scholarly journals Initial Results after the Implementation of an Edge-To-Edge Transcatheter Tricuspid Valve Repair Program

2021 ◽  
Vol 10 (18) ◽  
pp. 4252
Author(s):  
Pedro Luis Cepas-Guillen ◽  
Juan Carlos de la Fuente Mancera ◽  
Joan Guzman Bofarull ◽  
Marta Farrero ◽  
Ander Regueiro ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Nyha Class ◽  
High Volume ◽  
Tricuspid Valve Repair ◽  
Primary Efficacy ◽  
Primary Efficacy Endpoint ◽  
Class Iii ◽  
Valve Repair ◽  
Serious Adverse Events

Transcatheter tricuspid valve repair (TTVr) has emerged as an alternative for the treatment of severe tricuspid regurgitation (TR). We report our initial experience with an edge-to-edge TTVr system in a high-volume institution. Methods: We included consecutive patients who underwent edge-to-edge TTVr systems. The primary efficacy endpoint was a reduction in the TR of at least one grade. The primary safety endpoint was procedure-related clinical serious adverse events. Results: A total of 28 patients underwent TTVr with edge-to-edge systems. All patients presented with at least severe TR with a high impact on quality of life (82% of patients in NYHA class ≥ III). The Triclip system was the most used device (89%). The primary efficacy endpoint was met in all patients. Only one patient experienced a procedural complication (femoral pseudoaneurysm). At three-month follow-up, 83% of patients were in NYHA I or II (18% baseline vs. 83% 3 months follow-up; p < 0.001). Echocardiography follow-up showed residual TR ≤ 2 in 79% of patients (paired p < 0.001). At the maximum follow-up (median follow up = 372 days), no patients had died. Conclusions: Edge-to-edge TTVr systems seem to represent a very valid alternative to prevent morbidity and mortality associated with TR as depicted by the favorable efficacy and safety.

P1755 Clinical and echocardiographic outcomes of mitral valve repair surgery

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 &lt; 0.001) and diabetes mellitus (32.5% vs 10.4%, p &lt; 0.001). Baseline left ventricular ejection fraction (LVEF) was &gt;50% in 78.4%, reduced (30-50%) 18.1% and poor (&lt;30%) in 3.4%. Functional etiology was significantly associated with LVEF &lt;50% (70% vs 9.1%, p &lt; 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.

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

2021 ◽  
Author(s):  
Xiaoyi Dai ◽  
Peng Teng ◽  
Sihan Miao ◽  
Wei Si ◽  
Qi Zheng ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Nyha Class ◽  
Valve Surgery ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Tricuspid Valve Surgery ◽  
The Mean

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.

scholarly journals Effectiveness of Artificial Neochordae Implantation in Tricuspid Valve Repair

2019 ◽  
Vol 46 (2) ◽  
pp. 100-106
Author(s):  
Salih Salihi ◽  
H. Tarik Kiziltan ◽  
Ahmad Huraibat ◽  
Askin Ali Korkmaz ◽  
Ibrahim Kara ◽  
...  
Keyword(s):  
New York ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Heart Association ◽  
Functional Class ◽  
Tricuspid Valve Repair ◽  
Class Iii ◽  
Valve Repair ◽  
New York Heart Association

Various techniques for treating tricuspid regurgitation have been described; however, because of scarce data about the long-term outcomes of different repairs, the optimal technique has not been established. We evaluated the effectiveness and durability of artificial neochordae implantation in the treatment of tricuspid regurgitation. From 2009 through 2014, 507 patients underwent tricuspid valve repair at our institution. Of those, 48 patients implanted with artificial neochordae were included in our study. The median age of the participants was 62 years (range, 4–77 yr) and 50% were women. Thirty patients (63%) were in New York Heart Association functional class III, and 11 (23%) were in class II. The cause of tricuspid regurgitation was functional in 33 patients (69%) and rheumatic in 15 (31%). In 46 patients, neochordae implantation was performed in addition to Kay annuloplasty (n=13) or ring annuloplasty (n=33). Forty-two patients were discharged from the hospital with absent or mild tricuspid regurgitation. The mean follow-up period was 44.3 ± 20.2 months. Follow-up echocardiograms revealed that tricuspid regurgitation was absent, minimal, or mild in 38 patients (80.8%), moderate in 7, and severe in 2. Our results indicate that the use of artificial neochordae implantation as an adjunct procedure to annuloplasty leads to effective and durable repair in comparison with conventional techniques for treating tricuspid regurgitation.

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

2018 ◽  
Vol 26 (11) ◽  
pp. 552-561 ◽  
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

scholarly journals Potential Role and Prognostic Value of Erythropoietin Levels in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

2020 ◽  
Vol 7 ◽  
Author(s):  
Silvia Mas-Peiro ◽  
Philipp C. Seppelt ◽  
Roberta De Rosa ◽  
Marie-Isabel Murray ◽  
Jörg Yogarajah ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Prognostic Value ◽  
Severe Aortic Stenosis ◽  
Strong Predictor ◽  
Nyha Class ◽  
High Volume ◽  
Class Iii ◽  
Eligibility Criteria ◽  
Term Survival

Background: Both EPO levels and anemia have shown prognostic value in several cardiac disorders. An observational study with a prospective follow-up was performed to investigate their independent prognostic roles in severe aortic stenosis.Methods: An up to 36-month follow-up of consecutive patients with severe aortic stenosis undergoing TAVR in a high-volume center was performed. Patients with eGRF &lt;30 mL/min/1.73 m2 were excluded. EPO levels and/or anemia status and its association with mid-term mortality were assessed.Results: Out of 407, 360 met eligibility criteria. Median age was 83 years, with 71.4% having a NYHA class III/IV. Anemia was present in 51.9%, and iron deficiency in 52.8%. Median (IQR) EPO levels were 14.4 (9.30–24.30) mIU/mL. Median follow-up was 566 days. Anemia was associated with overall mortality (HR 2.40, 95% CI 1.51–3.80, p &lt; 0.001). Higher logEPO levels were associated with mid-term mortality (HR 4.05, 95% CI 2.29–7.16, p &lt; 0.001), even after adjusting for clinically and/or statistically relevant factors (multivariate HR 2.25, 95 CI 1.09–4.66, p = 0.029). Kaplan-Meier analyses showed early diverging curves for anemia vs. non-anemia, whereas curves for patients in various EPO level quartiles started to diverge at about 100 days, with differences consistently increasing during the subsequent entire follow-up period.Conclusions: Differently from anemia, which was a strong predictor for both early and late mortality in severe aortic stenosis after TAVR, independent prognostic value of EPO only emerged after post-TAVR recovery. EPO prognostic value was independent from anemia and mild-to-moderate renal dysfunction. High EPO levels could be useful to identify patients with severe aortic stenosis showing a compromised mid-term survival in spite of TAVR use and independently from early TAVR results.

Modified unicaval drainage in reoperative isolated tricuspid valve repair via totally thoracoscopic approach

Perfusion ◽  
2020 ◽  
Vol 35 (7) ◽  
pp. 649-657
Author(s):  
Biao-Chuan He ◽  
Ying-Jie Ke ◽  
Kan Zhou ◽  
Ze-Rui Chen ◽  
Jue Yang ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Venous Drainage ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Thoracoscopic Approach ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Drainage Group

Aim: The aim of this study was to investigate the feasibility, safety, and clinical effect of modified unicaval drainage for thoracoscopic reoperative isolated tricuspid valve repair, compared with conventional bicaval drainage. Methods: A total of 45 consecutive cases of patients who underwent thoracoscopic reoperative isolated tricuspid valve repair on beating-heart were enrolled and divided into two groups according to the different venous drainage (Group A: modified unicaval drainage, Group B: conventional bicaval drainage). A retrospective analysis of perioperative data and clinical outcomes were performed and all the surviving cases were followed up. Re-evaluation of echocardiography and electrocardiogram was performed prior to discharge, and at first month, sixth month, and every year follow-up. Results: The overall postoperative 30-day mortality was 4.5% in Group A and 8.7% in Group B. The postoperative tricuspid valve regurgitation grade of both groups decreased significantly from preoperative regurgitation grade, p < 0.001, without intergroup significant difference, p = 0.815. Follow-up duration ranged from 6 to 38 months, there was one death at 24 months in Group A, and another at 9 months in Group B, respectively. Nobody from both groups experienced reintervention for residual tricuspid regurgitation. No significant difference could be identified about the incidence of postoperative morbidities and follow-up adverse events. Conclusion: Both strategies of caval venous drainage can provide satisfactory exposure for thoracoscopic reoperative isolated tricuspid valve repair and equivalent favorable postoperative outcome. And the modified unicaval drainage group may even preserve the anesthetic time and decrease the risk of iatrogenic jugular injury, achieving a more simplified procedure with better cosmetic outcome.

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 Comparison of Ring and Suture Annuloplasty in the Treatment of Tricuspid Regurgitation

2021 ◽  
Author(s):  
Mateus Tamba ◽  
Quinling Fu ◽  
Kaili Han ◽  
Xiaoke Sun ◽  
Liang Zhang ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Optimal Method ◽  
Ring Group ◽  
Wilcoxon Rank Sum Test ◽  
Ring Annuloplasty ◽  
Significant Difference ◽  
Suture Group

Background: Significant TR is common in patients with cardiac disease and because of its prognostic importance, TV came to the spotlight in the last decades. Functional TR is mostly treated when undergoing left-sided valve surgery, whereas idiopathic TR surgery is uncommon. The aim of this study is to compare the durability of tricuspid valve annuloplasty techniques, and to explore the optimal method for TV repair surgery. Methods: 1005 patients who underwent tricuspid valve repair from February 2012 to March 2019, were retrospectively studied. The patients had tricuspid valve repair while receiving surgery for other cardiac conditions. The study population was divided into Suture group (n=483, 48.1%), and Ring group (n=522, 51.9%). Data variation between and within the groups was analyzed with Mann-Whitney U test, Wilcoxon rank-sum test, and Radit analysis. Results: At two-year follow-up, in the Suture group, none/trace TR subjects were 63.9%, and 1.4% had severe TR; In the Ring group were: 63.9% none/trace, and 0.6% severe. Both groups’ two-year follow-up TR status was significantly different with preoperative TR status (p<0.05). At two-year follow-up, Suture group had 63.9% none/trace and 1.4% severe; and Ring group had 63.9% none/trace and 0.6% severe TR and there was no significant difference between the groups (p>0.05). Conclusions: Both annuloplasty techniques have good short-term outcomes. However, suture annuloplasty deteriorates faster than ring annuloplasty, making the latter to be the ideal technique for TV repair.

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.

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