P1878Long-term effect of atrial fibrillation on the evolution of mitral and tricuspid valve regurgitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Pype ◽  
L Embrechts ◽  
B Cornez ◽  
C Van Paesschen ◽  
A Sarkozy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Tricuspid Valve ◽  
Rhythm Control ◽  
Volume Index ◽  
Integrative Approach ◽  
Control Group ◽  
Valve Regurgitation ◽  
Tricuspid Valve Regurgitation ◽  
Atrial Remodelling

Abstract Background While severe mitral regurgitation is a well-established risk factor for atrial fibrillation (AF), it is less known whether atrial fibrillation induces mitral/tricuspid valve regurgitation (MR/TR). The present study aims to identify the long-term effects of permanent or non-permanent AF on atrial remodelling and on the progression of MR/TR. Methods The severity of MR/TR was assessed at baseline and after a period of 65±10 months in 37 patients with permanent AF, in 80 patients with non-permanent AF (of whom 43 were treated with ablation) and in 53 control patients with persistent sinus rhythm. MR/TR was qualitatively assessed by the multi-integrative approach, and quantitatively by measurement of the colour jet area. Results At baseline, AF patients had larger MR jet areas than control patients. At follow up, progression of MR, expressed as delta MR jet area, was 0.05±1.3 cm2 in the control group, 0.73±2.1 cm2 in the non-permanent AF group and 1.95±3.6 cm2 in the permanent AF group (p=0.001). Severe MR at follow up was observed in 0%, 2.5%, 8%, respectively. After adjustment for baseline clinical and echocardiographic parameters, permanent AF remained independently associated with the progression of MR. There was a significant positive correlation between a progression of MR and an increase in left atrial volume index (r=0.31, p<0.001). Although rhythm control in non-permanent AF patients was better with AF ablation than with medical treatment only, the MR evolution was similar (delta MR jet area: 0.85±2.05 cm2 vs 0.61±2.12 cm2, p=0.6). Comparable findings, albeit less pronounced, were observed for the association between of AF and TR progression. MR jet area Conclusions The presence of longstanding AF is associated with a significant progression of MR/TR mainly due to atrial remodelling. Our data showed a beneficial effect of sustained rhythm control, either medically or by ablation, on MR/TR progression.

scholarly journals Uni-port total thoracoscopic surgery versus median sternotomy for redo tricuspid valve replacement: A retrospective study

2020 ◽  
Author(s):  
Licheng Yan ◽  
Fuzhen Zheng ◽  
Haiyu Chen ◽  
Jiayin Bao ◽  
Guoxing Weng
Keyword(s):  
Valve Replacement ◽  
Tricuspid Valve ◽  
Thoracoscopic Surgery ◽  
Median Sternotomy ◽  
Control Group ◽  
Study Group ◽  
Valve Regurgitation ◽  
Tricuspid Valve Replacement ◽  
Tricuspid Valve Regurgitation

Abstract BACKGROUNDː This study compared the perioperative and follow-up period data of patients who underwent redo tricuspid valve replacements performed via thoracoscopic surgery or median sternotomy. The purpose was to evaluate the feasibility, safety, and surgical outcomes of redo tricuspid valve replacement via uni-port thoracoscopic surgery. METHODSː Forty-nine patients with severe tricuspid valve regurgitation after left-side valve replacement underwent redo tricuspid valve replacements in our hospital from April 2012 to September 2019. 26 patients underwent uni-port total thoracoscopy surgery, whereas 23 patients had the surgery performed via median sternotomy. We collected perioperative and 3- to 36-month postoperative data. RESULTSː No deaths occurred in the intraoperative period. Time of cardiopulmonary bypass in the study group was significantly longer than that in the control group (P<0.05), but the operative times in the study and control groups were not significantly different. Thoracic drainage, length of ICU stay, postoperative hospital stay and complication rates in the study group were significantly different from those in the control group (P<0.05). Throughout the follow-up period, uni-port total thoracoscopic TVR is not inferior to traditional surgery with respect to cardiac function and recurrence of tricuspid valve regurgitation. CONCLUSIONSː Uni-port total thoracoscopic tricuspid valve replacement is safe, feasible and effective, and that can be considered as a primary treatment strategy for patients with severe TR after previous left-sided valve procedure.

scholarly journals Uni-Port Total Thoracoscopic Surgery Versus Median Sternotomy for Redo Tricuspid Valve Replacement: A Retrospective Study

2020 ◽  
Vol 23 (3) ◽  
pp. E350-E357
Author(s):  
Licheng Yan ◽  
Fuzhen Zheng ◽  
Haiyu Chen ◽  
Jiayin Bao ◽  
Guoxing Weng
Keyword(s):  
Valve Replacement ◽  
Tricuspid Valve ◽  
Thoracoscopic Surgery ◽  
Median Sternotomy ◽  
Control Group ◽  
Study Group ◽  
Valve Regurgitation ◽  
Tricuspid Valve Replacement ◽  
Tricuspid Valve Regurgitation

Background: This study compared the perioperative and follow-up period data of patients who underwent redo tricuspid valve replacements performed via thoracoscopic surgery or median sternotomy. The purpose was to evaluate the feasibility, safety, and surgical outcomes of redo tricuspid valve replacement via uni-port thoracoscopic surgery. Methods: Forty-nine patients with severe tricuspid valve regurgitation after left-side valve replacement underwent redo tricuspid valve replacements in our hospital from April 2012 to September 2019. Twenty-six patients underwent uni-port total thoracoscopy surgery, whereas 23 patients had the surgery performed via median sternotomy. We collected perioperative and 3- to 36-month postoperative data. Results: No deaths occurred in the intraoperative period. Time of cardiopulmonary bypass in the study group significantly was longer than that in the control group (P < .05), but the operative times in the study and control groups were not significantly different. Thoracic drainage, length of ICU stay, postoperative hospital stay, and complication rates in the study group were significantly different from those in the control group (P < .05). Throughout the follow-up period, uni-port total thoracoscopic TVR was not inferior to traditional surgery with respect to cardiac function and recurrence of tricuspid valve regurgitation. Conclusions: Uni-port total thoracoscopic tricuspid valve replacement is safe,  feasible and effective, and that can be considered as a primary treatment strategy for patients with severe TR after previous left-sided valve procedure.

Long-term effect of atrial fibrillation on the evolution of mitral and tricuspid valve regurgitation

2019 ◽  
Vol 75 (7) ◽  
pp. 639-647
Author(s):  
L. Pype ◽  
L. Embrechts ◽  
B. Cornez ◽  
C. Van Paesschen ◽  
A. Sarkozy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Tricuspid Valve ◽  
Term Effect ◽  
Valve Regurgitation ◽  
Tricuspid Valve Regurgitation ◽  
Long Term Effect

scholarly journals SEVERE ATRIAL FIBRILLATION-RELATED FUNCTIONAL TRICUSPID VALVE REGURGITATION: PREDICTORS FOR HEART FAILURE ADMISSIONS

2021 ◽  
Vol 77 (18) ◽  
pp. 1726
Author(s):  
Lin Fei Perryn Ng ◽  
Robin Cherian ◽  
Wern Miin Soo ◽  
Siew Pang Chan ◽  
William Kong ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Tricuspid Valve ◽  
Valve Regurgitation ◽  
Tricuspid Valve Regurgitation

scholarly journals Pulsating hemorrhagic varicose veins caused by tricuspid valve regurgitation: report of a case treated by laser ablation and foam sclerotherapy

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Atsushi Guntani ◽  
Sho Yamashita ◽  
Shinsuke Mii
Keyword(s):  
Laser Ablation ◽  
Tricuspid Valve ◽  
Varicose Veins ◽  
Combined Treatment ◽  
Common Disease ◽  
Valve Regurgitation ◽  
Foam Sclerotherapy ◽  
Tricuspid Valve Regurgitation ◽  
Endovenous Laser Ablation

Abstract Background Varicose veins are one of the most common disease; however, secondary varicose veins caused by tricuspid valve regurgitation (TVR) are rare. Case presentation A patient who developed pulsating bleeding from superficial varicose veins due to TVR was successfully treated by endovenous laser ablation (EVLA) of the great saphenous vein (GSV) and repeated foam sclerotherapy of varicose veins. There were no complications, such as rebleeding or recanalization of the GSV during the 1-year follow-up period. Conclusions We herein report a rare case of pulsatile hemorrhagic varicose veins caused by TVR that was successfully managed by combined treatment of EVLA and foam sclerotherapy. When pulsatile varicose veins are found, the presence of TVR should be suspected.

scholarly journals Rediscovered and Unforgotten: Transcatheter Interventions for the Treatment of Severe Tricuspid Valve Regurgitation

2021 ◽  
Vol 15 ◽  
Author(s):  
Kusha Rahgozar ◽  
Sharon Bruoha ◽  
Edwin Ho ◽  
Ythan Goldberg ◽  
Mei Chau ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Valve Regurgitation ◽  
Poor Survival ◽  
Tricuspid Valve Regurgitation ◽  
The Past ◽  
Time Period ◽  
Long Term Follow Up ◽  
Transcatheter Interventions

Tricuspid valve regurgitation is both globally prevalent and undertreated. Historically, surgical intervention for isolated tricuspid regurgitation (TR) was avoided despite the prevalence of TR, largely due to poor surgical outcomes and an incomplete understanding of how it independently affects mortality. Over the past two decades, TR has been shown by several studies to be an independent predictor of worse functional status and poor survival on long-term follow-up. During this same time period, transcatheter interventions for the treatment of valvular heart disease have evolved dramatically. While the transcatheter repair and replacement of the tricuspid valve in patients with severe TR remains in the early stages of investigation relative to the mitral or aortic valve, the field is rapidly expanding. Here, the authors review the field of transcatheter tricuspid valve interventions for severe TR, focusing on the orthotropic devices and valves currently available worldwide.

scholarly journals Rhythm or rate control strategy in CRT recipients with long-standing persistent atrial fibrillation - preliminary results of the PilotCRAfT study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
JB Ciszewski ◽  
M Tajstra ◽  
E Gadula-Gacek ◽  
I Kowalik ◽  
A Maciag ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Control Strategy ◽  
Rate Control ◽  
Left Ventricular ◽  
Rhythm Control ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
The Mean ◽  
Crt Response

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): National Institute of Cardiology in Warsaw Statutory Grant Background The presence of atrial fibrillation (AF) in cardiac resynchronization therapy (CRT) recipients is common and AF is a marker of poorer CRT response. The negative influence of AF on CRT efficacy is mediated mainly by the drop of the effectively captured biventricular paced beats percentage (BiVp%) which should exceed 95-98% to warrant good CRT response.  Sinus rhythm (SR) restoration may improve CRT efficacy which in turn may protect AF recurrence. However, there is lack of randomized studies comparing rhythm and rate control strategies in these patients. Purpose The purpose of the Pilot-CRAfT study (NCT01850277) was to compare the efficacy of rhythm vs rate control strategy in CRT patients with long-standing persistent or permanent atrial fibrillation. Methods The study included patients with CRT and permanent or persistent AF lasting for ≥6 months, resulting in BiVp% &lt;95%, who were randomly assigned to rhythm or rate control strategy. The rhythm control strategy comprised of external electrical cardioversion (EEC). The rate control strategy included pharmacotherapy and atrioventricular node ablation (AVNA) as needed. Both of the study arms received amiodarone. The follow-up lasted 12 months. The primary endpoint was the 12-month BiVp%. The patients underwent ECHO, cardiopulmonary test, quality of live (QoL) and clinical outcomes assessment.   Results The study included 43 CRT patients (97,7% males) aged 68,4 (SD: ±8,3) years with mean BiVp% 82,4% ±9,7% at baseline. The mean duration of AF paroxysm was 25 ±19 months. The mean baseline left ventricular ejection fraction (LVEF), left atrium area and maximal oxygen uptake (VO2max) were: 30 ±8%, 33 ±7 cm2, 14 ±5 mL/(kg*min), respectively. The EEC was performed in 19 out of 22 patients assigned to the rhythm control arm. The immediate success rate of EEC was 58%. 42% of  the rhythm control arm patients remained in SR after 12 months. In the rate control group 1 person underwent AVNA and in 1 patient spontaneous SR resumption was observed. After 12 months there was significant BiVp% increase in both the rhythm and the rate control arms (98,1 ±2,3 vs 96,3 ±3,9%, respectively. The BiVp% differences between the groups were not significant (P = 0,093). However, in the per protocol analysis, the rhythm control group had greater LVEF after 12 months as opposed to the rate control arm (36,8% vs 29,9% respectively, P = 0,039). The LVEF raised significantly in the rhythm control group (ΔLVEF 5,0 (95%CI: 1,54; 8,46)). No significant differences between the groups in the VO2max, QoL, clinical and safety end-points were noticed. Conclusions Structured follow-up of CRT patients with long-standing persistent or permanent AF leads to significant BiVp% increase exceeding 95%. The rate control strategy did not improve CRT effectivness, irrespective of high BiVp%. However limited in the efficacy, the rhythm control strategy may improve CRT outcome in these patients, resulting in LVEF increase.

Motivational Interviewing to Support Oral AntiCoagulation adherence in patients with non-valvular Atrial Fibrillation (MISOAC-AF): a randomised clinical trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Tzikas ◽  
A Samaras ◽  
A Kartas ◽  
D Vasdeki ◽  
G Fotos ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Medication Adherence ◽  
Medical Care ◽  
Oral Anticoagulation ◽  
Intervention Group ◽  
Control Group ◽  
Motivational Intervention ◽  
Clinical Events ◽  
Secondary Outcomes

Abstract Background Oral anticoagulation (OAC) is paramount to effective thromboprophylaxis; yet adherence to OAC remains largely suboptimal in patients with atrial fibrillation (AF). Purpose We aimed to assess the impact of an educational, motivational intervention on the adherence to OAC in patients with non-valvular AF. Methods Hospitalised patients with non-valvular AF who received OAC were randomly assigned to usual medical care or a proactive intervention, comprising motivational interviewing and tailored counseling on medication adherence. The primary study outcome was adherence to OAC at 1-year, evaluated as Proportion of Days Covered (PDC) by OAC regimens and assessed through nationwide prescription registers. Secondary outcomes included the rate of persistence to OAC, gaps in treatment, proportion of VKA-takers with labile INR (defined as time to therapeutic range&lt;70%) and clinical events. Results A total of 1009 patients were randomised, 500 in the intervention group and 509 in the control group. At 1-year follow-up, 77.2% (386/500) of patients in the intervention group had good adherence (PDC&gt;80%), compared with 55% (280/509) in the control group (adjusted odds ratio 2.84, 95% confidence interval 2.14–3.75; p&lt;0.001). Mean PDC±SD was 0.85±0.26 and 0.75±0.31, respectively (p&lt;0.001). Patients that received the intervention were more likely to persist in their OAC therapy at 1 year, while usual medical care was associated with more major (≥3 months) treatment gaps [Figure]. Among 212 VKA-takers, patients in the intervention group were less likely to have labile INR compared with those in the control group [21/120 (17.1%) vs 34/92 (37.1%), OR 0.33 95% CI 1.15–0.72, p=0.005]. Clinical events over a median follow-up period of 2 years occurred at a numerically lower, yet non-significant, rate in the intervention group [Table]. Conclusions In patients receiving OAC therapy for non-valvular AF, a motivational intervention significantly improved patterns of medication adherence, without significantly affecting clinical outcomes. Primary and secondary outcomes Funding Acknowledgement Type of funding source: None

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