Concomitant Tricuspid Valve Repair in Patients Undergoing LVAD Placement Reduces Incidence of Acute Right Heart Failure

Abstract Background Severely reduced right heart function and high operative risk are major challenges in the treatment of tricuspid regurgitation (TR) as both can lead to low cardiac output heart failure (LCO-Hf). Alternative methods and criteria for patient selection are actively being sought. Case summary We report on a 66-year-old patient with severe right heart failure (rHF) with recurrent TR after prior surgical valve repair with a 32-mm-Edwards-MC3 annuloplasty ring (AR). Surgical revision was discarded due to extreme high surgical risk. A right ventricular assist device was discussed but declined by the patient. Percutaneous edge-to-edge repair was not applicable due to massive tethering of the anterior leaflet and complete lack of coadaptation. According to the Heart team decision, percutaneous tricuspid valve-in-ring implantation was performed using a 29-mm Sapien-3 prosthesis (SP3) under moderate balloon overinflation. Despite satisfying positioning, the prosthesis showed massive intravalvular regurgitation due to immobility of the septally oriented cusp, which was most likely caused by eccentric bulging of the prosthesis in the opening region of the AR. Implantation of a second prosthesis leads to a perfectly functional result. Importantly, no major haemodynamic complications ensued. Discussion Although being a potential risk of tricuspid valve repair LCO-hf could not be observed in the present case. Additionally, deformation of the implanted transcatheter aortic valve replacement prosthesis resulting from the regional lack of abutment in AR should be considered as a potential complication. Hence, further careful evaluation of the feasibility of percutaneous tricuspid valve treatment, also in patients with rHF, is needed.

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Right heart failure and benefits of adjuvant tricuspid valve repair in patients undergoing left ventricular assist device implantation

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezu040 ◽

2014 ◽

Vol 46 (5) ◽

pp. 802-807 ◽

Cited By ~ 19

Author(s):

T. Fujita ◽

J. Kobayashi ◽

H. Hata ◽

O. Seguchi ◽

Y. Murata ◽

...

Keyword(s):

Heart Failure ◽

Right Heart Failure ◽

Left Ventricular ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Right Heart ◽

Assist Device ◽

Ventricular Assist ◽

Device Implantation ◽

Left Ventricular Assist

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Impact of Tricuspid Valve Repair for Moderate Tricuspid Regurgitation at the Time of Left Ventricular Assist Device Implantation on the Occurrence of Right Heart Failure

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2020.01.259 ◽

2020 ◽

Vol 39 (4) ◽

pp. S444

Author(s):

Y.D. Barac ◽

M. Bishawi ◽

C. Milano ◽

J. Schroder ◽

M. Daneshmand ◽

...

Keyword(s):

Heart Failure ◽

Right Heart Failure ◽

Left Ventricular ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Right Heart ◽

Assist Device ◽

Ventricular Assist ◽

Device Implantation ◽

Left Ventricular Assist

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Tricuspid valve repair via partial sternotomy for traumatic valve insufficiency

Asian Cardiovascular and Thoracic Annals ◽

10.1177/02184923211010080 ◽

2021 ◽

pp. 021849232110100

Author(s):

Motohiro Maeda ◽

Jiro Honda ◽

Yosuke Ishi

Keyword(s):

Tricuspid Valve ◽

Chest Trauma ◽

Right Heart Failure ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Cardiac Trauma ◽

Partial Sternotomy ◽

Tricuspid Valve Insufficiency ◽

Valve Insufficiency ◽

Early Surgical Intervention

Tricuspid valve insufficiency rarely follows a blunt chest trauma. When the tricuspid valve is solely injured, the cardiac trauma may stay asymptomatic and tolerable, which often makes it difficult to determine the indication for surgery. We report a case of a patient with tricuspid regurgitation secondary to trauma due to a motorcycle accident. The patient was initially asymptomatic, but shortness of breath emerged two years after the accident. He underwent the tricuspid valve repair with chordae reconstruction and annuloplasty via lower partial sternotomy. We advocate that early surgical intervention prevents right heart failure, atrial fibrillation, and valve replacement.

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Prognostic significance of the get with the guidelines-heart failure (GWTG-HF) risk score in patients undergoing trans-catheter tricuspid valve repair (TTVR)

Heart and Vessels ◽

10.1007/s00380-021-01874-3 ◽

2021 ◽

Author(s):

Refik Kavsur ◽

Hannah Emmi Hupp-Herschel ◽

Atsushi Sugiura ◽

Tetsu Tanaka ◽

Can Öztürk ◽

...

Keyword(s):

Heart Failure ◽

Renal Function ◽

Mitral Regurgitation ◽

Risk Stratification ◽

Tricuspid Valve ◽

Risk Score ◽

Left Ventricular Ejection ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Get With The Guidelines

AbstractThe Get-With-The-Guidelines-Heart-Failure (GWTG-HF) score is a risk assessment tool to predict mortality in patients with heart-failure (HF). We aimed to evaluate the GWTG-HF score for risk stratification in HF patients with tricuspid regurgitation undergoing trans-catheter tricuspid valve repair (TTVR). In total, 181 patients who underwent TTVR via edge-to-edge repair (86%) or annuloplasty (14%) were enrolled. Patients were categorized into a low- (≤ 43 points), intermediate- (44–53 points) and high-risk score groups (≥ 54 points). TTVR led to an improvement of TR (p < 0.0001) and NYHA (p < 0.0001). Kaplan–Meier analysis and log-rank test revealed that higher GWTG-HF scores were associated with reduced rates of event-free survival regarding mortality (96% vs 89% vs 73%, respectively, p = 0.001) and hospitalization for heart failure (HHF) (89% vs 86% vs 74%, respectively, p = 0.026). After adjusting for important variables like renal function, left ventricular ejection fraction and mitral regurgitation, the GWTG-HF score remained an independent predictor of the composite endpoint of HHF or mortality (hazard ratio 1.04 per 1-point increase, p = 0.029). Other remaining predictors were renal function and mitral regurgitation. The GWTG-HF score used as a risk stratification tool of mortality and HHF maintains its prognostic value in a HF population with severe TR undergoing TTVR.

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