Minimally Invasive Isolated Tricuspid Valve Repair: the Trend for Redo Tricuspid Valve Surgery

Abstract Background: Tricuspid regurgitation after left-sided valve surgery was associated with terrible outcomes and high perioperative mortality for redo surgical treatment. In current years, minimally invasive redo isolated tricuspid valve repair is increasingly performed in our institution to address tricuspid regurgitation. Methods: Thirty-seven consecutive patients with previous left-sided valve surgery underwent minimally invasive redo isolated tricuspid valve repair in our institution between November 2017 and December 2020. Twenty-nine patients(78.4%) were women and the mean age of patients was 58.4±8.5 years. Follow-up was 100% complete with a mean follow-up time of 16.8±9.4 months.Results: Both the in-hospital and 30-day mortalities were 2.7%. The overall NYHA class had improved significantly during the follow-up(p＜0.001). The grade of TR had decreased before discharge(p＜0.001) and during the follow-up(p＜0.001) compared with the preoperative level although severe TR was recurrent in one patient.Conclusions: Minimally invasive redo isolated tricuspid valve repair has remarkable early and midterm outcomes, may be the preferred surgical option to address tricuspid regurgitation after previous left-sided valve surgery when it is feasible.

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

The Heart Surgery Forum ◽

10.1532/hsf.1469 ◽

2015 ◽

Vol 18 (6) ◽

pp. 226 ◽

Cited By ~ 1

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

Background: 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. Methods: 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. Results: 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, P = .005), although TR severity was significantly improved from immediately post-bypass. Conclusions: 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.

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Role of Tricuspid Valve Repair for Moderate Tricuspid Regurgitation during Minimally Invasive Mitral Valve Surgery

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0033-1333844 ◽

2013 ◽

Vol 61 (05) ◽

pp. 386-391 ◽

Cited By ~ 13

Author(s):

Alexander Verevkin ◽

Michael Borger ◽

Meinhard Mende ◽

Piroze Davierwala ◽

Jens Garbade ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Tricuspid Valve Repair ◽

Valve Repair

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Abstract 14868: Promises of Transcatheter Tricuspid Valvular Interventions in Patients With Clinically Significant Tricuspid Regurgitation: A Meta-analysis

Circulation ◽

10.1161/circ.142.suppl_3.14868 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Kaveh Rezaei Bookani ◽

Nso Nso ◽

Farshid Radparvar ◽

Mark Ricciardi

Keyword(s):

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Clinical Registries ◽

The Mean ◽

Clinically Significant

Introduction: Clinically significant tricuspid regurgitation is common especially in patients with structural heart disease and is independently associated with poor outcomes. Several transcatheter interventions for tricuspid valve repair are under investigation. We aimed to illustrate and summarize the efficacy and safety of these interventions. Methods: We conducted a literature search for relevant clinical registries and trials published until April 2020. We searched PubMed, Scopus, Web of Science, and Cochrane CENTRAL. We performed the analysis of continuous outcomes using the mean difference (MD) while used the risk ratio (RR) for analysis of dichotomous outcomes. We included the following outcomes: Tricuspid annular plane systolic excursion (TAPSE), Vena Contracta (VC), Tricuspid Annulus diameter (TAD), Tricuspid regurgitation volume (TRV), Left ventricular ejection fraction (LVEF), and mortality rates. The random-effects model was used for the analysis of heterogeneous data, while homogeneous data were analyzed under the fixed-effects model. Results: We obtained fifteen clinical registries/trials and included a total of 1329 patients. We found that tricuspid valve interventional devices improved LVEF (MD = 1.46%, 95% CI [0.45, 2.47], p=0.005), led to smaller VC (MD = -4.69, 95% CI [-5.50, -3.88], p=0.005), lower TRV (MD = -11.68, 95% CI [-21.25, -2.11], p=0.02), and smaller TAD (MD = -3.78mm, 95% CI [-5.09, -2.47], p<0.001). No significant difference was noted regarding TAPSE (MD=0.07mm, 95% CI [-0.29, 0.44], p=0.7). Results of the six minutes walking test showed that patients could walk 40 more meters after intervention (MD = 40.64, 95% CI [23.89, 57.40], p<0.001). Pooled mortality rate was 8.2%, stroke 1%, and bleeding 5% during the mean 12 months follow up. Conclusions: Transcatheter tricuspid valve repair devices prove to be effective interventions in decreasing regurgitation and improving functional capacity in patients with clinically significant TR. Mortality (8% during mean 12 months follow up) seems to be related to underlying cardiovascular disease.

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Longitudinal echocardiographic and clinical follow-up of patients undergoing mitral valve surgery without concomitant tricuspid valve repair

Netherlands Heart Journal ◽

10.1007/s12471-018-1159-4 ◽

2018 ◽

Vol 26 (11) ◽

pp. 552-561 ◽

Cited By ~ 1

Author(s):

R. Jansen ◽

B. R. van Klarenbosch ◽

M. J. Cramer ◽

R. C. A. Meijer ◽

P. H. M. Westendorp ◽

...

Keyword(s):

Mitral Valve ◽

Tricuspid Valve ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Tricuspid Valve Repair ◽

Valve Repair

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P1755 Clinical and echocardiographic outcomes of mitral valve repair surgery

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1114 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

P Garcia Bras ◽

L Moura Branco ◽

P Coelho ◽

V Vaz Ferreira ◽

A Castelo ◽

...

Keyword(s):

Mitral Valve ◽

Tricuspid Valve ◽

Nyha Class ◽

Left Ventricular Ejection ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Replacement Surgery ◽

All Cause Mortality ◽

Mean Time

Abstract Background Mitral valve regurgitation (MVR) represents the second most frequent valvular heart disease. MV surgical repair is often the preferred treatment when MV anatomy is suitable. Purpose To characterize the population who underwent MV repair surgery and evaluate the outcomes of residual MVR, allcause mortality and functional classification. Methods Retrospective analysis of 262 patients (P) admitted between 2008 and 2017 for MV repair surgery. P who undergone simultaneous coronary artery bypass graft (CABG) surgery, atrial fibrillation (AF) surgery and tricuspid valve repair were also included. P with endocarditis, P who underwent simultaneous aortic valve replacement and P with rheumatic predominant MV stenosis were excluded, the remaining 204 P were analysed. Clinical and echocardiographic characteristics were evaluated in a mean follow-up of 30 months. Results 204 P, 67.2% male, mean age 62 + 14 years. The most frequent etiology was organic (80.4%), mostly of degenerative cause. Functional etiology was present in 19.6%, mostly ischemic (72.4%). 16.8% underwent simultaneous CABG, 12.3% tricuspid valve repair and 7.8% AF ablation. Hypertension was significantly associated with functional etiology (90% vs 72.8%, p = 0.022), as well as hypercholesterolemia (80% vs 48.2%, p < 0.001) and diabetes mellitus (32.5% vs 10.4%, p < 0.001). Baseline left ventricular ejection fraction (LVEF) was >50% in 78.4%, reduced (30-50%) 18.1% and poor (<30%) in 3.4%. Functional etiology was significantly associated with LVEF <50% (70% vs 9.1%, p < 0.001). 161P (78.9%) had MV prolapse: 120P (74.5%) posterior, 29P (18%) anterior and 7.4% (12P) of both leaflets. P2 was the most frequently involved scallop, in 92P (57.1%), followed by P3, in 41P (25.4%). There was MV chordae rupture in 94P (58.3%). Post-surgery echocardiography revealed that 93.8% had mild or no residual MVR. 30-day mortality rate was 0%. There was MVR recurrence with MV replacement surgery in 15P (7.5%), mean time 37.1 months. All-cause mortality was registered in 28P (13.7%), with a mean time of 43.7 months after MV surgery. Of the P without MVR recurrence or mortality, 111P (70%) were in NYHA class I, 41P (26%) in NYHA class II and 6P (4%) in NYHA class III. 6P were lost to follow-up. Upon echocardiographic revaluation there was no residual MVR in 53P (39%), mild MVR in 67P (49%) and moderate MVR in 16P (11.8%). Conclusion In P who underwent MV repair surgery, there was 7.5% recurrence rate with follow-up MV replacement surgery and an all-cause mortality of 13.7%. In a mean follow-up of 30 months, 70% of P were in NYHA I class and there was none or mild residual MVR in 88% of P.

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

European Heart Journal ◽

10.1093/eurheartj/ehz746.0090 ◽

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.

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Tricuspid valve repair for treatment and prevention of secondary tricuspid regurgitation in patients undergoing mitral valve surgery

Current Cardiology Reports ◽

10.1007/s11886-008-0020-6 ◽

2008 ◽

Vol 10 (2) ◽

pp. 110-117 ◽

Cited By ~ 36

Author(s):

Ani C. Anyanwu ◽

Joanna Chikwe ◽

David H. Adams

Keyword(s):

Mitral Valve ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Treatment And Prevention

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Right Minithoraсotomy as a Standard Approach for Mitral Valve Surgery

Ukrainian journal of cardiovascular surgery ◽

10.30702/ujcvs/20.3803/013023-028 ◽

2020 ◽

pp. 23-28

Author(s):

O. D. Babliak ◽

V. M. Demianenko ◽

D. Y. Babliak ◽

A. I. Marchenko ◽

K. A. Revenko ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Repair ◽

Tricuspid Valve ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Standard Approach ◽

Wound Complications ◽

Tricuspid Valve Repair ◽

Valve Repair

Background. Minimally invasive mitral valve surgery provides many advantages for patients. The aim. To investigate and represent our own experience in minimally invasive mitral valve surgery, and to describe the operative technique. Materials and methods. The study was included 100 consecutive patients who underwent a minimally invasive mitral valve repair or replacement through the right lateral minithoracotomy from June 2017 to December 2019. Results. Mitral valve repair was performed in 87 patients (87%), and 13 patients (13%) were required mitral valve replacement. In 24 patients (24%), concomitant procedures were performed: tricuspid valve repair, atrial septal defect repair and left atrial myxomectomy. Ring anuloplasty was performed in all patients who underwent mitral valve repair. Additional methods of correction were used in accordance to the lesion anatomy: neochords implantation, cleft and leaflet perforation closure, leaflet resection, Alfieri (edge-to-edge) stitch, posterior leaflet plication. There was no in-hospital and 30-day mortality. Post-operative strokes were not reported. No wound complications were observed in the femoral cannulation area. The total length of stay in a hospital was 6 ± 1.46 (3–9) days. There were no cases of mitral valve insufficiency greater more than mild degree after mitral valve repair at the time of discharge. Conclusions. Minimally invasive mitral valve surgery can be performed as a routine standard approach, provides safe and effective correction of the mitral valve defects, allows excellent results of mitral valve repair and replacement in various abnormalities. Minimally invasive approach enables to perform a large number of reconstructive valve techniques and perform simultaneous correction of atrial septal defects, tricuspid valve repair and atrial neoplasm removal.

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Outcomes of Isolated Tricuspid Valve Surgery

The Heart Surgery Forum ◽

10.1532/hsf.3093 ◽

2020 ◽

Vol 23 (6) ◽

pp. E763-E769

Author(s):

Gemma Sánchez-Espín ◽

Jorge Rodríguez-Capitán ◽

Juan José Otero Forero ◽

Víctor Manuel Becerra Muñoz ◽

Emiliano Andrés Rodríguez Caulo ◽

...

Keyword(s):

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Functional Class ◽

Valve Surgery ◽

Perioperative Mortality ◽

Severe Tricuspid Regurgitation ◽

Tricuspid Valve Surgery ◽

Long Term Mortality

Background: Isolated tricuspid valve surgery is a rarely performed procedure and traditionally is associated with a bad prognosis, although its clinical outcomes still are little known. The aim of this study was to assess the short- and long-term clinical outcomes obtained at our center after isolated tricuspid valve surgery as treatment for severe tricuspid regurgitation. Methods: This retrospective study included 71 consecutive patients with severe tricuspid regurgitation who underwent isolated tricuspid valve surgery between December 1996 and December 2017. Perioperative and long-term mortality, tricuspid valve reoperation, and functional class were analyzed after follow up. Results: Regarding surgery, 7% of patients received a De Vega annuloplasty, 14.1% an annuloplasty ring, 11.3% a mechanical prosthesis, and 67.6% a biological prosthesis. Perioperative mortality was 12.7% and no variable was shown to be predictive of this event. After a median follow up of 45.5 months, long-term mortality was 36.6%, and the multivariate analysis identified atrial fibrillation as the only predictor (Hazard Ratio 3.014, 95% confidence interval 1.06-8.566; P = 0.038). At the end of follow up, 63.6% of survivors had functional class I. Conclusions: Isolated tricuspid valve surgery was infrequent in our center. Perioperative mortality was high, as was long-term mortality. However, a high percentage of survivors were barely symptomatic after follow up.

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