Effect of variable annular reduction on functional tricuspid regurgitation and right ventricular dynamics in an ovine model of tachycardia-induced cardiomyopathy

Commentary: Annular reduction of the tricuspid valve—maybe less, maybe a little more?

“…7 On the other side, the clinical benefits of tricuspid annuloplasty for relevant functional TR are well documented, showing improved mid-and long-term survival, especially in patients with concomitant surgery for left-sided valve disease. 5,6,8 The latter aspect indicates an important clinical limitation of the presented experimental work. 6 The authors primarily focused on RV functional parameters, thereby potentially neglecting concomitant left ventricular disease and mitral regurgitation in the presence of biventricular cardiomyopathy.…”

“…5,6,8 The latter aspect indicates an important clinical limitation of the presented experimental work. 6 The authors primarily focused on RV functional parameters, thereby potentially neglecting concomitant left ventricular disease and mitral regurgitation in the presence of biventricular cardiomyopathy. Thus, not addressing a relevant mitral regurgitation at the time of tricuspid annuloplasty, as recommended by current guidelines and also usually done in the routine surgical practice, weakens the clinical relevance of the present work beyond its acute hemodynamic setup.…”

“…3 Although these data are in compliance with the recommendations of the European Society of Cardiology/European Association for Cardio-Thoracic Surgery and American Heart Association/American College of Cardiology, surgical correction of relevant TR is currently discouraged in both in the presence of severe biventricular dysfunction or pulmonary hypertension due to its poor prognosis. 4,5 In this issue of the Journal, Jazwiec and colleagues 6 present functional data on the hemodynamic effects of gradual tricuspid annular reduction for the treatment of secondary TR in an ovine tachycardia-induced cardiomyopathy model. In this meticulously instrumented experimental study, biventricular failure with tricuspid annular dilatation and relevant TR occurred after a 2-week pacing period.…”

“…Thus, not addressing a relevant mitral regurgitation at the time of tricuspid annuloplasty, as recommended by current guidelines and also usually done in the routine surgical practice, weakens the clinical relevance of the present work beyond its acute hemodynamic setup. Nonetheless, Jazwiec and colleagues 6 can be congratulated for their efforts in highlighting an important and emerging area of cardiac surgery.…”

The tricuspid valve also maladapts: A multiscale study in sheep with biventricular heart failure

“…In turn, a better understanding of TR may inform improved surgical strategies or provide alternative treatment routes. Therefore, our objective was to fill this gap in knowledge and investigate whether the tricuspid valve anterior leaflet (TVAL), similarly to the mitral valve, (mal)adapts in an ovine, tachycardia-induced cardiomyopathy (TIC) biventricular heart failure model that we have previously used to study valvular disease (24)(25)(26).…”