scholarly journals Right versus left heart reverse remodelling after treating ischaemic mitral and tricuspid regurgitation

2020 ◽  
Author(s):  
Haytham Elgharably ◽  
Hoda Javadikasgari ◽  
Marijan Koprivanac ◽  
Ashley M Lowry ◽  
Kimi Sato ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Tricuspid Regurgitation ◽  
Tricuspid Valve Repair ◽  
Left Heart ◽  
Valve Repair ◽  
Right Heart ◽  
Reverse Remodelling ◽  
The Right

Abstract OBJECTIVES Repair outcomes of tricuspid regurgitation (TR) associated with ischaemic mitral regurgitation (IMR) are inferior to functional TR in terms of TR recurrence and right ventricular (RV) reverse remodelling. Our objective is to analyse right versus left heart reverse remodelling after surgery for IMR-associated TR. METHODS From 2001 to 2011, 568 patients with severe IMR underwent mitral valve surgery (repair 87%, replacement 13%), and 131 had concomitant tricuspid valve repair. Median follow-up was 3.0 years; 25% of living patients were followed up for 6.3 years. Longitudinal analysis of 1527 follow-up echocardiograms was performed to assess ventricular reverse remodelling and function. RESULTS Unlike the left heart, the right heart failed to reverse remodel (failed to recover ventricular function or halt dilatation). During follow-up after surgery, the right ventricle continued to dilate while the left ventricle regressed in size. RV ejection fraction decreased (46% at 1 month and 44% at 5 years), while left ventricular ejection fraction increased (33% and 37%, respectively). RV strain showed early (−11% at 1 month) and late (−12% at 5 years) dysfunction. Patients who underwent tricuspid valve repair had worse RV function. Mitral regurgitation remained stable after surgical intervention, and TR gradually recurred (37% moderate, 20% severe at 7 years). CONCLUSIONS Surgical treatment of IMR and TR along with revascularization failed to induce reverse remodelling of the right heart. These findings warrant further investigations to identify optimal timing and approach of intervention for IMR-associated TR with respect to RV remodelling.

scholarly journals Tricuspid regurgitation in ischemic mitral regurgitation patients: prevalence, predictors for outcome and long-term follow-up

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ofir Koren ◽  
Henda Darawsha ◽  
Ehud Rozner ◽  
Daniel Benhamou ◽  
Yoav Turgeman
Keyword(s):  
Cohort Study ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Tricuspid Regurgitation ◽  
Ischemic Mitral Regurgitation ◽  
Lv Ejection Fraction ◽  
Severe Grade

Abstract Background Functional tricuspid regurgitation (FTR) is common in left-sided heart pathology involving the mitral valve. The incidence, clinical impact, risk factors, and natural history of FTR in the setting of ischemic mitral regurgitation (IMR) are less known. Method We conducted a cohort study based on data collected from January 2012 to December 2014. Patients diagnosed with IMR were eligible for the study. The median follow-up was 5 years. The primary outcome is defined as FTR developing at any stage. Results Among the 134 IMR patients eligible for the study, FTR was detected in 29.9% (N = 40, 20.0% mild, 62.5% moderate, and 17.5% severe). In the FTR group, the average age was 60.7 ± 9.2 years (25% females), the mean LV ejection fraction (LVEF) was 37.3 ± 6.45 [%], LA area 46.4 ± 8.06 (mm2), LV internal diastolic diameter (LVIDD) 59.6 ± 3.94 (mm), RV fractional area change 22.3 ± 4.36 (%), systolic pulmonary artery pressure (SPAP) 48.4 ± 9.45 (mmHg). Independent variables associated with FTR development were age ≥ 65y [OR 1.2], failed revascularization, LA area ≥ 42.5 (mm2) [OR 17.1], LVEF ≤ 24% [OR 32.5], MR of moderate and severe grade [OR 419.4], moderate RV dysfunction [OR 91.6] and pulmonary artery pressure of a moderate or severe grade [OR 33.6]. During follow-up, FTR progressed in 39 (97.5%) patients. Covariates independently associated with FTR progression were lower LVEF, RV dysfunction, and PHT of moderate severity. LA area and LVIDD were at the margin of statistical significance (p = 0.06 and p = 0.05, respectively). Conclusion In our cohort study, FTR development and progression due to IMR was a common finding. Elderly patients with ischemic MR following unsuccessful PCI are at higher risk. FTR development and severity are directly proportional to LV ejection fraction, to the extent of mitral regurgitation, and SPAP. FTR tends to deteriorate in the majority of patients over a mean of 5-y follow-up.

scholarly journals P1364 Contractile reserve predicts reverse remodelling after successful percutaneous mitral valve repair in patients with functional mitral regurgitation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P Mortelmans ◽  
P Debonnaire ◽  
B P Paelinck ◽  
D De Bock ◽  
P Coussement ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Functional Mitral Regurgitation ◽  
Contractile Reserve ◽  
Valve Repair ◽  
Percutaneous Mitral Valve Repair ◽  
Reverse Remodelling ◽  
Mitraclip Therapy

Abstract Background Recent randomised trials have shown conflicting results regarding the usefulness of percutaneous mitral valve repair using MitraClip in patients with severe functional mitral regurgitation (FMR). At present, it remains unclear whether patients with FMR and advanced heart failure might benefit from MitraClip therapy. Moreover, it has been shown that left ventricular reverse remodelling (LVRR) post-MitraClip is associated with a favourable outcome. Purpose We sought to assess whether baseline contractile reserve (CR) can predict LVRR and improvement of LV ejection fraction (EF) in FMR patients undergoing MitraClip therapy. Methods Consecutive patients with symptomatic severe FMR referred for MitraClip were recruited in two tertiary centres. All patients were scheduled for a semi-supine bicycle exercise echocardiography before and 6 months after the intervention. Patients who were not able to perform an exercise test and who did not complete 6 month follow up were excluded from further analysis. Baseline CR was obtained by subtracting peak exercise LVEF from LVEF at rest. LVRR was defined as a 10% decrease in LV end systolic volume (ESV) at follow-up. Results 34 patients completed 6 month follow up (61% male, age 71 ± 10 years, LVEF 32 ± 8%). LVRR was observed in 15 patients (44%). We found a trend towards a moderate correlation between baseline CR and relative decrease in LVESV at 6 months (Pearson Rho -0.321, p = 0.064). This correlation became significant in a sub-analysis considering only patients with post-procedural FMR grade ≤2 (n = 27; Pearson Rho -0.444, p = 0.020). In contrast, LVRR was not related to baseline LVEF, LV dimensions or volumes. Furthermore, baseline CR was strongly correlated with an increase of LVEF at 6 months post-MitraClip in these patients (Pearson Rho 0.653, p < 0.001). Conclusion CR predicts LVRR and improvement of LVEF in patients with FMR after successful MitraClip therapy (reduction of FMR towards grade ≤2), in contrast to resting indices of LV dysfunction and dilatation. More studies with outcome data are needed to determine whether CR is a useful parameter to identify patients with FMR who might benefit from MitraClip therapy.

5940Right ventricular reverse remodeling occurs early after transcatheter tricuspid valve repair for isolated severe tricuspid regurgitation and is associated with better outcome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Orban ◽  
L Stolz ◽  
D Braun ◽  
T Stocker ◽  
K Stark ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Outcome ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Significant Trend ◽  
Tricuspid Valve Repair ◽  
Tricuspid Annulus ◽  
Valve Repair ◽  
Severe Tricuspid Regurgitation

Abstract Background Transcatheter edge-to-edge tricuspid valve repair (TTVR) is a novel treatment option in patients with severe tricuspid regurgitation (TR), right-sided heart failure and prohibitive surgical risk. Purpose We investigated whether RVRR can occur early after TTVR in patients with isolated TR and its potential association with clinical outcome. Method We measured right ventricular parameters by transthoracic echocardiography (TTE) at baseline (BL) in 44 consecutive patients undergoing TTVR for isolated severe TR. We obtained follow-up (FU) TTEs after 1 month. Results At BL, we observed dilated RVs with an RV end-diastolic area (RVEDA) of 28.0±8.3cm2, RV mid diameter of 40.7±7.3mm and tricuspid annulus of 47.5±8.1mm. The majority of patients (63%) showed RV systolic dysfunction with either a tricuspid annular plane excursion (TAPSE) <17mm or fractional area change (FAC) <35%. In 40 Patients (90%), a periprocedural TR reduction by at least 1 degree was achieved (p<0.01). During further clinical FU (272±183 days), 21 patients died (of whom 14 had prior hospitalizations for heart failure before death), 8 patients had hospitalizations for heart failure, 1 patient underwent heart transplantation and 1 patient was lost to clinical FU. We acquired a short-term echocardiographic follow-up (Echo-FU) after 30 days in 36 patients (82%). TR reduction was stable after 1 month with a TR grade ≤2+ in 26 of 36 patients (72%, p<0.01 vs BL). We detected RVRR in the majority of patients with 1-month Echo-FU: RVEDA decreased from 28.8±8.2 to 26.3±7.4cm2 (p<0.01), RV mid diameter from 41.2±7.3 to 38.5±7.7mm (p<0.01) and tricuspid annulus from 48.3±8.3 to 42.8±6.6mm (Figure, p<0.01). We observed a non-significant trend towards reduction of TAPSE (17.5mm to 16.1 mm, p=0.12) and FAC (37.8% to 35.5%, p=0.17), which could represent a normalization of systolic function of a previously hyperactive RV. Next, we evaluated whether RVRR is potentially associated with clinical outcome. We stratified patients into two groups with more or less than median change in RVEDA, RV mid diameter and TV annulus. Fewer combined clinical events (time to death or repeat intervention or first hospitalization for heart failure) were observed in patients with pronounced decrease of RV mid diameter (p=0.03) and TV annulus (Figure, p=0.02) at FU. A decrease of RVEDA showed a non-significant trend towards better outcome (p=0.06). Figure 1 Conclusions Our report demonstrates that RVRR occurs already 1 month after TTVR for isolated TR and is associated with less clinical endpoints.

scholarly journals Successful percutaneous mitral valve leaflet repair for primary mitral regurgitation results in functional improvement and positive cardiac reverse remodelling

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
TP Craven ◽  
PG Chew ◽  
M Gorecka ◽  
LAE Brown ◽  
A Das ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Valve Leaflet ◽  
Reference Standard ◽  
Mitral Valve Leaflet ◽  
Reverse Remodelling ◽  
Primary Mitral Regurgitation

Abstract Funding Acknowledgements Type of funding sources: None. Background Percutaneous mitral valve leaflet repair can be an effective treatment for primary mitral regurgitation (MR) patients deemed high-risk for surgery. Accurate assessment of cardiac reverse remodelling is essential to optimise future patient selection. Cardiovascular magnetic resonance (CMR) is the reference standard for cardiac volumetric assessment and compared to transthoracic echocardiography (TTE) provides superior reproducibility in MR quantification. Prior CMR studies have analysed cardiac reverse remodelling following percutaneous intervention in combined cohorts of primary and secondary MR patients. However, as aetiology of MR can significantly impact outcomes, focused studies are warranted. Purpose Assess cardiac reverse remodelling and quantify changes in MR following percutaneous mitral valve leaflet repair for primary MR using the reference standard (CMR). Methods 12 patients with at least moderate-severe MR on TTE were prospectively recruited to undergo CMR imaging and 6-minute walk tests (6MWT) at baseline and 6 months following percutaneous mitral valve leaflet repair (MitraClip). CMR protocol involved: left-ventricular (LV) short axis cines (bSSFP, SENSE-2, 10mm, no gap), transaxial right-ventricular (RV) cines (bSSFP, SENSE-2, 8mm, no gap), two and four chamber cines and aortic through-plane phase contrast imaging, planned at the sino-tubular junction. MR was quantified indirectly using LV and aortic stroke volumes. Results 12 patients underwent percutaneous mitral valve leaflet repair (MitraClip) for posterior mitral valve leaflet prolapse, however 1 patient declined follow up after single-leaflet clip detachment resulting in 11 patients (age 83 ± 5years, 9 male) completing follow up imaging. At 6-months: significant improvements occurred in New York Heart Association functional class (Table 1) and 6MWT distances (223 ± 71m to 281 ± 65m, p = 0.005) and significant reductions occurred in indexed left ventricular end-diastolic volumes (LVEDVi) (118 ± 21ml/m2 to 94 ± 27ml/m2, p = 0.001), indexed left ventricular end-systolic volumes (58 ± 19ml/m2 to 48 ± 21ml/m2, p = 0.007) and quantitated MR volume (55 ± 22ml to 24 ± 12ml, p = 0.003) and MR fraction (49 ± 9.4% to 29 ± 14%, p= &lt;0.001). There were no statistically significant changes in left ventricular ejection fraction (LVEF), right ventricular dimensions/ejection fraction or bi-atrial dimensions (Table 1). All patients demonstrated decreased LVEDVi and quantified MR (Figure 1). Conclusion Successful percutaneous mitral valve leaflet repair for primary MR results in reduction in MR, positive LV reverse remodelling, preservation of LVEF, and functional improvements. Larger CMR studies are now required to further guide optimal patient selection.

scholarly journals Tricuspid regurgitation in ischemic mitral regurgitation patients – prevalence, predictors for outcome and long-term follow-up

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
O Koren ◽  
H D Darawsha ◽  
E H U D Rozner ◽  
Y O A V Turgeman
Keyword(s):  
Cohort Study ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Tricuspid Regurgitation ◽  
Ischemic Mitral Regurgitation ◽  
Lv Ejection Fraction ◽  
Severe Grade

Abstract Background Functional tricuspid regurgitation (FTR) is common in left-sided heart pathology involving the mitral valve. The incidence, clinical impact, risk factors, and natural history of FTR in the setting of ischemic mitral regurgitation (IMR) are less known. Method We conducted a cohort study based on data collected from January 2012 to December 2014. Patients diagnosed with IMR were eligible for the study. The median follow-up was five years. The primary outcome is defined as FTR developing at any stage. Results Among the 134 IMR patients eligible for the study, FTR was detected in 29.9% (N=40, 20.0% mild, 62.5% moderate, and 17.5% severe). In the FTR group, the average age was 60.7±9.2 years (25% females), the mean LV ejection fraction (LVEF) was 37.3±6.45 [%], LA area 46.4±8.06 [mm2], LV internal diastolic diameter (LVIDD) 59.6±3.94 [mm], RV fractional area change (RVFAC) 22.3±4.36 [%], systolic pulmonary artery pressure (SPAP) 48.4±9.45 [mmHg]. Independent variables associated with FTR development were age ≥65y [OR 1.2], failed revascularization, LA area ≥42.5 [mm2] [OR 17.1], LVEF ≤24% [OR 32.5], MR of moderate and severe grade [OR 419.4], moderate RV dysfunction [OR 91.6] and pulmonary artery pressure of a moderate or severe grade [OR 33.6]. During follow-up, FTR progressed in 39 (97.5%) patients. Covariates independently associated with FTR progression were lower LVEF, RV dysfunction, and PHT of moderate severity. LA area and LVIDD were at the margin of statistical significance (p=0.06 and p=0.05, respectively). Conclusion In our cohort study, FTR development and progression due to IMR was a common finding. Elderly patients with ischemic MR following unsuccessful PCI are at higher risk. FTR development and severity are directly proportional to LV ejection fraction, to the extent of mitral regurgitation, and SPAP. FTR tends to deteriorate in the majority of patients over a mean of 5-y follow-up. FUNDunding Acknowledgement Type of funding sources: None.

Residual Tricuspid Regurgitation following Tricuspid Valve Repair during Concomitant Valve Surgery Worsens Late Survival

2015 ◽  
Vol 18 (6) ◽  
pp. 226 ◽  
Author(s):  
Robert A. Sorabella ◽  
Erin Mamuyac ◽  
Halit Yerebakan ◽  
Marc Najjar ◽  
Vivian Choi ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Subgroup Analysis ◽  
Cohort Analysis ◽  
Valve Surgery ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
The Impact ◽  
Late Survival

<strong>Background:</strong> Concomitant tricuspid valve repair (TVr) for functional tricuspid regurgitation (TR) at the time of left-sided valve surgery has become increasingly more common over the past decade. The impact of residual post-repair TR on late outcomes remains unclear.<br /><strong>Methods:</strong> All patients undergoing TVr during concomitant left-sided valve surgery at our institution from 2005-2012 were retrospectively reviewed. Patients were stratified into 2 groups according to the degree of post-cardiopulmonary bypass TR observed on intraoperative transesophageal echocardiography; 0-1+ TR (No TR, n = 246) and ≥2+ TR (Residual TR, n = 26). Primary outcomes of interest were 30-day survival, 4-year survival, and follow-up TR grade. A propensity-matched subgroup analysis was performed in addition to the overall cohort analysis.<br /><strong>Results:</strong> Mean age for all patients was 70.3 ± 13.0 years and 107 (39%) patients were male. There was no difference in 30-day survival between groups (92% No TR versus 96% Residual TR, P = .70). Kaplan-Meier analysis of overall 4-year survival showed a trend toward worsened survival in the Residual TR group (log rank P = .17) and propensity-matched subgroup analysis showed significantly worse 4-year survival for Residual TR (log rank P = .02). At mean echocardiographic follow up of 11.9 ± 22.5 months, TR grade was significantly worse in the Residual TR group compared to No TR (1.5 ± 0.8 Residual TR versus 0.9 ± 0.9 No TR, <br />P = .005), although TR severity was significantly improved from immediately post-bypass. <br /><strong>Conclusions:</strong> Patients left with residual TR following TVr during concomitant left-sided valve surgery have significantly decreased late survival compared to patients left with no post-repair TR.

Tricuspid Valve Repair in Infancy Using Neochordae: Three-Dimensional Echocardiographic Imaging

2017 ◽  
Vol 8 (6) ◽  
pp. 740-742
Author(s):  
Billie-Jean Martin ◽  
Nee S. Khoo ◽  
Jeffrey Smallhorn ◽  
Mohammed Al Aklabi
Keyword(s):  
Hospital Discharge ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Three Dimensional ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Dimensional Echocardiography ◽  
Three Dimensional Echocardiography

Tricuspid regurgitation (TR) in infancy poses a surgical challenge. Both two- and three-dimensional echocardiography (3DE) can provide detailed information about the mechanism(s) of valve failure and insights into valve adaptation during follow-up. We report two patients who underwent tricuspid valve repair using Gore-Tex neochordae, repairs which were facilitated by and assessed with 3DE. Both infants had less than mild residual TR and no valve tethering at hospital discharge. Furthermore, follow-up 3DEs have helped to confirm valve competence, lack of tethering, and growth of the valve and valve apparatus.

Tricuspid valvuloplasty for isolated tricuspid regurgitation in children

2020 ◽  
Vol 30 (8) ◽  
pp. 1076-1080
Author(s):  
Guanxi Wang ◽  
Kai Ma ◽  
Kunjing Pang ◽  
Sen Zhang ◽  
Lei Qi ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Tricuspid Regurgitation ◽  
Excellent Result ◽  
Functional Class ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Severe Tricuspid Regurgitation ◽  
Nyha Functional Class ◽  
Hospital Patients

AbstractBackground:Isolated congenital tricuspid regurgitation other than Ebstein’s anomaly was rare especially for children. The objective of this study was to investigate the clinical characteristics and to assess the results of tricuspid valvuloplasty for children with isolated tricuspid regurgitation.Methods:From January 2010 to June 2019, 10 consecutive patients with isolated tricuspid regurgitation who were unresponsive to drug therapy underwent tricuspid valvuloplasty in our hospital. Patients’ clinical data were analysed retrospectively.Results:Mean age at operation was 48.5 ± 31.0 (range: 9–106) months and mean weight at operation was 16.1 ± 6.9 (range: 8.6–33.0) kg. All patients presented severe isolated tricuspid regurgitation. According to pathological lesions, the main causes accounted for chordae tendinea rupture (3/10), leaflet cleft (2/10), mal-connected chordal tendinea to leaflets (2/10), elongated chordae (1/10) and chordae absent (1/10), and severe anterior leaflet dysplasia (1/10). Individualised tricuspid valvuloplasty was adapted to all of them successfully. Post-operative echocardiography showed no tricuspid regurgitation in two patients and mild regurgitation in eight patients. The cardiothoracic ratios on their chest roentgenograms decreased from 0.59 ± 0.05 to 0.54 ± 0.05. At the latest follow-up (50.4 ± 47.2 months), echocardiography showed that mild to moderate tricuspid regurgitation in seven patients, moderate tricuspid regurgitation in three patients, and no patient with severe tricuspid regurgitation. All patients were in NYHA functional class I.Conclusions:For patients with isolated tricuspid regurgitation who were not well responsive to drug therapy, individualised tricuspid valve repair can achieve an excellent result.

Durability of suture versus ring tricuspid annuloplasty: Looking at very long term (18 years)

2021 ◽  
pp. 021849232110195
Author(s):  
Davide Carino ◽  
Edoardo Zancanaro ◽  
Alessandra Sala ◽  
Stefania Ruggeri ◽  
Elisabetta Lapenna ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Cardiac Death ◽  
Suture Techniques ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Ring Annuloplasty ◽  
Suture Group

Background Several papers already reported better outcomes of tricuspid valve repair with ring annuloplasty compared to suture techniques. However, the follow-up is usually limited to 10 years. With this study, we aim to analyze the results of tricuspid valve repair according to the technique employed when the follow-up is extended to more than 15 years. Materials and methods A retrospective review of our institutional database was carried on to find all patients who underwent tricuspid valve repair between January 1998 and December 2004. Kaplan–Meier method was employed to estimate survival and log-rank test was used to make intergroup comparison. Cox regression was employed to identify risk factor for mortality. Cumulative incidence function using death as competitive outcome was used to estimate cardiac death. To describe the time course of tricuspid regurgitation, a longitudinal analysis using generalized estimating equations with random intercept for correlated data was performed. Results One hundred forty-six patients were identified: 89 in the suture group and 57 in the ring group. No difference in term of long-term survival and cardiac death was evident between the two groups. A significant higher rate of tricuspid regurgitation ≥2+ and ≥3+ recurrence was evident in the suture group during the whole follow-up (p < 0.001). Conclusion Our results corroborate the better results of tricuspid valve repair by means of ring implantation compared to suture techniques also when the follow-up is extended up to 18 years. Ring annuloplasty should be considered the first option for tricuspid valve repair due to a better durability.

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