98 results on '"transcatheter tricuspid valve intervention"'
Search Results
2. EVOQUE Tricuspid Valve Replacement System: State-of-the-Art Screening and Intraprocedural Guidance.
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Hahn, Rebecca T., Makkar, Raj, Makar, Moody, Davidson, Charles, Puthamana, Jyothy, Zahr, Firas, Chadderdon, Scott, Fam, Neil, Ong, Geraldine, Yadav, Pradeep K., Thourani, Vinod H., Vannan, Mani A., Tchétché, Didier, Dumonteil, Nicolas, Bonfils, Laurent, Lepage, Laurent, Smith, Robert, Grayburn, Paul A., Webb, John G., and Moss, Robert
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- 2024
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3. Impact of Tricuspid Regurgitation on Outcomes of Transcatheter Aortic Valve Replacement With Balloon-Expandable Valves.
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Zahr, Firas, Elmariah, Sammy, Vemulapalli, Sreekanth, Kodali, Susheel K., Hahn, Rebecca T., Anderson, Allen S., Eleid, Mackram F., Davidson, Charles J., Sharma, Rahul P., O'Neill, William W., Bethea, Brian, Thourani, Vinod H., Chakravarty, Tarun, Gupta, Aakriti, and Makkar, Raj R.
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Tricuspid regurgitation (TR) is highly prevalent in the transcatheter aortic valve replacement (TAVR) population, but clear management guidelines are lacking. The aims of this study were to elucidate the prevalence and consequences of severe TR in patients with aortic stenosis undergoing TAVR and to examine the change in TR post-TAVR, including predictors of improvement and its impact on longer term mortality. Using Centers for Medicare and Medicaid Services–linked TVT (Transcatheter Valve Therapy) Registry data, a propensity-matched analysis was performed among patients undergoing TAVR with baseline mild, moderate, or severe TR. Kaplan-Meier estimates were used to assess the impact of TR on 3-year mortality. Multivariable analysis identified predictors of 30-day TR improvement. Of the 312,320 included patients, 84% had mild, 13% moderate, and 3% severe TR. In a propensity-matched cohort, severe baseline TR was associated with higher in-hospital mortality (2.5% vs 2.1% for moderate TR and 1.8% for mild TR; P = 0.009), higher 1-year mortality (24% vs 19.6% for moderate TR and 16.6% for mild TR; P < 0.0001), and 3-year mortality (54.2% vs 48.5% for moderate TR and 43.3% for mild TR; P < 0.0001). Among the patients with severe TR at baseline, 76.4% improved to moderate or less TR 30 days after TAVR. Baseline mitral regurgitation moderate or greater, preserved ejection fraction, higher aortic valve gradient, and better kidney function predicted TR improvement after TAVR. However, severe 30-day residual TR was associated with higher 1-year mortality (27.4% vs 18.7% for moderate TR and 16.8% for mild TR; P < 0.0001). Severe baseline and 30-day residual TR after TAVR are associated with increased mortality up to 3 years. This analysis identifies a higher risk group that could be evaluated for the recently approved tricuspid interventions. [Display omitted] [ABSTRACT FROM AUTHOR]
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- 2024
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4. Multimodality Imaging of Tricuspid Valve Disease at the Dawn of Transcatheter Intervention
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Kodali, Susheel, Agarwal, Vratika, Kelsey, Anita M., editor, Vemulapalli, Sreek, editor, and Sadeghpour, Anita, editor
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- 2024
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5. Tricuspid Regurgitation: Analysis of Outcomes and Risk Assessment.
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Jain, Ankit, Gebhardt, Brian, Subramani, Sudhakar, Mehrotra, Mayank, Gaber, Mohamed, and Ramakrishna, Harish
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- 2024
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6. Transcatheter Therapy for the Tricuspid Valve: A Focused Review of Edge-to-Edge Repair and Orthotopic Valve Replacement.
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Madhavan, Mahesh V., Agarwal, Vratika, and Hahn, Rebecca T.
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Purpose of Review: Patients with severe tricuspid regurgitation (TR) are at risk for significant morbidity and mortality. Transcatheter tricuspid valve interventions (TTVI) may offer patients less invasive treatment alternatives to surgery. This review evaluates the most common class of device currently used worldwide to treat TR, tricuspid transcatheter edge-to-edge repair (T-TEER) and orthotopic transcatheter tricuspid valve replacement (TTVR), both of which are now approved in the USA and Europe. Recent Findings: The first pivotal randomized clinical trial, TRILUMINATE, demonstrated that T-TEER can safely reduce TR and is associated with improved health status outcomes. However, results of this trial have raised questions about whether this device can provide sufficient TR reduction to impact clinical outcomes. Orthotopic TTVR has recently gained attention with initial data suggesting near-complete TR elimination. Summary: The current review examines the technical features and anatomic limitations of the most commonly used devices for T-TEER and orthotopic TTVR, discusses the current clinical data for these devices, and offers a theoretical construct for device selection. [ABSTRACT FROM AUTHOR]
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- 2024
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7. Klinik und Therapie der Trikuspidalklappeninsuffizienz.
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Stocker, Thomas J. and Hausleiter, Jörg
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Copyright of Innere Medizin (2731-7080) is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2024
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8. Prediction of Mortality and Heart Failure Hospitalization After Transcatheter Tricuspid Valve Interventions: Validation of TRISCORE.
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Adamo, Marianna, Russo, Giulio, Pagnesi, Matteo, Pancaldi, Edoardo, Alessandrini, Hannes, Andreas, Martin, Badano, Luigi P., Braun, Daniel, Connelly, Kim A., Denti, Paolo, Estevez-Loureiro, Rodrigo, Fam, Neil, Gavazzoni, Mara, Hahn, Rebecca T., Harr, Claudia, Hausleiter, Joerg, Himbert, Dominique, Kalbacher, Daniel, Ho, Edwin, and Latib, Azeem
- Abstract
Data on the prognostic role of the TRI-SCORE in patients undergoing transcatheter tricuspid valve intervention (TTVI) are limited. The aim of this study was to evaluate the performance of the TRI-SCORE in predicting outcomes of patients undergoing TTVI. TriValve (Transcatheter Tricuspid Valve Therapies) is a large multicenter multinational registry including patients undergoing TTVI. The TRI-SCORE is a risk model recently proposed to predict in-hospital mortality after tricuspid valve surgery. The TriValve population was stratified based on the TRI-SCORE tertiles. The outcomes of interest were all-cause death and all-cause death or heart failure hospitalization. Procedural complications and changes in NYHA functional class were also reported. Among the 634 patients included, 223 patients (35.2%) had a TRI-SCORE between 0 and 5, 221 (34.8%) had 6 or 7, and 190 (30%) had ≥8 points. Postprocedural blood transfusion, acute kidney injury, new atrial fibrillation, and in-hospital mortality were more frequent in the highest TRI-SCORE tertile. Postprocedure length of stay increased with a TRI-SCORE increase. A TRI-SCORE ≥8 was associated with an increased risk of 30-day all-cause mortality and all-cause mortality and the composite endpoint assessed at a median follow-up of 186 days (OR: 3.00; 95% CI: 1.38-6.55; HR: 2.17; 95% CI: 1.78-4.13; HR: 2.08, 95% CI: 1.57-2.74, respectively) even after adjustment for procedural success and EuroSCORE II or Society of Thoracic Surgeons Predicted Risk of Mortality. The NYHA functional class improved across all TRI-SCORE values. In the TriValve registry, the TRI-SCORE has a suboptimal performance in predicting clinical outcomes. However, a TRISCORE ≥8 is associated with an increased risk of clinical events and a lack of prognostic benefit after successful TTVI. [Display omitted] [ABSTRACT FROM AUTHOR]
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- 2024
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9. Artificial intelligence–enabled assessment of right ventricular to pulmonary artery coupling in patients undergoing transcatheter tricuspid valve intervention.
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Fortmeier, Vera, Lachmann, Mark, Stolz, Lukas, Stein, Jennifer von, Unterhuber, Matthias, Kassar, Mohammad, Gerçek, Muhammed, Schöber, Anne R, Stocker, Thomas J, Omran, Hazem, Körber, Maria I, Hesse, Amelie, Harmsen, Gerhard, Friedrichs, Kai Peter, Yuasa, Shinsuke, Rudolph, Tanja K, Joner, Michael, Pfister, Roman, Baldus, Stephan, and Laugwitz, Karl-Ludwig
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PULMONARY artery physiology ,TRICUSPID valve surgery ,PEARSON correlation (Statistics) ,RESEARCH funding ,ARTIFICIAL intelligence ,MULTIVARIATE analysis ,HEART valve prosthesis implantation ,RESEARCH ,RIGHT ventricular dysfunction ,ECHOCARDIOGRAPHY ,CARDIAC catheterization ,REGRESSION analysis - Abstract
Aims Right ventricular to pulmonary artery (RV-PA) coupling has been established as a prognostic marker in patients with severe tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve interventions (TTVI). RV-PA coupling assesses right ventricular systolic function related to pulmonary artery pressure levels, which are ideally measured by right heart catheterization. This study aimed to improve the RV-PA coupling concept by relating tricuspid annular plane systolic excursion (TAPSE) to mean pulmonary artery pressure (mPAP) levels. Moreover, instead of right heart catheterization, this study sought to employ an extreme gradient boosting (XGB) algorithm to predict mPAP levels based on standard echocardiographic parameters. Methods and results This multicentre study included 737 patients undergoing TTVI for severe TR; among them, 55 patients from one institution served for external validation. Complete echocardiography and right heart catheterization data were available from all patients. The XGB algorithm trained on 10 echocardiographic parameters could reliably predict mPAP levels as evaluated on right heart catheterization data from external validation (Pearson correlation coefficient R : 0.68; P value: 1.3 × 10
−8 ). Moreover, predicted mPAP (mPAPpredicted ) levels were superior to echocardiographic systolic pulmonary artery pressure (sPAPechocardiography ) levels in predicting 2-year mortality after TTVI [area under the curve (AUC): 0.607 vs. 0.520; P value: 1.9 × 10−6 ]. Furthermore, TAPSE/mPAPpredicted was superior to TAPSE/sPAPechocardiography in predicting 2-year mortality after TTVI (AUC: 0.633 vs. 0.586; P value: 0.008). Finally, patients with preserved RV-PA coupling (defined as TAPSE/mPAPpredicted > 0.617 mm/mmHg) showed significantly higher 2-year survival rates after TTVI than patients with reduced RV-PA coupling (81.5% vs. 58.8%, P < 0.001). Moreover, independent association between TAPSE/mPAPpredicted levels and 2-year mortality after TTVI was confirmed by multivariate regression analysis (P value: 6.3 × 10−4 ). Conclusion Artificial intelligence–enabled RV-PA coupling assessment can refine risk stratification prior to TTVI without necessitating invasive right heart catheterization. A comparison with conservatively treated patients is mandatory to quantify the benefit of TTVI in accordance with RV-PA coupling. [ABSTRACT FROM AUTHOR]- Published
- 2024
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10. Transcatheter Tricuspid Valve Intervention for the Treatment of Tricuspid Regurgitation with TriClip: All You Need to Know.
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Matli, Kamal, Namnoum, Georges, Al-Osta, Soad, Masri, Alaa, Veugeois, Aurelie, Diakov, Christelle, Caussin, Christophe, and Ghanem, Georges
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TRICUSPID valve surgery , *TRICUSPID valve , *PATIENT selection , *POSTOPERATIVE care , *PATIENT safety , *PROSTHETIC heart valves , *TREATMENT effectiveness , *TRICUSPID valve diseases , *CARDIAC catheterization , *SYMPTOMS - Abstract
Severe tricuspid regurgitation (TR) is a common pathology in the daily practice of a cardiologist. This disease entity is associated with significant morbidity and mortality if left untreated. Classically, surgical repair or replacement were the only therapeutic options present and were often not performed due to high postprocedural mortality. Transcatheter tricuspid valve intervention has emerged as a novel and effective therapeutic option for the treatment of significant TR. Several devices have been developed with different mechanisms of action. In this review, we will provide an overview of transcatheter edge-to-edge repair of TR using the TriClip device (Abbott, Santa Clara, CA, USA). [ABSTRACT FROM AUTHOR]
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- 2024
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11. Tricuspid Regurgitation and Right Heart Failure: The Role of Imaging in Defining Pathophysiology, Presentation, and Novel Management Strategies.
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Agarwal, Vratika and Hahn, Rebecca
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During the last few years, there has been a substantial shift in efforts to understand and manage secondary or functional tricuspid regurgitation (TR) given its prevalence, adverse prognostic impact, and symptom burden associated with progressive right heart failure. Understanding the pathophysiology of TR and right heart failure is crucial for determining the best treatment strategy and improving outcomes. In this article, we review the complex relationship between right heart structural and hemodynamic changes that drive the pathophysiology of secondary TR and discuss the role of multimodality imaging in the diagnosis, management, and determination of outcomes. [ABSTRACT FROM AUTHOR]
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- 2024
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12. Screen Failures for Transcatheter Tricuspid Valve Repair: Implications for Patient Management and Future Innovation.
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Latib, Azeem and Scotti, Andrea
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[Display omitted] [ABSTRACT FROM AUTHOR]
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- 2023
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13. Contemporary insights into the epidemiology, impact and treatment of secondary tricuspid regurgitation across the heart failure spectrum.
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Heitzinger, Gregor, Pavo, Noemi, Koschatko, Sophia, Jantsch, Charlotte, Winter, Max‐Paul, Spinka, Georg, Dannenberg, Varius, Kastl, Stefan, Prausmüller, Suriya, Arfsten, Henrike, Dona, Carolina, Nitsche, Christian, Halavina, Kseniya, Koschutnik, Matthias, Mascherbauer, Katharina, Gabler, Cornelia, Strunk, Guido, Hengstenberg, Christian, Hülsmann, Martin, and Bartko, Philipp E.
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HEART failure , *UNIVERSAL healthcare , *HEALTH facilities , *EPIDEMIOLOGY , *VENTRICULAR ejection fraction , *COMMUNITIES - Abstract
Aim: Tricuspid regurgitation secondary to heart failure (HF) is common with considerable impact on survival and hospitalization rates. Currently, insights into epidemiology, impact, and treatment of secondary tricuspid regurgitation (sTR) across the entire HF spectrum are lacking, yet are necessary for healthcare decision‐making. Methods and results: This population‐based study included data from 13 469 patients with HF and sTR from the Viennese community over a 10‐year period. The primary outcome was long‐term mortality. Overall, HF with preserved ejection fraction was the most frequent (57%, n = 7733) HF subtype and the burden of comorbidities was high. Severe sTR was present in 1514 patients (11%), most common among patients with HF with reduced ejection fraction (20%, n = 496). Mortality of patients with sTR was higher than expected survival of sex‐ and age‐matched community and independent of HF subtype (moderate sTR: hazard ratio [HR] 6.32, 95% confidence interval [CI] 5.88–6.80, p < 0.001; severe sTR: HR 9.04; 95% CI 8.27–9.87, p < 0.001). In comparison to HF and no/mild sTR patients, mortality increased for moderate sTR (HR 1.58, 95% CI 1.48–1.69, p < 0.001) and for severe sTR (HR 2.19, 95% CI 2.01–2.38, p < 0.001). This effect prevailed after multivariate adjustment and was similar across all HF subtypes. In subgroup analysis, severe sTR mortality risk was more pronounced in younger patients (<70 years). Moderate and severe sTR were rarely treated (3%, n = 147), despite availability of state‐of‐the‐art facilities and universal health care. Conclusion: Secondary tricuspid regurgitation is frequent, increasing with age and associated with excess mortality independent of HF subtype. Nevertheless, sTR is rarely treated surgically or percutaneously. With the projected increase in HF prevalence and population ageing, the data suggest a major burden for healthcare systems that needs to be adequately addressed. Low‐risk transcatheter treatment options may provide a suitable alternative. [ABSTRACT FROM AUTHOR]
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- 2023
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14. Investigating the unmet need for the treatment of tricuspid regurgitation.
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Tagliari, Ana Paula and Taramasso, Maurizio
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TRICUSPID valve surgery ,TRICUSPID valve diseases ,PATIENTS' rights ,TRICUSPID valve - Abstract
Tricuspid regurgitation has been increasingly recognized as a clinically relevant entity with a long-term prognostic impact on quality of life and survival. Despite this, there are still some unmet clinical needs regarding the management of tricuspid regurgitation that require further investigation. This review addresses current evidence for the treatment of tricuspid regurgitation, focusing primarily on new catheter-based technologies. In addition, we discuss recent registries and clinical trial outcomes. A multimodality and multiparametric integrative approach has been preconized to assess tricuspid regurgitation mechanism and severity, and new technologies have been developed to address the main causative factors of tricuspid regurgitation. Matching the right device to the right patient and deciding when is the best time for intervention are major challenges in the management of tricuspid regurgitation. [ABSTRACT FROM AUTHOR]
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- 2023
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15. Functional Mitral and Tricuspid Regurgitation across the Whole Spectrum of Left Ventricular Ejection Fraction: Recognizing the Elephant in the Room of Heart Failure.
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Cammalleri, Valeria, Antonelli, Giorgio, De Luca, Valeria Maria, Carpenito, Myriam, Nusca, Annunziata, Bono, Maria Caterina, Mega, Simona, Ussia, Gian Paolo, and Grigioni, Francesco
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MITRAL valve insufficiency , *HEART failure , *VENTRICULAR ejection fraction , *VENTRICULAR dysfunction , *HEART failure patients - Abstract
Functional mitral regurgitation (FMR) and tricuspid regurgitation (FTR) occur due to cardiac remodeling in the presence of structurally normal valve apparatus. Two main mechanisms are involved, distinguishing an atrial functional form (when annulus dilatation is predominant) and a ventricular form (when ventricular remodeling and dysfunction predominate). Both affect the prognosis of patients with heart failure (HF) across the entire spectrum of left ventricle ejection fraction (LVEF), including preserved (HFpEF), mildly reduced (HFmrEF), or reduced (HFrEF). Currently, data on the management of functional valve regurgitation in the various HF phenotypes are limited. This review summarizes the epidemiology, pathophysiology, and treatment of FMR and FTR within the different patterns of HF, as defined by LVEF. [ABSTRACT FROM AUTHOR]
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- 2023
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16. Early and mid-term outcomes of transcatheter tricuspid valve repair: systematic review and meta-analysis of observational studies.
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Alperi, Alberto, Avanzas, Pablo, Almendárez, Marcel, León, Víctor, Hernández-Vaquero, Daniel, Silva, Iria, Fernández del Valle, David, Fernández, Félix, Díaz, Rocío, Rodes-Cabau, Josep, Morís, César, and Pascual, Isaac
- Abstract
Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2023
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17. Sex-Related Differences in Clinical Characteristics and Outcome Prediction Among Patients Undergoing Transcatheter Tricuspid Valve Intervention.
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Fortmeier, Vera, Lachmann, Mark, Körber, Maria I., Unterhuber, Matthias, Schöber, Anne R., Stolz, Lukas, Stocker, Thomas J., Kassar, Mohammad, Gerçek, Muhammed, Rudolph, Tanja K., Praz, Fabien, Windecker, Stephan, Pfister, Roman, Baldus, Stephan, Laugwitz, Karl-Ludwig, Hausleiter, Jörg, Lurz, Philipp, and Rudolph, Volker
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Men and women differ regarding comorbidities, pathophysiology, and the progression of valvular heart diseases. This study sought to assess sex-related differences regarding clinical characteristics and the outcome of patients with severe tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve intervention (TTVI). All 702 patients in this multicenter study underwent TTVI for severe TR. The primary outcome was 2-year all-cause mortality. Among 386 women and 316 men in this study, men were more often diagnosed with coronary artery disease (52.9% in men vs 35.5% in women; P = 5.6 × 10
−6 ). Subsequently, the underlying etiology for TR in men was predominantly secondary ventricular (64.6% in men vs 50.0% in women; P = 1.4 × 10−4 ), whereas women more often presented with secondary atrial etiology (41.7% in women vs 24.4% in men, P = 2.0 × 10−6 ). Notably, 2-year survival after TTVI was similar in women and men (69.9% in women vs 63.7% in men; P = 0.144). Multivariate regression analysis identified dyspnea expressed as New York Heart Association functional class, tricuspid annulus plane systolic excursion (TAPSE), and mean pulmonary artery pressure (mPAP) as independent predictors for 2-year mortality. The prognostic significance of TAPSE and mPAP differed between sexes. Consequently, we looked at right ventricular–pulmonary arterial coupling expressed as TAPSE/mPAP and identified sex-specific thresholds to best predict survival; women with a TAPSE/mPAP ratio <0.612 mm/mm Hg displayed a 3.43-fold increased HR for 2-year mortality (P < 0.001), whereas men with a TAPSE/mPAP ratio <0.434 mm/mm Hg displayed a 2.05-fold increased HR for 2-year mortality (P = 0.001). Even though men and women differ in the etiology of TR, both sexes show similar survival rates after TTVI. The TAPSE/mPAP ratio can improve prognostication after TTVI, and sex-specific thresholds should be applied to guide future patient selection. [Display omitted] [ABSTRACT FROM AUTHOR]- Published
- 2023
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18. Prognostic Value of Tricuspid Valve Gradient After Transcatheter Edge-to-Edge Repair: Insights From the TriValve Registry.
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Coisne, Augustin, Scotti, Andrea, Taramasso, Maurizio, Granada, Juan F., Ludwig, Sebastian, Rodés-Cabau, Josep, Lurz, Philipp, Hausleiter, Jörg, Fam, Neil, Kodali, Susheel K., Pozzoli, Alberto, Alessandrini, Hannes, Biasco, Luigi, Brochet, Eric, Denti, Paolo, Estevez-Loureiro, Rodrigo, Frerker, Christian, Ho, Edwin C., Monivas, Vanessa, and Nickenig, Georg
- Abstract
Data regarding the impact of the tricuspid valve gradient (TVG) after tricuspid transcatheter edge-to-edge repair (TEER) are scarce. This study sought to evaluate the association between the mean TVG and clinical outcomes among patients who underwent tricuspid TEER for significant tricuspid regurgitation. Patients with significant tricuspid regurgitation who underwent tricuspid TEER within the TriValve (International Multisite Transcatheter Tricuspid Valve Therapies) registry were divided into quartiles based on the mean TVG at discharge. The primary endpoint was the composite of all-cause mortality and heart failure hospitalization. Outcomes were assessed up to the 1-year follow-up. A total of 308 patients were included from 24 centers. Patients were divided into quartiles of the mean TVG as follows: quartile 1 (n = 77), 0.9 ± 0.3 mm Hg; quartile 2 (n = 115), 1.8 ± 0.3 mm Hg; quartile 3 (n = 65), 2.8 ± 0.3 mm Hg; and quartile 4 (n = 51), 4.7 ± 2.0 mm Hg. The baseline TVG and the number of implanted clips were associated with a higher post-TEER TVG. There was no significant difference across TVG quartiles in the 1-year composite endpoint (quartiles 1-4: 35%, 30%, 40%, and 34%, respectively; P = 0.60) or the proportion of patients in New York Heart Association class III to IV at the last follow-up (P = 0.63). The results were similar after adjustment for clinical and echocardiographic characteristics (composite endpoint quartile 4 vs quartile 1-quartile 3 adjusted HR: 1.05; 95% CI: 0.52-2.12; P = 0.88) or exploring post-TEER TVG as a continuous variable. In this retrospective analysis of the TriValve registry, an increased discharge TVG was not significantly associated with adverse outcomes after tricuspid TEER. These findings apply for the explored TVG range and up to the 1-year follow-up. Further investigations on higher gradients and longer follow-up are needed to better guide the intraprocedural decision-making process. [Display omitted] [ABSTRACT FROM AUTHOR]
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- 2023
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19. Sex-related characteristics and short-term outcomes of patients undergoing transcatheter tricuspid valve intervention for tricuspid regurgitation.
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Scotti, Andrea, Coisne, Augustin, Taramasso, Maurizio, Granada, Juan F, Ludwig, Sebastian, Rodés-Cabau, Josep, Lurz, Philipp, Hausleiter, Jörg, Fam, Neil, Kodali, Susheel K, Rosiene, Joel, Feinberg, Ari, Pozzoli, Alberto, Alessandrini, Hannes, Biasco, Luigi, Brochet, Eric, Denti, Paolo, Estévez-Loureiro, Rodrigo, Frerker, Christian, and Ho, Edwin C
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TRICUSPID valve surgery ,TRICUSPID valve ,TREATMENT effectiveness - Abstract
Aims The impact of sexuality in patients with significant tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve intervention (TTVI) is unknown. The aim of this study was to investigate sex-specific outcomes in patients with significant TR treated with TTVI vs. medical therapy alone. Methods and results The Transcatheter Tricuspid Valve Therapies (TriValve) registry collected data on patients with significant TR from 24 centres who underwent TTVI from 2016 to 2021. A control cohort was formed by medically managed patients with ≥severe isolated TR diagnosed in 2015–18. The primary endpoint was freedom from all-cause mortality. Secondary endpoints were heart failure (HF) hospitalization, New York Heart Association (NYHA) functional status, and TR severity. One-year outcomes were assessed for the TriValve cohort and compared with the control cohort with the inverse probability of treatment weighting (IPTW). A total of 556 and 2072 patients were included from the TriValve and control groups, respectively. After TTVI, there was no difference between women and men in 1-year freedom from all-cause mortality 80.9% vs. 77.9%, P = 0.56, nor in HF hospitalization (P = 0.36), NYHA Functional Classes III and IV (P = 0.17), and TR severity >2+ at last follow-up (P = 0.42). Multivariable Cox-regression weighted by IPTW showed improved 1-year survival after TTVI compared with medical therapy alone in both women (adjusted hazard ratio 0.45, 95% confidence interval 0.23–0.83, P = 0.01) and men (adjusted hazard ratio 0.42, 95% confidence interval 0.18–0.89, P = 0.03). Conclusion After TTVI in high-risk patients, there were no sex-related differences in terms of survival, HF hospitalization, functional status, and TR reduction up to 1 year. The IPTW analysis shows a survival benefit of TTVI over medical therapy alone in both women and men. [ABSTRACT FROM AUTHOR]
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- 2023
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20. Tricuspid Valve Geometrical Changes in Patients with Functional Tricuspid Regurgitation: Insights from a CT Scan Analysis Focusing on Commissures.
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Cammalleri, Valeria, Nobile, Edoardo, De Stefano, Domenico, Carpenito, Myriam, Mega, Simona, Bono, Maria Caterina, De Filippis, Aurelio, Nusca, Annunziata, Quattrocchi, Carlo Cosimo, Grigioni, Francesco, and Ussia, Gian Paolo
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TRICUSPID valve , *COMPUTED tomography , *CARDIAC patients - Abstract
Background: Cardiac computed tomography (CT) provides important insights into the geometrical configuration of the tricuspid valve (TV). The purpose of the present study was to assess the geometrical changes of TV in patients with functional tricuspid regurgitation (TR) using novel CT scan parameters and to correlate these findings with echocardiography. Methods: This single-center study enrolled 86 patients undergoing cardiac CT and divided them into two groups according to the presence or not of severe TR (43 patients with TR ≥ 3+ and 43 controls). The measurements collected were as follows: TV annulus area and perimeter, septal-lateral and antero-posterior annulus diameters, eccentricity, distance between commissures, segment between the geometrical centroid and commissures, and the angles of commissures. Results: We found a significant correlation between all annulus measurements and the grade of TR, except in regard to angles. TR ≥ 3+ patients had significantly larger TV annulus area and perimeter, larger septal-lateral, and antero-posterior annulus dimensions, as well as larger commissural distance and centroid-commissural distance. In patients with TR ≥ 3+ and controls, the eccentricity index predicted a circular shape and an oval shape of the annulus, respectively. Conclusions: These novel CT variables focusing on commissures increase the anatomical understanding of the TV apparatus and the TV geometrical changes in patients with severe functional TR. [ABSTRACT FROM AUTHOR]
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- 2023
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21. Epiphenomenon or Prognostically Relevant Interventional Target? A Novel Proportionality Framework for Severe Tricuspid Regurgitation
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Vera Fortmeier, Mark Lachmann, Matthias Unterhuber, Lukas Stolz, Mohammad Kassar, Laurin Ochs, Muhammed Gerçek, Anne R. Schöber, Thomas J. Stocker, Hazem Omran, Maria I. Körber, Amelie Hesse, Kai Peter Friedrichs, Shinsuke Yuasa, Tanja K. Rudolph, Michael Joner, Roman Pfister, Stephan Baldus, Karl‐Ludwig Laugwitz, Fabien Praz, Stephan Windecker, Jörg Hausleiter, Philipp Lurz, and Volker Rudolph
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pulmonary hypertension ,transcatheter tricuspid valve intervention ,tricuspid regurgitation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Tricuspid regurgitation (TR) frequently develops in patients with long‐standing pulmonary hypertension, and both pathologies are associated with increased morbidity and mortality. This study aimed to improve prognostic assessment in patients with severe TR undergoing transcatheter tricuspid valve intervention (TTVI) by relating the extent of TR to pulmonary artery pressures. Methods and Results In this multicenter study, we included 533 patients undergoing TTVI for moderate‐to‐severe or severe TR. The proportionality framework was based on the ratio of tricuspid valve effective regurgitant orifice area to mean pulmonary artery pressure. An optimal threshold for tricuspid valve effective regurgitant orifice area/mean pulmonary artery pressure ratio was derived on 353 patients with regard to 2‐year all‐cause mortality and externally validated on 180 patients. Patients with a tricuspid valve effective regurgitant orifice area/mean pulmonary artery pressure ratio ≤1.25 mm2/mm Hg (defining proportionate TR) featured significantly lower 2‐year survival rates after TTVI than patients with disproportionate TR (56.6% versus 69.6%; P=0.005). In contrast with patients with disproportionate TR (n=398), patients with proportionate TR (n=135) showed more pronounced mPAP levels (37.9±9.06 mm Hg versus 27.9±8.17 mm Hg; P
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- 2023
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22. Multicenter Experience With the Transcatheter Leaflet Repair System for Symptomatic Tricuspid Regurgitation.
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Wild, Mirjam G., Löw, Kornelia, Rosch, Sebastian, Gerçek, Muhammed, Higuchi, Satoshi, Massberg, Steffen, Näbauer, Michael, Rudolph, Volker, Markovic, Sinisa, Boekstegers, Peter, Rassaf, Tienush, Luedike, Peter, Geisler, Tobias, Braun, Daniel, Stolz, Lukas, Praz, Fabien, Lurz, Philip, and Hausleiter, Jörg
- Abstract
Transcatheter treatment techniques for tricuspid regurgitation (TR) have evolved in recent years, with leaflet repair being the most commonly used, but thus far evidence on the PASCAL and PASCAL Ace system is based mainly on compassionate use data. This is the first report on commercial use in a multicenter study with a large patient cohort investigating the safety and efficacy of the PASCAL and PASCAL Ace system in the treatment of TR. In a retrospective, multicenter, observational setting, data from all consecutive patients undergoing leaflet repair for TR at 8 centers was collected, including a centralized analysis of echocardiographic data. A total of 235 high-risk patients (mean age 78 ± 8 years, 49% women, mean Society of Thoracic Surgeons Predicted Risk of Mortality score 8.6% ± 6.8%) were included. TR was functional in 87% of patients and graded severe or higher in 91%. TR was successfully reduced to moderate or less in 78% of patients (P < 0.001). Procedural success was 78% (n = 153). At the latest available follow-up (median 173 days), TR reduction was sustained (78% with TR moderate or less; P < 0.001), and echocardiography showed indications of right ventricular remodeling (mean right ventricular end-diastolic diameter 56 ± 9 mm vs 53 ± 9 mm; P < 0.001). Patients' symptoms diminished significantly (63% were in New York Heart Association functional class I or II at follow-up; P < 0.001). In a device-specific analysis, the PASCAL and PASCAL Ace showed no difference in TR reduction (postprocedural TR moderate or less in 77% vs 78%; P = 0.82). In early clinical experience, the PASCAL (Ace) leaflet repair system has high technical and procedural success rates with efficient TR reduction and significant clinical and echocardiographic improvement at follow-up. [Display omitted] [ABSTRACT FROM AUTHOR]
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- 2022
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23. Durability of benefit after transcatheter tricuspid valve intervention: insights from actigraphy.
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Stocker, Thomas J., Cohen, David J., Arnold, Suzanne V., Sommer, Saskia, Braun, Daniel, Stolz, Lukas, Hertell, Helene, Weckbach, Ludwig T., Wild, Mirjam G., Doldi, Philipp, Orban, Martin, Orban, Mathias, Deseive, Simon, Higuchi, Satoshi, Massberg, Steffen, Nabauer, Michael, and Hausleiter, Jörg
- Abstract
Aims: Tricuspid regurgitation (TR) is associated with high mortality, morbidity and reduced physical capacity. This study was designed to examine the long‐term impact of transcatheter tricuspid valve intervention (TTVI) on physical activity by using the method of actigraphy. Methods and results: Overall, we prospectively included 128 heart failure patients with severe TR (median age 79 years, 48% female) who were scheduled for TTVI. Patients were equipped with activity tracking devices for 1 week before TTVI, and again at 1–6 months and 1 year after TTVI. We compared continuous physical activity (CPA), defined as the mean number of steps/day with New York Heart Association class, quality of life assessments, and 6‐min walk distance (all p <0.01). TTVI reduced TR to grade ≤2+ in 94% of patients. Median (interquartile range [IQR]) CPA at baseline was 3108 (1350–4959) steps/day, which increased by 31.4% to 3958 (1823–5657) steps/day at 1–6 months and 4080 (2293–6514) steps/day at 1 year after TTVI (p <0.001 for both comparisons). The impact of TTVI was significantly higher in advanced heart failure patients with low baseline activity (baseline CPA <1350 steps/day; 1‐year CPA increase: +121.3%; p <0.001), when compared to moderate activity patients (baseline CPA 1350–4959 steps/day; 1‐year CPA increase: +27.5%; p <0.01) or high activity patients (baseline CPA >4959 steps/day; 1‐year CPA change: +2.6%; p = 0.39). Conclusion: One‐week actigraphy demonstrates durable improvement of physical activity after TTVI. Fragile chronic heart failure patients with very low baseline activity, as determined by actigraphy in this study, significantly benefit from transcatheter intervention and should not be excluded from TTVI. [ABSTRACT FROM AUTHOR]
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- 2022
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24. Burden of Heart Failure in Patients With Tricuspid Regurgitation and Effect of Transcatheter Repair on Different Subdimensions of Quality of Life.
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Stocker TJ, Sommer S, Cohen DJ, Spertus JA, Stolz L, Doldi PM, Weckbach LT, Nabauer M, Massberg S, and Hausleiter J
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- Humans, Female, Male, Aged, Aged, 80 and over, Treatment Outcome, Tricuspid Valve physiopathology, Tricuspid Valve surgery, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation methods, Surveys and Questionnaires, Cost of Illness, Severity of Illness Index, Quality of Life, Tricuspid Valve Insufficiency physiopathology, Heart Failure psychology, Heart Failure physiopathology, Cardiac Catheterization methods
- Abstract
Background: Right-sided heart failure (HF) due to severe tricuspid regurgitation (TR) is associated with reduced quality of life (QoL). Here, we analyzed the impact of TR on specific QoL dimensions and the effect of transcatheter tricuspid valve intervention (TTVI) on individual QoL items., Methods and Results: In this study, we included 174 patients with HF (49% women; median age, 79 years; 97% New York Heart Association ≥3) with baseline QoL assessment undergoing TTVI by transcatheter edge-to-edge-repair at our center between April 2016 and March 2022. QoL was assessed by the standardized Minnesota Living With HF Questionnaire. QoL change after TTVI and correlation to functional end points were analyzed. In addition, all QoL domains and the 21 individual items of the Minnesota Living With HF Questionnaire were analyzed. TTVI significantly reduced TR (TR ≥3: baseline 95%, 1-year-follow-up 7%; P <0.001). Total Minnesota Living with HF Questionnaire score improved from 37 (interquartile range, 26-50) points to 31 (interquartile range, 17-42) points (median follow-up-interval, 355 days; P <0.001). QoL improvement was associated with positive New York Heart Association class, 6-minute walking distance, and actigraphy changes (all P <0.05). The detailed analysis revealed that all items of the physical-related QoL dimension were impaired at baseline and strongly improved after TTVI. In contrast, the emotional and "social" Minnesota Living With HF Questionnaire dimensions were largely unaffected at baseline, yet specific items improved with TTVI., Conclusions: In this single-center study, we delineate the QoL-associated disease burden of TR and identify specific QoL items that improved after TTVI. Our findings support TTVI in patients with reduced QoL and may add to the development of specific tools assessing the functional status of an increasing patient population undergoing TTVI.
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- 2024
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25. Advances in the Assessment of Patients With Tricuspid Regurgitation: A State-of-the-Art Review on the Echocardiographic Evaluation Before and After Tricuspid Valve Interventions.
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Badano LP, Tomaselli M, Muraru D, Galloo X, Li CHP, and Ajmone Marsan N
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Tricuspid regurgitation (TR) can have a significant impact on the health and mortality of a patient. Unfortunately, many patients with advanced right-sided heart failure are not referred for isolated tricuspid valve (TV) surgery in a timely manner. This delayed referral has resulted in a high in-hospital mortality rate and significant undertreatment. Fortunately, transcatheter TV intervention (TTVI) has emerged as a safe and effective alternative to surgery, successfully reducing TR severity and improving patients' quality of life. Current guidelines emphasize the importance of assessing TR severity and its impact on the right heart chambers for selecting the appropriate intervention. However, the echocardiographic assessment of both right chambers and TV anatomy, along with TR severity, poses specific challenges, leading to the underestimation of TR severity. Recently, three-dimensional echocardiography has become crucial to enhance the characterization of TR severity. Moreover, it is essential to evaluate residual TR after TTVI to gauge the intervention's success and predict the patient's prognosis. This review provides a thorough evaluation of the echocardiographic parameters used to assess TR severity before and after TTVI. It presents a critical analysis of the accuracy and reliability of these parameters, highlighting their strengths and limitations to establish standardized diagnostic criteria and treatment protocols for TR, which will inform clinical decision-making and improve patient outcomes., Competing Interests: Conflicts of Interest Dr. Muraru and Dr. Badano are members of the speaker bureaus of GE Healthcare and Philips Medical Systems and received research grants from GE Healthcare, Philips Medical Systems, TomTec Imaging Systems, and ESaOTE. The Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, has received unrestricted research grants from Abbott Vascular, Alnylam, Bayer, Biotronik, Bioventrix, Boston Scientific, Edwards Lifesciences, GE Healthcare, Medtronic, Medis Medical Imaging Systems, Pie Medical, Pfizer, and Novartis. Dr. Ajmone Marsan has received speaker fees from Abbott Vascular, Philips Ultrasound, GE Healthcare, Pfizer, and Omron., (Copyright © 2024 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)
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- 2024
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26. Functional Mitral and Tricuspid Regurgitation across the Whole Spectrum of Left Ventricular Ejection Fraction: Recognizing the Elephant in the Room of Heart Failure
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Valeria Cammalleri, Giorgio Antonelli, Valeria Maria De Luca, Myriam Carpenito, Annunziata Nusca, Maria Caterina Bono, Simona Mega, Gian Paolo Ussia, and Francesco Grigioni
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heart failure ,mitral regurgitation ,tricuspid regurgitation ,atrial functional mitral regurgitation ,atrial functional tricuspid regurgitation ,transcatheter tricuspid valve intervention ,Medicine - Abstract
Functional mitral regurgitation (FMR) and tricuspid regurgitation (FTR) occur due to cardiac remodeling in the presence of structurally normal valve apparatus. Two main mechanisms are involved, distinguishing an atrial functional form (when annulus dilatation is predominant) and a ventricular form (when ventricular remodeling and dysfunction predominate). Both affect the prognosis of patients with heart failure (HF) across the entire spectrum of left ventricle ejection fraction (LVEF), including preserved (HFpEF), mildly reduced (HFmrEF), or reduced (HFrEF). Currently, data on the management of functional valve regurgitation in the various HF phenotypes are limited. This review summarizes the epidemiology, pathophysiology, and treatment of FMR and FTR within the different patterns of HF, as defined by LVEF.
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- 2023
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27. Novel Computed Tomography Variables for Assessing Tricuspid Valve Morphology: Results from the TRIMA (Tricuspid Regurgitation IMAging) Study.
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Cammalleri, Valeria, Carpenito, Myriam, De Stefano, Domenico, Ussia, Gian Paolo, Bono, Maria Caterina, Mega, Simona, Nusca, Annunziata, Cocco, Nino, Nobile, Edoardo, De Filippis, Aurelio, Vitez, Luka, Quattrocchi, Carlo Cosimo, and Grigioni, Francesco
- Abstract
Background: Computed tomography (CT) is the recommended imaging technique for defining the anatomical suitability for current transcatheter technologies and planning tricuspid valve (TV) intervention. The aim of the Tricuspid Regurgitation IMAging (TRIMA) study was to assess the geometrical characteristics of the TV complex using novel CT parameters. Methods: This prospective, single-center study enrolled 22 consecutive patients with severe tricuspid regurgitation, who underwent a cardiac CT study dedicated to the right chambers. The following variables were obtained: annulus area and perimeter, septal-lateral and antero-posterior diameters, tenting height, and anatomical regurgitant orifice area. Moreover, the following novel annular parameters were assessed: distance between commissures, distance between TV centroid and commissures, and angles between centroid and commissures. Results: A significant phasic variability during the cardiac cycle existed for all variables except for eccentricity, angles, and distance between the postero-septal and antero-posterior commissure and distance between the centroid and antero-posterior commissure. There was a significant relationship between the TV annulus area and novel annular parameters, except for annular angles. Additionally, novel annular variables were found to predict the annulus area. Conclusions: These novel additional variables may provide an initial platform from which the complexity of the TV annular morphology can continue to be better understood for further improving transcatheter therapies. [ABSTRACT FROM AUTHOR]
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- 2022
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28. Tricuspid Valve Geometrical Changes in Patients with Functional Tricuspid Regurgitation: Insights from a CT Scan Analysis Focusing on Commissures
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Valeria Cammalleri, Edoardo Nobile, Domenico De Stefano, Myriam Carpenito, Simona Mega, Maria Caterina Bono, Aurelio De Filippis, Annunziata Nusca, Carlo Cosimo Quattrocchi, Francesco Grigioni, and Gian Paolo Ussia
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tricuspid valve ,transcatheter tricuspid valve intervention ,tricuspid valve commissures ,computed tomography ,multimodality imaging ,atrial functional tricuspid regurgitation ,Medicine - Abstract
Background: Cardiac computed tomography (CT) provides important insights into the geometrical configuration of the tricuspid valve (TV). The purpose of the present study was to assess the geometrical changes of TV in patients with functional tricuspid regurgitation (TR) using novel CT scan parameters and to correlate these findings with echocardiography. Methods: This single-center study enrolled 86 patients undergoing cardiac CT and divided them into two groups according to the presence or not of severe TR (43 patients with TR ≥ 3+ and 43 controls). The measurements collected were as follows: TV annulus area and perimeter, septal-lateral and antero-posterior annulus diameters, eccentricity, distance between commissures, segment between the geometrical centroid and commissures, and the angles of commissures. Results: We found a significant correlation between all annulus measurements and the grade of TR, except in regard to angles. TR ≥ 3+ patients had significantly larger TV annulus area and perimeter, larger septal-lateral, and antero-posterior annulus dimensions, as well as larger commissural distance and centroid-commissural distance. In patients with TR ≥ 3+ and controls, the eccentricity index predicted a circular shape and an oval shape of the annulus, respectively. Conclusions: These novel CT variables focusing on commissures increase the anatomical understanding of the TV apparatus and the TV geometrical changes in patients with severe functional TR.
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- 2023
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29. Solving the Pulmonary Hypertension Paradox in Patients With Severe Tricuspid Regurgitation by Employing Artificial Intelligence.
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Fortmeier, Vera, Lachmann, Mark, Körber, Maria I., Unterhuber, Matthias, von Scheidt, Moritz, Rippen, Elena, Harmsen, Gerhard, Gerçek, Muhammed, Friedrichs, Kai Peter, Roder, Fabian, Rudolph, Tanja K., Yuasa, Shinsuke, Joner, Michael, Laugwitz, Karl-Ludwig, Baldus, Stephan, Pfister, Roman, Lurz, Philipp, and Rudolph, Volker
- Abstract
This study aimed to improve echocardiographic assessment of pulmonary hypertension (PH) in patients presenting with severe tricuspid regurgitation (TR). Echocardiographic assessment of PH in patients with severe TR carries several pitfalls for underestimation, hence concealing the true severity of PH in very sick patients in particular, and ultimately obscuring the impact of PH on survival after transcatheter tricuspid valve intervention (TTVI). All patients in this study underwent TTVI for severe TR between 2016 and 2020. To predict the mean pulmonary artery pressure (mPAP) solely based on echocardiographic parameters, we trained an extreme gradient boosting (XGB) algorithm. The derivation cohort was constituted by 116 out of 162 patients with both echocardiography and right heart catheterization data, preprocedurally obtained, from a bicentric registry. Moreover, 142 patients from an independent institution served for external validation. Systolic pulmonary artery pressure was consistently underestimated by echocardiography in comparison to right heart catheterization (40.3 ± 15.9 mm Hg vs 44.1 ± 12.9 mm Hg; P = 0.0066), and the assessment was most discrepant among patients with severe defects of the tricuspid valve and impaired right ventricular systolic function. Using 9 echocardiographic parameters as input variables, an XGB algorithm could reliably predict mPAP levels (R = 0.96, P < 2.2 × 10
-16 ). Moreover, patients with elevations in predicted mPAP levels ≥29.9 mm Hg showed significantly reduced 2-year survival after TTVI (58.3% [95% CI: 41.7%-81.6%] vs 78.8% [95% CI: 68.7%-90.5%]; P = 0.026). Importantly, the poor prognosis associated with elevation in predicted mPAP levels was externally confirmed (HR for 2-year mortality: 2.9 [95% CI: 1.5-5.7]; P = 0.002). PH in patients with severe TR can be reliably assessed based on echocardiographic parameters in conjunction with an XGB algorithm, and elevations in predicted mPAP levels translate into increased mortality after TTVI. [Display omitted] [ABSTRACT FROM AUTHOR]- Published
- 2022
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30. Transcatheter Tricuspid Valve Therapy: From Anatomy to Intervention
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Valeria Cammalleri, Myriam Carpenito, Maria Caterina Bono, Simona Mega, Gian Paolo Ussia, and Francesco Grigioni
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tricuspid valve ,tricuspid anatomy ,echocardiography ,computed tomography ,transcatheter tricuspid valve intervention ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Nowadays, severe symptomatic tricuspid regurgitation (TR) affects millions of persons worldwide. However, the benefit of surgical correction of isolated secondary TR remains controversial because of the increased risk of periprocedural mortality and morbidity. In recent years, novel transcatheter tricuspid valve interventions (TTVI) were developed to treat TR, so that TTVI is currently considered in symptomatic, inoperable, anatomically eligible patients. TTVI can be divided into these five domains: edge-to-edge leaflet repair, tricuspid annuloplasty, caval implants, spacer, and total valve replacement. Each transcatheter intervention needs specific imaging protocols for assessing the anatomical feasibility and consequentially predicting the procedural success. This review summarizes the available multimodality imaging tools for screening patients with TR, and identifies anatomical characteristics to choose the best option for the patient.
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- 2021
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31. Early Experience of 3-Dimensional Intracardiac Echocardiography in Transcatheter Tricuspid Interventions.
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Wang L, Petrossian G, Robinson N, Chung W, Khan J, Shin D, Mihalatos D, Cohen DJ, Ali ZA, and Khalique O
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- 2024
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32. [Clinical aspects and treatment of tricuspid valve regurgitation].
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Stocker TJ and Hausleiter J
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- Humans, Heart Valve Prosthesis Implantation methods, Tricuspid Valve surgery, Tricuspid Valve diagnostic imaging, Echocardiography, Tricuspid Valve Insufficiency surgery, Tricuspid Valve Insufficiency therapy, Tricuspid Valve Insufficiency diagnosis
- Abstract
Tricuspid regurgitation (TR) leading to right heart failure is prevalent and associated with increased mortality. The significant under-recognition of the disease resulted from insufficient medical therapies and the high associated risk of surgical therapy. Over the last decade there has been a rapid development of interventional treatment options so that the disease has increasingly become the focus of attention of specialists in internal medicine and interventional cardiologists. The etiology of TR is differentiated into primary TR, secondary atrial TR, secondary ventricular TR and TR associated with cardiac implantable electronic devices (CIED). The TR was identified as an independent predictor of mortality, independent of associated diseases such as atrial fibrillation, left-sided heart failure or pulmonary hypertension. Even patients with low to moderate TR have a significantly increased risk of mortality. Early diagnostics and estimation of the severity by echocardiography as well as timely referral to a tertiary heart valve center are decisive in order to evaluate possible treatment options before irreversible right ventricular damage and secondary organ dysfunction occur. For transcatheter edge-to-edge repair and transcatheter tricuspid valve replacement there is now first evidence from randomized controlled studies. While the understanding of TR is continuously improving, new tricuspid valve repair and replacement systems are in a state of steady progress. Whether the treatment has an effect on reduction of the mortality and stabilization of right ventricular failure with a reduction in hospitalization, will first be shown in future studies., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)
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- 2024
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33. Etiologies and Impact of Exclusion Rates for Transcatheter Mitral and Tricuspid Valve Structural Heart Clinical Trials at a High-Volume Quaternary Care Hospital.
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Chen L, Wang L, Petrossian G, Robinson N, Chung W, Henry M, Mihalatos D, Bano R, Weber J, Khan J, Cohen DJ, Berke A, Ali Z, and Khalique OK
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- Humans, Tricuspid Valve surgery, Cardiac Catheterization, Treatment Outcome, Hospitals, Heart Valve Prosthesis Implantation, Mitral Valve Insufficiency surgery
- Abstract
There are various devices under clinical investigation for transcatheter mitral valve intervention and transcatheter tricuspid valve intervention (TTVI); however, the exclusion rates remain high. We aimed to investigate the exclusion rates for transcatheter mitral valve repair (TMVr), transcatheter mitral valve replacement (TMVR), transcatheter tricuspid valve repair (TTVr), and transcatheter tricuspid valve replacement (TTVR). There were 129 patients who were referred to St. Francis Hospital & Heart Center valve clinic and completed screening between January 2021 and July 2022. The causes for exclusion were classified into 4 categories: patient withdrawal, anatomic unsuitability, clinical criteria, and medical futility. In 129 patients, the exclusion rates for TMVr, TMVR, TTVr, and TTVR were 81%, 85%, 91%, and 87%, respectively. Patient withdrawal and medical futility were leading etiologies for exclusion, followed by anatomic unsuitability. TMVr had the highest rate of patient withdrawal (64%) and the lowest anatomic unsuitability (5%) because of short posterior leaflet length. Replacement interventions have a higher anatomic unsuitability (33%) than repair interventions (17%) (p = 0.04). Most exclusions of anatomic unsuitability were because of mitral stenosis or small annulus size for TMVR and large annulus size for TTVR. A total of 50% of exclusions from TTVr were because of the presence of pacemaker/defibrillator leads. In patients excluded from their respective trials, patients being referred for TMVr had the highest recurrent hospitalization and repair group had a higher mortality (p <0.01 and p = 0.01, respectively). In conclusion, the exclusion rates for transcatheter mitral valve intervention and TTVI trials remain high because of various reasons, limiting patient enrollment and treatment. This supports the need for further device improvement or exploring alternative means of therapy., Competing Interests: Declaration of competing interest Dr. Khalique has consulting agreements with Edwards, Abbott Structural, Restore medical, Triflo, and Croivalve and has equity in Triflo. Dr. Ali has consulting agreements with Abiomed, Astra Zeneca, Boston Scientific, Cathworks, Opsens, Phillips, and Shockwave; has equity in Elucid, Lifelink, Spectrawave, Shockwave, and VitalConnect; and receives institutional grant from Abbott, Abiomed, Acist, Amgen, Boston Scientific, Cathworks, Canon, Conavi, Heartflow, Inari, Medtronic Inc, National Institute of Health, Nipro, Opsens Medical, Medis, Philips, Shockwave, Siemens, Spectrawave, and Teleflex. Dr. Khan has equity in Transmural Systems and serves as a proctor for Edwards Lifesciences and Medtronic and receives institutional grant from Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, and Philips. Dr. Cohen has consulting agreements with Edwards Lifesciences, Abbott, and Medtronic and receives institutional grant from Edwards Lifesciences, Abbott, and Boston Scientific. The remaining authors have no competing interests to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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34. Expanding the Tools for Transcatheter Tricuspid Valve Intervention
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Maurizio Taramasso, MD, PhD
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transcatheter tricuspid valve intervention ,tricuspid regurgitation ,tricuspid valve ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2020
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35. Novel Computed Tomography Variables for Assessing Tricuspid Valve Morphology: Results from the TRIMA (Tricuspid Regurgitation IMAging) Study
- Author
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Valeria Cammalleri, Myriam Carpenito, Domenico De Stefano, Gian Paolo Ussia, Maria Caterina Bono, Simona Mega, Annunziata Nusca, Nino Cocco, Edoardo Nobile, Aurelio De Filippis, Luka Vitez, Carlo Cosimo Quattrocchi, and Francesco Grigioni
- Subjects
tricuspid valve ,transcatheter tricuspid valve intervention ,commissures ,computed tomography ,Medicine - Abstract
Background: Computed tomography (CT) is the recommended imaging technique for defining the anatomical suitability for current transcatheter technologies and planning tricuspid valve (TV) intervention. The aim of the Tricuspid Regurgitation IMAging (TRIMA) study was to assess the geometrical characteristics of the TV complex using novel CT parameters. Methods: This prospective, single-center study enrolled 22 consecutive patients with severe tricuspid regurgitation, who underwent a cardiac CT study dedicated to the right chambers. The following variables were obtained: annulus area and perimeter, septal-lateral and antero-posterior diameters, tenting height, and anatomical regurgitant orifice area. Moreover, the following novel annular parameters were assessed: distance between commissures, distance between TV centroid and commissures, and angles between centroid and commissures. Results: A significant phasic variability during the cardiac cycle existed for all variables except for eccentricity, angles, and distance between the postero-septal and antero-posterior commissure and distance between the centroid and antero-posterior commissure. There was a significant relationship between the TV annulus area and novel annular parameters, except for annular angles. Additionally, novel annular variables were found to predict the annulus area. Conclusions: These novel additional variables may provide an initial platform from which the complexity of the TV annular morphology can continue to be better understood for further improving transcatheter therapies.
- Published
- 2022
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36. Future Perspectives in Percutaneous Treatment of Tricuspid Regurgitation
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Antonio Mangieri, Matteo Pagnesi, Damiano Regazzoli, Alessandra Laricchia, Edwin Ho, Ythan Goldberg, Mei Chau, Francesco Gallo, Andrea Fisicaro, Arif Khokhar, Antonio Colombo, Francesco Giannini, and Azeem Latib
- Subjects
transcatheter tricuspid valve intervention ,transcatheter tricuspid valve replacement ,tricuspid valve ,tricuspid regurgitation ,intracardiac echocardiography ,transesophageal echocardiography ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Tricuspid regurgitation (TR) has a not negligible prevalence and its severity is correlated with poorer outcomes. However, surgical options are rarely offered to these patients because of their high surgical risk. Given that medical therapy plays a limited role in the management of these patients, there is an increasing clinical need for transcatheter treatment options. Although, transcatheter tricuspid valve interventions (TTVIs) are still at an early stage, emerging data suggests their clinical effectiveness and safety, with preliminary results highlighting the potential benefits of transcatheter treatments over medical therapy. In this review, we highlight the challenges and future directions of current and emerging technologies dedicated to the treatment of TR along with an analysis of the next steps required in future clinical trials and studies dedicated to the treatment of the forgotten valve.
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- 2020
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37. Artificial intelligence-enabled assessment of right ventricular to pulmonary artery coupling in patients undergoing transcatheter tricuspid valve intervention.
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Fortmeier V, Lachmann M, Stolz L, von Stein J, Unterhuber M, Kassar M, Gerçek M, Schöber AR, Stocker TJ, Omran H, Körber MI, Hesse A, Harmsen G, Friedrichs KP, Yuasa S, Rudolph TK, Joner M, Pfister R, Baldus S, Laugwitz KL, Windecker S, Praz F, Lurz P, Hausleiter J, and Rudolph V
- Subjects
- Humans, Tricuspid Valve, Pulmonary Artery diagnostic imaging, Artificial Intelligence, Echocardiography, Heart Ventricles diagnostic imaging, Ventricular Function, Right, Tricuspid Valve Insufficiency, Ventricular Dysfunction, Right
- Abstract
Aims: Right ventricular to pulmonary artery (RV-PA) coupling has been established as a prognostic marker in patients with severe tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve interventions (TTVI). RV-PA coupling assesses right ventricular systolic function related to pulmonary artery pressure levels, which are ideally measured by right heart catheterization. This study aimed to improve the RV-PA coupling concept by relating tricuspid annular plane systolic excursion (TAPSE) to mean pulmonary artery pressure (mPAP) levels. Moreover, instead of right heart catheterization, this study sought to employ an extreme gradient boosting (XGB) algorithm to predict mPAP levels based on standard echocardiographic parameters., Methods and Results: This multicentre study included 737 patients undergoing TTVI for severe TR; among them, 55 patients from one institution served for external validation. Complete echocardiography and right heart catheterization data were available from all patients. The XGB algorithm trained on 10 echocardiographic parameters could reliably predict mPAP levels as evaluated on right heart catheterization data from external validation (Pearson correlation coefficient R: 0.68; P value: 1.3 × 10-8). Moreover, predicted mPAP (mPAPpredicted) levels were superior to echocardiographic systolic pulmonary artery pressure (sPAPechocardiography) levels in predicting 2-year mortality after TTVI [area under the curve (AUC): 0.607 vs. 0.520; P value: 1.9 × 10-6]. Furthermore, TAPSE/mPAPpredicted was superior to TAPSE/sPAPechocardiography in predicting 2-year mortality after TTVI (AUC: 0.633 vs. 0.586; P value: 0.008). Finally, patients with preserved RV-PA coupling (defined as TAPSE/mPAPpredicted > 0.617 mm/mmHg) showed significantly higher 2-year survival rates after TTVI than patients with reduced RV-PA coupling (81.5% vs. 58.8%, P < 0.001). Moreover, independent association between TAPSE/mPAPpredicted levels and 2-year mortality after TTVI was confirmed by multivariate regression analysis (P value: 6.3 × 10-4)., Conclusion: Artificial intelligence-enabled RV-PA coupling assessment can refine risk stratification prior to TTVI without necessitating invasive right heart catheterization. A comparison with conservatively treated patients is mandatory to quantify the benefit of TTVI in accordance with RV-PA coupling., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2024
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- View/download PDF
38. Patients' selection for transcatheter tricuspid valve interventions: Who will benefit?
- Author
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Harb, Serge C. and Kapadia, Samir R.
- Abstract
Tricuspid regurgitation (TR) is a common valvular pathology and is associated with significant morbidity and mortality. However, there is no currently defined optimal management strategy: medical therapy is limited to diuretics, and tricuspid valve surgery is rarely performed and associated with high risks. This has led to the emergence of numerous transcatheter therapies that are showing promising early results but are faced with multiple challenges. The tricuspid valve anatomy is complex and variable, imaging of tricuspid valve by echocardiography can be difficult, and current grading of TR severity and right ventricular size and function is mostly subjective. Also, the optimal timing of the intervention and appropriate selection of patients who will benefit remain topics of debate with limited supporting data. In this review, we present the current challenges and considerations in patients' selection and propose a trial design and selection criteria aimed to address these limitations. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
39. Tricuspid Regurgitation and Right Heart Failure: The Role of Imaging in Defining Pathophysiology, Presentation, and Novel Management Strategies.
- Author
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Agarwal V and Hahn R
- Subjects
- Humans, Multimodal Imaging, Tricuspid Valve Insufficiency diagnostic imaging, Heart Failure diagnostic imaging, Heart Failure therapy
- Abstract
During the last few years, there has been a substantial shift in efforts to understand and manage secondary or functional tricuspid regurgitation (TR) given its prevalence, adverse prognostic impact, and symptom burden associated with progressive right heart failure. Understanding the pathophysiology of TR and right heart failure is crucial for determining the best treatment strategy and improving outcomes. In this article, we review the complex relationship between right heart structural and hemodynamic changes that drive the pathophysiology of secondary TR and discuss the role of multimodality imaging in the diagnosis, management, and determination of outcomes., (Copyright © 2023 Elsevier Inc. All rights reserved.)
- Published
- 2023
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- View/download PDF
40. Outcomes After Current Transcatheter Tricuspid Valve Intervention: Mid-Term Results From the International TriValve Registry.
- Author
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Taramasso, Maurizio, Alessandrini, Hannes, Latib, Azeem, Asami, Masahiko, Attinger-Toller, Adrian, Biasco, Luigi, Braun, Daniel, Brochet, Eric, Connelly, Kim A., Denti, Paolo, Deuschl, Florian, Englmeier, Andrea, Fam, Neil, Frerker, Christian, Hausleiter, Jörg, Himbert, Dominique, Ho, Edwin, Juliard, Jean-Michel, Kaple, Ryan, and Kreidel, Felix
- Abstract
Abstract Objectives A large, prospective international registry was developed to evaluate the initial clinical applications of transcatheter tricuspid valve intervention (TTVI) with different devices. Background TTVI for native tricuspid valve dysfunction has been emerging during the last few years as an alternative therapeutic option to serve a large high-risk population of patients with severe symptomatic tricuspid regurgitation (TR). Methods The TriValve Registry included 312 high-risk patients with severe TR (76.4 ± 8.5 years of age; 57% female; EuroSCORE II 9 ± 8%) at 18 centers. Interventions included repair at the level of the leaflets (MitraClip, Abbott Vascular, Santa Clara, California; PASCAL Edwards Lifesciences, Irvine, California), annulus (Cardioband, Edwards Lifesciences; TriCinch, 4tech, Galway, Ireland; Trialign, Mitraling, Tewksbury, Massachusetts), or coaptation (FORMA, Edwards Lifesciences) and replacement (Caval Implants, NaviGate, NaviGate Cardiac Structures, Lake Forest, California). Clinical outcomes were prospectively determined during mid-term follow-up. Results A total of 108 patients (34.6%) had prior left heart valve intervention (84 surgical and 24 transcatheter, respectively). TR etiology was functional in 93%, and mean annular diameter was 46.9 ± 9 mm. In 75% of patients the regurgitant jet was central (vena contracta 1.1 ± 0.5; effective regurgitant orifice area 0.78 ± 0.6 cm
2 ). Pre-procedural systolic pulmonary artery pressure was 41 ± 14.8 mm Hg. Implanted devices included: MitraClip in 210 cases, Trialign in 18 cases, TriCinch first generation in 14 cases, caval valve implantation in 30 cases, FORMA in 24 cases, Cardioband in 13 cases, NaviGate in 6 cases, and PASCAL in 1. In 64% of the cases, TTVI was performed as a stand-alone procedure. Procedural success (defined as the device successfully implanted and residual TR ≤2+) was 72.8%. Greater coaptation depth (odds ratio: 24.1; p = 0.002) was an independent predictor of reduced device success. Thirty-day mortality was 3.6% and was significantly lower among patients with procedural success (1.9% vs. 6.9%; p = 0.04); Actuarial survival at 1.5 years was 82.8 ± 4% and was significantly higher among patients who had procedural success achieved. Conclusions TTVI is feasible with different technologies, has a reasonable overall procedural success rate, and is associated with low mortality and significant clinical improvement. Mid-term survival is favorable in this high-risk population. Greater coaptation depth is associated with reduced procedural success, which is an independent predictor of mortality. Graphical abstract [ABSTRACT FROM AUTHOR]- Published
- 2019
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41. Transcatheter treatment for tricuspid valve disease
- Author
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Georg Nickenig, Ralph Stephan von Bardeleben, Felix Kreidel, Michele Senni, Francesco Maisano, Antonio Mangieri, Rebecca T. Hahn, Philipp Lurz, Victoria Delgado, Bernard Prendergast, José Luis Zamorano, Fabien Praz, Denisa Muraru, Jörg Hausleiter, Praz, F, Muraru, D, Kreidel, F, Lurz, P, Hahn, R, Delgado, V, Senni, M, Von Bardeleben, R, Nickenig, G, Hausleiter, J, Mangieri, A, Zamorano, J, Prendergast, B, and Maisano, F
- Subjects
medicine.medical_specialty ,Heart disease ,Volume overload ,Regurgitation (circulation) ,Internal medicine ,medicine ,610 Medicine & health ,tricuspid regurgitation ,Imaging modalitie ,imaging modalities ,Ejection fraction ,Tricuspid valve ,business.industry ,Atrial fibrillation ,MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE ,transoesophageal echocardiogram ,medicine.disease ,Pulmonary hypertension ,chronic heart failure ,tricuspid valve disease ,medicine.anatomical_structure ,Heart failure ,Cardiology ,transcatheter tricuspid valve intervention ,Cardiology and Cardiovascular Medicine ,business - Abstract
Approximately 4% of subjects aged 75 years or more have clinically relevant tricuspid regurgitation (TR). Primary TR results from anatomical abnormality of the tricuspid valve apparatus and is observed in only 8-10% of the patients with tricuspid valve disease. Secondary TR is more common and arises as a result of annular dilation caused by right ventricular enlargement and dysfunction as a consequence of pulmonary hypertension, often caused by left-sided heart disease or atrial fibrillation. Irrespective of its aetiology, TR leads to volume overload and increased wall stress, both of which negatively contribute to detrimental remodelling and worsening TR. This vicious circle translates into impaired survival and increased heart failure symptoms in patients with and without reduced left ventricular ejection fraction. Interventions to correct TR are underutilised in daily clinical practice owing to increased surgical risk and late patient presentation. The recently introduced transcatheter tricuspid valve interventions aim to address this unmet need. Dedicated expertise and an interdisciplinary Heart Team evaluation are essential to integrate these new techniques successfully and select patients. The present article proposes a standardised approach to evaluate patients with TR who may be candidates for transcatheter interventions. In addition, a state-of-the-art review of the available transcatheter therapies, the main criteria for patient and device selection, and information concerning the remaining uncertainties are provided.
- Published
- 2021
42. Atrial Functional Tricuspid Regurgitation as a Distinct Pathophysiological and Clinical Entity: No Idiopathic Tricuspid Regurgitation Anymore
- Abstract
Functional tricuspid regurgitation (FTR) is a strong and independent predictor of patient morbidity and mortality if left untreated. The development of transcatheter procedures to either repair or replace the tricuspid valve (TV) has fueled the interest in the pathophysiology, severity assessment, and clinical consequences of FTR. FTR has been considered to be secondary to tricuspid annulus (TA) dilation and leaflet tethering, associated to right ventricular (RV) dilation and/or dysfunction (the “classical”, ventricular form of FTR, V-FTR) for a long time. Atrial FTR (A-FTR) has recently emerged as a distinct pathophysiological entity. A-FTR typically occurs in patients with persistent/permanent atrial fibrillation, in whom an imbalance between the TA and leaflet areas results in leaflets malcoaptation, associated with the dilation and loss of the sphincter-like function of the TA, due to right atrium enlargement and dysfunction. According to its distinct pathophysiology, A-FTR poses different needs of clinical management, and the various interventional treatment options will likely have different outcomes than in V-FTR patients. This review aims to provide an insight into the anatomy of the TV, and the distinct pathophysiology of A-FTR, which are key concepts to understanding the objectives of therapy, the choice of transcatheter TV interventions, and to properly use pre-, intra-, and post-procedural imaging.
- Published
- 2022
43. Challenges and future perspectives of transcatheter tricuspid valve interventions: adopt old strategies or adapt to new opportunities?
- Abstract
Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease and is associated with an increased risk of cardiovascular events and death at long-term follow-up. Functional TR accounts for over 90% of TR and is mainly due to annular or right ventricular dilatation. Most often, TR is observed in patients with left-sided valvular heart disease (with or without previous surgical correction) and pulmonary hypertension. Isolated TR is less frequent, though burdened by high surgical mortality. This, together with an incomplete understanding of the disease, has brought to a significant undertreatment in spite of the growing evidence of the impact of severe TR on mortality. Moreover, uncertainties about the appropriate timing for intervention and the predictors of procedural success have contributed to limit TR treatment. Transcatheter tricuspid valve replacement or repair interventions represent novel and less invasive alternatives to surgery and have shown early promising results. The purpose of this review is to provide a complete and updated overview of TR pathology with a special focus on current percutaneous treatment options, future challenges and directions.
- Published
- 2022
44. Challenges and future perspectives of transcatheter tricuspid valve interventions: adopt old strategies or adapt to new opportunities?
- Author
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Giulio Russo, Maurizio Taramasso, Daniela Pedicino, Marco Gennari, Mara Gavazzoni, Alberto Pozzoli, Denisa Muraru, Luigi P. Badano, Marco Metra, Francesco Maisano, Russo, G, Taramasso, M, Pedicino, D, Gennari, M, Gavazzoni, M, Pozzoli, A, Muraru, D, Badano, L, Metra, M, and Maisano, F
- Subjects
Heart Failure ,Heart Valve Prosthesis Implantation ,Cardiac Catheterization ,MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE ,Tricuspid regurgitation ,Structural heart disease intervention ,Valvular heart disease ,Tricuspid Valve Insufficiency ,Treatment Outcome ,Tricuspid valve repair ,transcatheter tricuspid valve interventions ,Humans ,transcatheter tricuspid valve intervention ,Tricuspid Valve ,Structural heart disease interventions ,Tricuspid valve replacement ,Cardiology and Cardiovascular Medicine - Abstract
Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease and is associated with an increased risk of cardiovascular events and death at long-term follow-up. Functional TR accounts for over 90% of TR and is mainly due to annular or right ventricular dilatation. Most often, TR is observed in patients with left-sided valvular heart disease (with or without previous surgical correction) and pulmonary hypertension. Isolated TR is less frequent, though burdened by high surgical mortality. This, together with an incomplete understanding of the disease, has brought to a significant undertreatment in spite of the growing evidence of the impact of severe TR on mortality. Moreover, uncertainties about the appropriate timing for intervention and the predictors of procedural success have contributed to limit TR treatment. Transcatheter tricuspid valve replacement or repair interventions represent novel and less invasive alternatives to surgery and have shown early promising results. The purpose of this review is to provide a complete and updated overview of TR pathology with a special focus on current percutaneous treatment options, future challenges and directions.
- Published
- 2022
45. Atrial Functional Tricuspid Regurgitation as a Distinct Pathophysiological and Clinical Entity: No Idiopathic Tricuspid Regurgitation Anymore
- Author
-
Diana R. Florescu, Denisa Muraru, Valentina Volpato, Mara Gavazzoni, Sergio Caravita, Michele Tomaselli, Pellegrino Ciampi, Cristina Florescu, Tudor A. Bălșeanu, Gianfranco Parati, Luigi P. Badano, Florescu, D, Muraru, D, Volpato, V, Gavazzoni, M, Caravita, S, Tomaselli, M, Ciampi, P, Florescu, C, Balseanu, T, Parati, G, and Badano, L
- Subjects
Settore MED/11 - Malattie dell'Apparato Cardiovascolare ,General Medicine ,Review ,Tricuspid regurgitation ,MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE ,Three-dimensional echocardiography ,Multimodality imaging ,Echocardiography ,transcatheter tricuspid valve interventions ,cardiovascular system ,Medicine ,cardiovascular diseases ,Transcatheter tricuspid valve intervention ,Atrial functional tricuspid regurgitation ,echocardiography ,multimodality imaging ,three-dimensional echocardiography ,tricuspid regurgitation - Abstract
Functional tricuspid regurgitation (FTR) is a strong and independent predictor of patient morbidity and mortality if left untreated. The development of transcatheter procedures to either repair or replace the tricuspid valve (TV) has fueled the interest in the pathophysiology, severity assessment, and clinical consequences of FTR. FTR has been considered to be secondary to tricuspid annulus (TA) dilation and leaflet tethering, associated to right ventricular (RV) dilation and/or dysfunction (the “classical”, ventricular form of FTR, V-FTR) for a long time. Atrial FTR (A-FTR) has recently emerged as a distinct pathophysiological entity. A-FTR typically occurs in patients with persistent/permanent atrial fibrillation, in whom an imbalance between the TA and leaflet areas results in leaflets malcoaptation, associated with the dilation and loss of the sphincter-like function of the TA, due to right atrium enlargement and dysfunction. According to its distinct pathophysiology, A-FTR poses different needs of clinical management, and the various interventional treatment options will likely have different outcomes than in V-FTR patients. This review aims to provide an insight into the anatomy of the TV, and the distinct pathophysiology of A-FTR, which are key concepts to understanding the objectives of therapy, the choice of transcatheter TV interventions, and to properly use pre-, intra-, and post-procedural imaging.
- Published
- 2022
46. Transcatheter Tricuspid Valve Therapy: From Anatomy to Intervention
- Author
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Simona Mega, Francesco Grigioni, Myriam Carpenito, Maria Caterina Bono, Valeria Cammalleri, and Gian Paolo Ussia
- Subjects
medicine.medical_specialty ,Tricuspid valve ,business.industry ,computed tomography ,Review ,Cardiovascular Medicine ,tricuspid valve ,Surgery ,Settore MED/11 ,medicine.anatomical_structure ,Intervention (counseling) ,RC666-701 ,Medicine ,echocardiography ,Diseases of the circulatory (Cardiovascular) system ,transcatheter tricuspid valve intervention ,tricuspid anatomy ,Cardiology and Cardiovascular Medicine ,business - Abstract
Nowadays, severe symptomatic tricuspid regurgitation (TR) affects millions of persons worldwide. However, the benefit of surgical correction of isolated secondary TR remains controversial because of the increased risk of periprocedural mortality and morbidity. In recent years, novel transcatheter tricuspid valve interventions (TTVI) were developed to treat TR, so that TTVI is currently considered in symptomatic, inoperable, anatomically eligible patients. TTVI can be divided into these five domains: edge-to-edge leaflet repair, tricuspid annuloplasty, caval implants, spacer, and total valve replacement. Each transcatheter intervention needs specific imaging protocols for assessing the anatomical feasibility and consequentially predicting the procedural success. This review summarizes the available multimodality imaging tools for screening patients with TR, and identifies anatomical characteristics to choose the best option for the patient.
- Published
- 2021
47. Transcatheter treatment for tricuspid valve disease
- Abstract
Approximately 4% of subjects aged 75 years or more have clinically relevant tricuspid regurgitation (TR). Primary TR results from anatomical abnormality of the tricuspid valve apparatus and is observed in only 8-10% of the patients with tricuspid valve disease. Secondary TR is more common and arises as a result of annular dilation caused by right ventricular enlargement and dysfunction as a consequence of pulmonary hypertension, often caused by left-sided heart disease or atrial fibrillation. Irrespective of its aetiology, TR leads to volume overload and increased wall stress, both of which negatively contribute to detrimental remodelling and worsening TR. This vicious circle translates into impaired survival and increased heart failure symptoms in patients with and without reduced left ventricular ejection fraction. Interventions to correct TR are underutilised in daily clinical practice owing to increased surgical risk and late patient presentation. The recently introduced transcatheter tricuspid valve interventions aim to address this unmet need. Dedicated expertise and an interdisciplinary Heart Team evaluation are essential to integrate these new techniques successfully and select patients. The present article proposes a standardised approach to evaluate patients with TR who may be candidates for transcatheter interventions. In addition, a state-of-the-art review of the available transcatheter therapies, the main criteria for patient and device selection, and information concerning the remaining uncertainties are provided.
- Published
- 2021
48. Epiphenomenon or Prognostically Relevant Interventional Target? A Novel Proportionality Framework for Severe Tricuspid Regurgitation.
- Author
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Fortmeier V, Lachmann M, Unterhuber M, Stolz L, Kassar M, Ochs L, Gerçek M, Schöber AR, Stocker TJ, Omran H, Körber MI, Hesse A, Friedrichs KP, Yuasa S, Rudolph TK, Joner M, Pfister R, Baldus S, Laugwitz KL, Praz F, Windecker S, Hausleiter J, Lurz P, and Rudolph V
- Subjects
- Humans, Tricuspid Valve diagnostic imaging, Tricuspid Valve surgery, Prognosis, Treatment Outcome, Tricuspid Valve Insufficiency diagnosis, Hypertension, Pulmonary
- Abstract
Background Tricuspid regurgitation (TR) frequently develops in patients with long-standing pulmonary hypertension, and both pathologies are associated with increased morbidity and mortality. This study aimed to improve prognostic assessment in patients with severe TR undergoing transcatheter tricuspid valve intervention (TTVI) by relating the extent of TR to pulmonary artery pressures. Methods and Results In this multicenter study, we included 533 patients undergoing TTVI for moderate-to-severe or severe TR. The proportionality framework was based on the ratio of tricuspid valve effective regurgitant orifice area to mean pulmonary artery pressure. An optimal threshold for tricuspid valve effective regurgitant orifice area/mean pulmonary artery pressure ratio was derived on 353 patients with regard to 2-year all-cause mortality and externally validated on 180 patients. Patients with a tricuspid valve effective regurgitant orifice area/mean pulmonary artery pressure ratio ≤1.25 mm
2 /mm Hg (defining proportionate TR) featured significantly lower 2-year survival rates after TTVI than patients with disproportionate TR (56.6% versus 69.6%; P =0.005). In contrast with patients with disproportionate TR (n=398), patients with proportionate TR (n=135) showed more pronounced mPAP levels (37.9±9.06 mm Hg versus 27.9±8.17 mm Hg; P <2.2×10-16 ) and more severely impaired right ventricular function (tricuspid annular plane systolic excursion: 16.0±4.11 versus 17.0±4.64 mm; P =0.012). Moreover, tricuspid valve effective regurgitant orifice area was smaller in patients with proportionate TR when compared with disproportionate TR (0.350±0.105 cm2 versus 0.770±0.432 cm2 ; P <2.2×10-16 ). Importantly, proportionate TR remained a significant predictor for 2-year mortality after adjusting for demographic and clinical variables (hazard ratio, 1.7; P =0.006). Conclusions The proposed proportionality framework promises to improve future risk stratification and clinical decision-making by identifying patients who benefit the most from TTVI (disproportionate TR). As a next step, randomized controlled studies with a conservative treatment arm are needed to quantify the net benefit of TTVI in patients with proportionate TR.- Published
- 2023
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49. Reversal of Femoral Vein Pulsatility Due to Severe Tricuspid Regurgitation After Transcatheter Tricuspid Valve-in-Valve Implantation: A "Wave Dissipation" Effect.
- Author
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Pereira, Ana Rita, van der Kley, Frank, Montero-Cabezas, Jose M., de Weger, Arend, and Delgado, Victoria
- Subjects
- *
FEMORAL vein , *TRICUSPID valve - Published
- 2021
- Full Text
- View/download PDF
50. Reversal of Femoral Vein Pulsatility Due to Severe Tricuspid Regurgitation After Transcatheter Tricuspid Valve-in-Valve Implantation: A 'Wave Dissipation' Effect
- Author
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Arend de Weger, José M. Montero-Cabezas, Ana Rita Pereira, Victoria Delgado, and Frank van der Kley
- Subjects
Heart Valve Prosthesis Implantation ,Pulmonary and Respiratory Medicine ,Cardiac Catheterization ,medicine.medical_specialty ,Tricuspid valve ,business.industry ,Femoral vein ,Regurgitation (circulation) ,Femoral Vein ,Femoral vein pulsatility ,Tricuspid Valve Insufficiency ,Valve in valve ,Severe tricuspid regurgitation ,Treatment Outcome ,medicine.anatomical_structure ,Heart Valve Prosthesis ,Internal medicine ,medicine ,Cardiology ,Valve-in-valve ,Humans ,Tricuspid Valve ,Transcatheter tricuspid valve intervention ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
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