on native valve but has not been tested in the setting of redo interventions. We aimed to evaluate the predictive value of the TRI-SCORE for in-hospital mortality in patients with redo ITVS and to compare its accuracy with conventional surgical risk scores.MethodsUsing a mandatory administrative database, we identified all consecutive adult patients who underwent a redo ITVS at 12 French tertiary centres between 2007 and 2017. Baseline characteristics and outcomes were collected from chart review and surgical scores were calculated.ResultsWe identified 70 patients who underwent a redo ITVS (54±15 years, 63% female). Prior intervention was a tricuspid valve repair in 51% and a replacement in 49%, and was combined with another surgery in 41%. A tricuspid valve replacement was performed in all patients for the redo surgery. Overall, in-hospital mortality and major postoperative complication rates were 10% and 34%, respectively. The TRI-SCORE was the only surgical risk score associated with in-hospital mortality (p=0.005). The area under the receiver operating characteristic curve for the TRI-SCORE was 0.83, much higher than for the logistic EuroSCORE (0.58) or EuroSCORE II (0.61). The TRI-SCORE was also associated with major postoperative complication rates and survival free of readmissions for heart failure.ConclusionRedo ITVS was rarely performed and was associated with an overall high in-hospital mortality and morbidity, but hiding important individual disparities. The TRI-SCORE accurately predicted in-hospital mortality after redo ITVS and may guide clinical decision-making process (www.tri-score.com).

Published
2023

7. Permanent Pacemaker Implantation After Tricuspid Valve Surgery

Author

Baptiste Bazire, Vincent Algalarrondo, and Julien Dreyfus

Subjects
Case Report, Cardiology and Cardiovascular Medicine
Abstract

Tricuspid valve (TV) surgery carries a high risk of atrioventricular block. In this report, we illustrate several options for managing conduction disorders after TV surgery. The choice of cardiac implantable devices must take account of several parameters such as surgical procedure, patient’s rhythm and history, and etiology of TV disease. (Level of Difficulty: Intermediate.)

Published
2023

9. First-in-human implantation of the Topaz transcatheter tricuspid valve replacement system

Author

Emmanuel Teiger, Mohammed Nejjari, Pascal Lim, Tobias Ruf, Philipp Blanke, Ulrich Schäfer, Hendrik Treede, Romain Gallet, and Julien Dreyfus

Subjects
Heart Valve Prosthesis Implantation, Cardiac Catheterization, Treatment Outcome, Heart Valve Prosthesis, Humans, Tricuspid Valve, Cardiology and Cardiovascular Medicine, Tricuspid Valve Insufficiency
Published
2022

11. Tricuspid valve replacement: The old and the new

Author

Julien Dreyfus, Gilles D. Dreyfus, and Maurizio Taramasso

Subjects
Heart Valve Prosthesis Implantation, Treatment Outcome, Humans, Tricuspid Valve, Cardiac Surgical Procedures, Cardiology and Cardiovascular Medicine, Tricuspid Valve Insufficiency
Abstract

Tricuspid regurgitation is a frequent and serious condition but tricuspid valve (TV) surgery, that may be a valve replacement when a repair is not feasible, is rarely performed. Recent development of transcatheter TV interventions offers new options for those high-surgical risk patients, especially TV replacement for patients who are not eligible for transcatheter TV repair. In this review, we describe indications and outcome after surgical TV replacement, and devices available or in development for transcatheter TV replacement.

Published
2022

12. Reproducibility of the 2016 American Society of Echocardiography-European Association of Cardiovascular Imaging Algorithm for Estimation of Left Ventricular Filling Pattern: Not Perfect but Good Enough

Author

Arnaud Hubert, Augustin Coisne, Julien Dreyfus, Yohann Bohbot, Yoan Lavie-Badie, Sammy Aghezzaf, Stéphanie Brun, Martin Nicol, Chloé Di Léna, Emmanuel Oger, Erwan Donal, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Lille, Centre cardiologique du Nord (CCN), CHU Amiens-Picardie, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Pontchaillou [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), and CHU Toulouse [Toulouse]

Subjects
Diastolic function, Acoustics and Ultrasonics, Radiological and Ultrasound Technology, Heart Ventricles, Biophysics, Doppler, Reproducibility of Results, United States, Ventricular Function, Left, Reproducibility, Ventricular Dysfunction, Left, Diastole, Echocardiography, Humans, Radiology, Nuclear Medicine and imaging, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Algorithms
Abstract

International audience; The 2016 American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) guidelines for the evaluation of left ventricular diastolic function reported a new algorithm to assess diastolic function and to estimate left ventricular filling pressure (LVFP). At least five to six different parameters were necessary to conclude, each of them with their own inter-observer variability. This article examines the reproducibility of each parameter of the algorithm and its influence on the final decision of the clinician. Echocardiographic exams of 12 non-selected patients without any known cardiac disease or follow-up but addressed to the hospital for symptoms were analyzed by two readers (one junior and one senior) in five French cardiologic tertiary centers. Inter-observer reproducibility at each step of the algorithm and final decision were analyzed. There was mild agreement on the final decision. The main reasons of discrepancy were disagreement on the significance of mitral annular calcifications and measured values that are just around the cut-off (despite good reproducibility, a slight variation could lead to misclassification of a dichotomous choice between a normal measure and a pathologic measure). Without considering performance, this multicentric French study puts forward limits to the actual algorithm recommended for LVFP pattern assessment. Agreement is excellent in caricatural (easy) cases (left ventricular pressure clearly normal or clearly elevated) but a great discordance exists in the gray zone. Improvement in the algorithm and in the method for LVFP determination is proposed.

Published
2022

13. Multicentric randomized evaluation of a tricuspid valve percutaneous repair system (clip for the tricuspid valve) in the treatment of severe secondary tricuspid regurgitation Tri.Fr Design paper

Author

Erwan Donal, Guillaume Leurent, Anne Ganivet, Philip Lurz, Augustin Coisne, Pascal De Groote, Stephane Lafitte, Lionel Leroux, Nicole Karam, Loic Biere, Frederic Rouleau, Catherine Sportouch, Julien Dreyfus, Mohammed Nejjari, Jean-Michel Josselin, Amedeo Anselmi, Elena Galli, Emma Bajeux, Patrice Guerin, Jean-François Obadia, Jean-Noel Trochu, Emmanuel Oger, CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Leipzig University, CHU Lille, CHU Bordeaux [Bordeaux], Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Clinique du Millénaire - Oc Santé [Montpellier], Oc Santé [Montpellier], Centre cardiologique du Nord (CCN), Institut de recherche en santé, environnement et travail (Irset), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université d'Angers (UA), École des Hautes Études en Santé Publique [EHESP] (EHESP), Centre hospitalier universitaire de Nantes (CHU Nantes), Hospices Civils de Lyon (HCL), Recherche en Pharmaco-épidémiologie et Recours aux Soins (REPERES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)

Subjects
Heart Valve Prosthesis Implantation, Cardiac Catheterization, [SDV]Life Sciences [q-bio], heart failure, General Medicine, 030204 cardiovascular system & hematology, Surgical Instruments, Severity of Illness Index, Tricuspid Valve Insufficiency, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Treatment Outcome, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Tricuspid Valve, prognosis, transoesophageal echocardiography, Cardiology and Cardiovascular Medicine, tricuspid regurgitation
Abstract

Aims Tricuspid regurgitation (TR) is associated with significant morbidity and mortality. Its independent prognostic role has been repeatedly demonstrated. However, this valvular heart condition is largely undertreated because of the increased risk of surgical repair. Recently, transcatheter techniques for the treatment of TR have emerged, but their implications for the clinical endpoints are still unknown. Methods and results The Tri.fr trial will be a multicentre, controlled, randomized (1:1 ratio), superior, open-label, and parallel-group study conducted in 300 patients with severe secondary TR that is considered non-surgical by heart teams. Inclusion will be possible only after core laboratory review of transthoracic and transoesophageal echocardiography and after validation by the clinical eligibility committee. A description of the mechanisms of the TR will be conducted by the core laboratory. Atrial or ventricular impacts on the severity of the secondary TR will be taken into account for the randomization. The patients will be followed for 12-month, and the primary outcome will be the Packer composite clinical endpoint [combining New York Heart Association class, patient global assessment (PGA), and major cardiovascular events]. It will test the hypothesis that a tricuspid valve percutaneous repair strategy using a clip dedicated to the tricuspid valve is superior to best guideline-directed medical therapy in symptomatic patients with severe secondary TR. Conclusion Tri.fr will be the first randomized, academic, multicentre study testing the value of percutaneous correction in patients with severe secondary TR.

Published
2021

15. Tricuspid regurgitation: Light at the end of the tunnel?

Author

David Messika-Zeitoun, Julien Dreyfus, Carmen Lab, Team3 Carmen, Centre cardiologique du Nord (CCN), Services de Pneumologie, Exploration Fonctionnelle Respiratoire et Cardiologie (Hôpital Louis Pradel), Hospices Civils de Lyon (HCL), University of Ottawa [Ottawa], and CarMeN, laboratoire

Subjects
Heart Valve Prosthesis Implantation, Cardiac Catheterization, [SDV]Life Sciences [q-bio], Insuffisance tricuspide, Percutané, General Medicine, TRI-SCORE, Tricuspid Valve Insufficiency, [SDV] Life Sciences [q-bio], Tricuspid regurgitation, Treatment Outcome, Transcatheter, Pronostic, Humans, Surgery, Tricuspid Valve, Chirurgie, Cardiology and Cardiovascular Medicine, Outcome
Abstract

International audience; No abstract available

Published
2021

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