Abstract 12929: Pacemaker Lead-induced Tricuspid Regurgitation in Patients With or Without RV Dilatation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Martin Riesenhuber ◽  
Andreas Spannbauer ◽  
Thomas Pezawas ◽  
Christoph Schukro ◽  
Marianne Gwechenberger ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Tricuspid Regurgitation ◽  
Multivariate Regression ◽  
Direct Interaction ◽  
Severe Mitral Regurgitation ◽  
Pacemaker Lead ◽  
Multivariate Regression Model ◽  
Before And After ◽  
Leadless Pacing ◽  
Model Independent

Introduction: Right ventricular (RV) leads of permanent pacemakers (PM) contribute or cause tricuspid regurgitation (TR) in up to 45% of implantations, which is associated with poor outcome. While primary lead-induced TR has its origin in direct interaction of the lead and the valve, secondary lead-induced TR has its origin in RV dilatation (RVD). Hypothesis: We hypothesize differences in lead-induced TR and its associated mortality comparing patients with vs. without RVD. Methods: Patients with first implantation of a cardiac PM with at least one transtricuspid RV-lead between May 2000 and April 2015 were retrospectively included. Echo was performed before and after PM implantation. Results: In total, 990 patients were enrolled (Table 1). Patients with RVD had progression of TR of at least one grade in 50.2%, compared to 35.9% in patients without RVD (p<0.001). In a multivariate regression model, independent predictors for lead-induced progression of TR were RVD (OR 1.46, 95% CI 1.01-2.12, p=0.045), and moderate/severe mitral regurgitation (OR 1.51, 95%CI 1.12-2.02, p=0.006). Independent predictors for 10-year-mortality were lead-induced progression of TR (HR 1.36, 95%CI 1.04-1.78, p=0.023), age > 80 years (HR 2.78, 95%CI 2.14-3.61, p<0.001), PM with single RV-lead (HR 1.35, 95%CI 1.03-1.77, p=0.032), heart failure (HR 1.75, 95%CI 1.32-2.32, p<0.001), chronic kidney disease (HR 1.61, 95%CI 1.24-2.09, p<0.001), moderate/severe mitral regurgitation (HR 1.31, 95%CI 1.03-1.74, p=0.031), and LVEDD > 25mm/m2 (HR 1.37, 95%CI 1.06-1.77, p=0.015). Conclusions: RVD is associated with lead-induced progression of TR, which is associated with decreased survival. Patients with RVD and indication for a PM, leadless pacing could be an alternative. If lead-induced TR occurs, transcatheter tricuspid valve intervention is a possibility, especially in patients with RVD.

scholarly journals Pacemaker lead-associated tricuspid regurgitation in patients with or without pre-existing right ventricular dilatation

2021 ◽  
Author(s):  
Martin Riesenhuber ◽  
Andreas Spannbauer ◽  
Marianne Gwechenberger ◽  
Thomas Pezawas ◽  
Christoph Schukro ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Right Ventricular ◽  
Tricuspid Regurgitation ◽  
Pacemaker Implantation ◽  
Ventricular Dilatation ◽  
Pacemaker Lead ◽  
Survival Analyses ◽  
Before And After ◽  
Right Ventricular Dilatation ◽  
Survival Predictors

Abstract Background Transcatheter tricuspid valve intervention became an option for pacemaker lead-associated tricuspid regurgitation. This study investigated the progression of tricuspid regurgitation (TR) in patients with or without pre-existing right ventricular dilatation (RVD) undergoing pacemaker implantation. Methods Patients were included if they had implantation of transtricuspid pacemaker lead and completed echocardiography before and after implantation. The cohort was divided in patients with and without RVD (cut-off basal RV diameter ≥ 42 mm). TR was graded in none/mild, moderate, and severe. Worsening of one grade was defined as progression. Survival analyses were plotted for 10 years. Results In total, 990 patients were analyzed (24.5% with RVD). Progression of TR occurred in 46.1% of patients with RVD and in 25.6% of patients without RVD (P < 0.001). Predictors for TR progression were RV dilatation (OR 2.04; 95% CI 1.27–3.29; P = 0.003), pre-existing TR (OR 4.30; 95% CI 2.51–7.38; P < 0.001), female sex (OR 1.68; 95% CI 1.16–2.43; P = 0.006), single RV lead (OR 1.67; 95% CI 1.09–2.56; P = 0.018), mitral regurgitation (OR 2.08; 95% CI 1.42–3.05; P < 0.001), and enlarged left atrium (OR 1.98; 95% CI 1.07–3.67; P = 0.03). Survival-predictors were pacemaker lead-associated TR (HR 1.38; 95% CI 1.04–1.84; P = 0.028), mitral regurgitation (HR 1.34; 95% CI 1.02–1.77; P = 0.034), heart failure (HR 1.75; 95% CI 1.31–2.33; P < 0.001), kidney disease (HR 1.62; 95% CI 1.25–2.11; P < 0.001), and age ≥ 80 years (HR 2.84; 95% CI 2.17–3.71; P < 0.001). Conclusions Patients with RVD receiving pacemaker suffered from increased TR progression, leading to decreased survival. Graphic abstract

scholarly journals B-PO03-056 CULPRIT, BYSTANDER, OR A HOLE OTHER MATTER: ENDOCARDIAL LV PACEMAKER LEAD EXTRACTION FOR SEVERE MITRAL REGURGITATION

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S211
Author(s):  
Christopher M. Verdick ◽  
Uday Gajjandra Sandhu ◽  
Ryle Przybylowicz ◽  
Bassel Beitinjaneh ◽  
Charles A. Henrikson
Keyword(s):  
Mitral Regurgitation ◽  
Lead Extraction ◽  
Severe Mitral Regurgitation ◽  
Pacemaker Lead

Surgical experience for prolapse of both atrioventricular valves in a patient with filamin A mutation

2014 ◽  
Vol 25 (2) ◽  
pp. 365-367 ◽  
Author(s):  
Takaya Hoashi ◽  
Isao Shiraishi ◽  
Hajime Ichikawa
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Valve Replacement ◽  
Tricuspid Regurgitation ◽  
Severe Mitral Regurgitation ◽  
Filamin A ◽  
Surgical Experience ◽  
Ehlers Danlos Syndrome ◽  
Tricuspid Annuloplasty ◽  
Danlos Syndrome

AbstractA 21-year-old man underwent mitral valve replacement and tricuspid annuloplasty for severe mitral regurgitation and moderate tricuspid regurgitation. Until the operation, he had been treated for hypermobility type Ehlers–Danlos syndrome. Gene examination revealed a mutation in filamin A gene, which is the gene responsible for X-linked myxomatous valvular dystrophy.

Pacemaker lead-induced progression of primary vs. secondary tricuspid regurgitation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Riesenhuber ◽  
A Spannbauer ◽  
T Pezawas ◽  
C Schukro ◽  
M Gwechenberger ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Patient Characteristics ◽  
Funding Source ◽  
Pacemaker Lead ◽  
Horizon 2020 ◽  
Ordinal Regression Model ◽  
Leadless Pacing ◽  
Public Grant ◽  
Visually Based ◽  
Programme Grant

Abstract Background Currently no data are available whether the implantation of right ventricular (RV) pacemaker (PM) lead worsens preexisting primary or secondary (functional due to RV dilatation, RVD) tricuspid regurgitation (TR). Purpose The aim of the present retrospective analysis was to assess TR after PM implantation with a RV lead. Methods Patients with PM implantation (n=990) were enrolled if they had routine echocardiography including assessment of TR before first implantation and immediately after. RVD and severity of TR were characterized visually. Based on RVD in baseline echocardiography, patients were divided into 2 groups: with primary TR (without preexisting RVD, n=743) or secondary TR (with preexisting RVD, n=243). Results Lead-induced worsening of TR was present in both groups (Table 1). Progression from mild/moderate to severe TR was observed in 6.7% of patients with primary TR, compared to 25.6% of patients with secondary TR (P=0.001). Using an ordinal regression model, the probability to progress to severe TR with primary TR was 14.8% (95% CI 11.0%-19.7%), compared to 41.6% (95% CI 40.3%-42.8%) with secondary TR (P&lt;0.001). Conclusion Preexisting secondary TR was associated with higher rates of lead-induced progression to severe TR compared to primary TR. Leadless pacing or tricuspid valve clipping post-PM implantation could be an option for patients with preexisting secondary TR and indication for a PM. Table 1. Patient characteristics. Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): This study was supported by the European Union's Horizon 2020 Future and Emerging Technologies Programme [Grant number 732170].

scholarly journals P1560 Acute changes of mitral annular dimensions after transcatheter egde-to-edge repair: an indirect annuloplasty method?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Papadopoulos ◽  
I Ikonomidis ◽  
M Chrissoheris ◽  
A Chalapas ◽  
P Kourkoveli ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Heart Team ◽  
Severe Mitral Regurgitation ◽  
Reduced Ejection Fraction ◽  
Device Implantation ◽  
Percentage Difference ◽  
Before And After ◽  
Acute Changes ◽  
The Impact

Abstract Background Percutaneous edge-to-edge mitral valve repair (PMVR) is a safe and alternative method for treating high-risk patients with severe mitral regurgitation (DMR or FMR). This transcatheter treatment aims at reducing the MR with a so-called "Alfieri stitch" method. However the impact on mitral annular dimensions after the device implantation is not well defined. The purpose of this study is to recognize the acute changes of mitral annular dimensions after transcatheter edge-to-edge repair. Methods We retrospectively analyzed 20 consecutive patients (aged 74 ± 10yrs) with degenerative or functional moderate-to-severe and severe mitral regurgitation (EROA 40.8 ± 20.5mm2, RV 52.6 ± 17.5ml) and reduced ejection fraction (EF 36.9 ± 15.4%). These patients were at high surgical risk or even inoperable in certain cases (logistic EuroSCORE 28.9 ± 18.2%) and evaluated by a heart team as candidates for transcatheter repair. All intraoperative transoesophageal echo studies were post processed with EchoPac v.203 or QLAB 9.0. 3D views of the mitral valve before and after the implantation of the device were analyzed with 4D AutoMVQ (GE) or MVQ (Phillips) software. Results PMVR was effective in treating the MR at the end of the operation (from 3.8 ± 0.4 to 1.3 ± 0.5 after the implantation, p &lt; 0.05) in all patients. There was a significant reduction of the annulus area (from 12.25 ± 3.0cm2 to 10.18 ± 2.88cm2, p &lt; 0.001) and circumference (from 13.23 ± 1.4cm to 12.18 ± 1.57cm, p &lt; 0.001), in both DMR and FMR cases. The percentage reduction of annulus area and circumference after PMVR was 17.3 ± 0.8% and 8 ± 5% respectively and the number of the clips used for that purpose were 1.55 ± 0.6. Additionally, edge-to-edge repair significantly reduced the anterior-posterior diameter (from 3.49 ± 0.56cm to 3.02 ± 0.55cm, r = 0.86, p &lt; 0.001) and the posteromedial-anterolateral diameter (from 4.15 ± 0.58cm to 3.88 ± 0.60cm, r = 0.9, p &lt; 0.001). The number of the clips used did not play an important role in the percentage difference of the annulus dimensions (20% reduction with one clip vs 14.3 ± 7.6% with two or more, p &lt; 0.05) and one possible explanation could be that patients receiving one clip had smaller annulus area comparing to the patients receiving two or more (11.2 ± 2.9mm2 vs 13.3 ± 2.7mm2 respectively, p &lt; 0.05). Conclusions Transcatheter edge-to-edge repair is effective in treating MR in patients with DMR and FMR and has a direct impact on mitral annular dimensions acutely after the implantation.

scholarly journals Tricuspid annular dimensions in patients with severe mitral regurgitation without severe tricuspid regurgitation

2021 ◽  
Vol 11 (1) ◽  
pp. 68-80
Author(s):  
Sohum Kapadia ◽  
Amar Krishnaswamy ◽  
Habib Layoun ◽  
Brian P. Griffin ◽  
Per Wierup ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Tricuspid Regurgitation ◽  
Severe Mitral Regurgitation ◽  
Severe Tricuspid Regurgitation

Regional Myocardial Strain Before and After Mitral Valve Repair for Severe Mitral Regurgitation

2001 ◽  
Vol 3 (3) ◽  
pp. 257-266 ◽  
Author(s):  
Rekha Mankad ◽  
Charles J. McCreery ◽  
Walter J. Rogers Jr. ◽  
Robert J. Weichmann ◽  
Edward B. Savage ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Myocardial Strain ◽  
Severe Mitral Regurgitation ◽  
Valve Repair ◽  
Before And After

scholarly journals Endothelial Dysfunction in Patients with Severe Mitral Regurgitation

2019 ◽  
Vol 8 (6) ◽  
pp. 835 ◽  
Author(s):  
Benedetta Porro ◽  
Paola Songia ◽  
Veronika A. Myasoedova ◽  
Vincenza Valerio ◽  
Donato Moschetta ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Endothelial Dysfunction ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Metabolic Pathway ◽  
Severe Mitral Regurgitation ◽  
Post Surgery ◽  
Before And After ◽  
Liquid Chromatography Tandem Mass ◽  
Antioxidant Defense Systems

Mitral valve prolapse (MVP) is the most common cause of severe mitral regurgitation. It has been reported that MVP patients—candidates for mitral valve repair (MVRep)—showed an alteration in the antioxidant defense systems as well as in the L-arginine metabolic pathway. In this study, we investigate if oxidative stress and endothelial dysfunction are an MVP consequence or driving factors. Forty-five patients undergoing MVRep were evaluated before and 6 months post surgery and compared to 29 controls. Oxidized (GSSG) and reduced (GSH) forms of glutathione, and L-arginine metabolic pathway were analyzed using liquid chromatography-tandem mass spectrometry methods while osteoprotegerin (OPG) through the ELISA kit and circulating endothelial microparticles (EMP) by flow cytometry. Six-month post surgery, in MVP patients, the GSSG/GSH ratio decreased while symmetric and asymmetric dimethylarginines levels remained comparable to the baseline. Conversely, OPG levels significantly increased when compared to their baseline. Finally, pre-MVRep EMP levels were significantly higher in patients than in controls and did not change post surgery. Overall, these results highlight that MVRep completely restores the increased oxidative stress levels, as evidenced in MVP patients. Conversely, no amelioration of endothelial dysfunction was evidenced after surgery. Thus, therapies aimed to restore a proper endothelial function before and after surgical repair could benefit MVP patients.

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