Invasive Cardiomechanics During Transcatheter Edge-to-Edge Repair for Massive Tricuspid Regurgitation Using Biventricular Pressure-Volume Loop Monitoring

Enden, Antoon J.M. van den; Bastos, M.; Schreuder, Jan J.; Daemen, Joost; Mieghem, Nicolas Van

doi:10.1016/j.jaccas.2021.07.030

Cited by 4 publications

(4 citation statements)

References 2 publications

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“…There was a decrease in PASP associated with replacement, however, we did not find any significant association between RV stroke volume and replacement despite the decrease in RV function. These results are consistent with pressure‐volume loop (PVL) analysis of RV mechanics pre‐ and posttricuspid T‐TEER, which demonstrated a decrease in RV ejection fraction with associated resolution of tricuspid regurgitant volume, but a stable RV SV and an actual improvement in RV stroke work and RV end‐systolic elastance, a load‐independent measure of RV function 16 . It is important to note that load‐dependent measures of RV function, including TAPSE, FAC and ejection fraction, are likely inadequate in assessing RV systolic function in the setting of significant TR, and that RV SV and its response to therapy is the more physiologically relevant parameter of RV systolic function.…”

Section: Discussionsupporting

confidence: 86%

Right ventricular remodeling and clinical outcomes following transcatheter tricuspid valve intervention

Dershowitz,

Lawlor,

Hamid

et al. 2023

Cathet Cardio Intervent

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AimsCharacterize the impact of residual tricuspid regurgitation (TR) on right ventricle (RV) remodeling and clinical outcomes after transcatheter tricuspid valve intervention.MethodsWe performed a single‐center retrospective analysis of transcatheter tricuspid valve repair (TTVr) or replacement (TTVR) patients. The primary outcomes were longitudinal tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), pulmonary artery systolic pressure (PASP), and RV dimensions (RVd). We used multivariable linear mixed models to evaluate association with replacement versus repair and degree of TR reduction with changes in these echo measures over time. Multivariable Cox regression was used to identify associations between changes in these echo measures and a composite clinical outcome of death, heart failure hospitalization, or re‐do tricuspid valve intervention.ResultsWe included a total of 61 patients; mean age was 77.5 ± 11.7 and 62% were female. TTVR was performed in 25 (41%) and TTVr in 36 (59%). Initially, 72% (n = 44) had ≤ severe TR and 28% (n = 17) had massive or torrential TR. The median number of follow up echos was 2: time to 1st follow‐up was 50 days (interquartile range [IQR]: 20, 91) and last follow‐up was 147 (IQR: 90, 327). Median TR reduction was 1 (IQR: 0, 2) versus 4 (IQR: 3, 6) grades in TTVr versus TTVR (p < 0.0001). In linear mixed modeling, TTVR was associated with decline in TAPSE and PASP, and TR reduction was associated with decreased RVd. In multivariable Cox regression, greater RVd was associated with the clinical outcome (hazard ratio: 9.27, 95% confidence interval: 1.23–69.88, p = 0.03).ConclusionGreater TR reduction is achieved by TTVR versus TTVr, which is in turn associated with RV reverse remodeling. RV dimension in follow‐up is associated with increased risk of a composite outcome of death, heart failure hospitalization, or re‐do tricuspid valve intervention.

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Section: Discussionsupporting

confidence: 86%

Right ventricular remodeling and clinical outcomes following transcatheter tricuspid valve intervention

Dershowitz,

Lawlor,

Hamid

et al. 2023

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…Conversely, tricuspid TEER may enhance left ventricular preload in response to right ventricular unloading. 9 PVL analysis provides a comprehensive, beat-to-beat visualization of cardiac and hemodynamic physiology from both load-dependent and load-independent perspectives. Insights regarding changes in cardiac mechanoenergetics, ventricular loading, and ventricular-vascular interactions surrounding endovascular structural interventions are scarce but pertinent to predict the (individual) response to changing ventricular preload or afterload conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, tricuspid TEER may enhance left ventricular preload in response to right ventricular unloading. 9 …”

Section: Discussionmentioning

confidence: 99%

“…A similar approach for tricuspid TEER was recently published. 9 For all cases, a pulmonary artery catheter will be inserted following femoral or internal jugular vein cannulation to allow volume calibration of PVL measurements. The volume calibration algorithm comprises an estimation of stroke volume using thermodilution to appraise cardiac output.…”

Section: Methodsmentioning

confidence: 99%

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