Pathogenic structural heart changes in early tricuspid regurgitation

Nemoto, Nobukatsu; Lesser, John R.; Pedersen, Wesley R.; Sorajja, Paul; Spinner, Erin M.; Garberich, Ross; Vock, David M.; Schwartz, Robert S.

doi:10.1016/j.jtcvs.2015.05.009

Cited by 69 publications

(33 citation statements)

References 45 publications

(45 reference statements)

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“…The grade of TR shows the advanced state of cardiac disease most often reflecting left sided valvular disease 18–20. In patients with left sided valvular disease, the elevated left atrial pressure is reflected through an elevated pulmonary artery pressure which in turn causes RV dilation and worsening of secondary TR 10 21. However, it does not follow a similar course in reverse.…”

Section: Discussionmentioning

confidence: 99%

Impact of tricuspid regurgitation on postoperative outcomes after non-cardiac surgeries

et al. 2020

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ObjectiveTricuspid regurgitation (TR) severity has known adverse implications, its impact on patients undergoing non-cardiac surgery (NCS) remains unclear. We sought to determine the impact of TR on patient outcomes after NCS.MethodsWe performed a retrospective cohort study in patients undergoing NCS. Outcomes in patients with moderate or severe TR were compared with no/trivial TR after adjusting for baseline characteristics and revised cardiac risk index (RCRI). The primary outcome was defined as 30-day mortality and heart failure (HF), while the secondary outcome was long-term mortality.ResultsOf the 7064 patients included, 312 and 80 patients had moderate and severe TR, respectively. Thirty-day mortality was higher in moderate TR (adjusted OR 2.44, 95% CI 1.25 to 4.76) and severe TR (OR 2.85, 95% CI 1.04 to 7.79) compared with no/trivial TR. There was no difference in 30-day HF in patients with moderate TR (OR 1.48, 95% CI 0.90 to 2.44) or severe TR (OR 1.42, 95% CI 0.60 to 3.39). The adjusted HR for long-term mortality in moderate TR was 1.55 (95% CI 1.31 to 1.82) and 1.87 (95% CI 1.40 to 2.50) for severe TR compared with no/trivial TR.ConclusionIncreasing TR severity has higher postoperative 30-day mortality in patients undergoing NCS, independent of RCRI risk factors, ejection fraction or mitral regurgitation. Severity of TR should be considered in risk stratification for patients undergoing NCS.

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Section: Discussionmentioning

confidence: 99%

Impact of tricuspid regurgitation on postoperative outcomes after non-cardiac surgeries

et al. 2020

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“…Thin image slices allow for detection of distinct valvular boundaries and useful spatial information for assessing RV function [67]. Studies support the prognostic value of cardiac CT for indexing FTR—such parameters include the RA and RV volumes, the leaflet tethering angles and height, and the annular diameter and area [68,69,70]. CT has also been used in the post-operative assessment of annuloplasty ring dislodgment and quantification of the spatial relationship between pacemaker leading in the RV and the associated TR [67,68,71].…”

Section: Functional Tricuspid Regurgitation: Diagnosis and Treatmementioning

confidence: 99%

Mechanics of the Tricuspid Valve—From Clinical Diagnosis/Treatment, In-Vivo and In-Vitro Investigations, to Patient-Specific Biomechanical Modeling

et al. 2019

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Proper tricuspid valve (TV) function is essential to unidirectional blood flow through the right side of the heart. Alterations to the tricuspid valvular components, such as the TV annulus, may lead to functional tricuspid regurgitation (FTR), where the valve is unable to prevent undesired backflow of blood from the right ventricle into the right atrium during systole. Various treatment options are currently available for FTR; however, research for the tricuspid heart valve, functional tricuspid regurgitation, and the relevant treatment methodologies are limited due to the pervasive expectation among cardiac surgeons and cardiologists that FTR will naturally regress after repair of left-sided heart valve lesions. Recent studies have focused on (i) understanding the function of the TV and the initiation or progression of FTR using both in-vivo and in-vitro methods, (ii) quantifying the biomechanical properties of the tricuspid valve apparatus as well as its surrounding heart tissue, and (iii) performing computational modeling of the TV to provide new insight into its biomechanical and physiological function. This review paper focuses on these advances and summarizes recent research relevant to the TV within the scope of FTR. Moreover, this review also provides future perspectives and extensions critical to enhancing the current understanding of the functioning and remodeling tricuspid valve in both the healthy and pathophysiological states.

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“…Functional tricuspid regurgitation (TR) is the result of either tricuspid annular dilation or increased chordal tethering. Annular dilation is strongly correlated to both right atrial and right ventricular (RV) dilation 1 . Since Dreyfus et al 2 demonstrated that TR may further impair even after successful mitral valve (MV) surgery, most surgeons started to treat less than severe TR in the presence of a dilated annulus (>40 mm or >21 mm/m 2 ) 3,4 .…”

Section: Introductionmentioning

confidence: 99%

Late tricuspid regurgitation and right ventricular remodeling after tricuspid annuloplasty

et al. 2020

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Background The aim of the present retrospective study was to evaluate the influence of preoperative right ventricular (RV) and tricuspid valve (TV) remodeling on the fate of tricuspid annuloplasty (TA) and right ventricle. Methods From May 2009 to December 2015, 423 patients who had undergone TA for functional tricuspid regurgitation (TR) were included in the study. Residual and recurrent TR were defined as moderate or more TR at discharge and follow‐up, respectively. RV remodeling was defined as RV dysfunction and/or dilation. Results Residual TR after TA was recorded in 54 patients (13%). Five‐year freedom from TR recurrence was 81% ± 3% in patients without residual TR and 41 ± 8 in patients with residual TR (P < .001). In patients without residual TR, the following risk factors for recurrent TR and late RV remodeling were identified: preoperative systolic pulmonary artery pressure, preoperative RV remodeling, severe preoperative TR or less than severe TR but with TV apparatus remodeling, and etiology of mitral regurgitation. Cox analysis with time‐dependent variables confirmed TR recurrence (hazard ratio [HR]: 3.1) and late RV remodeling (HR: 6.5) as risk factors for lower survival. No protective effect of either flexible band or rigid ring TA compared with DeVega procedure was found. Similarly, preoperative atrial fibrillation and pacemaker dependency, late failure of mitral valve surgery did not affect the fate of TR. Conclusions Prophylactic TA should be encouraged among surgeons. TA at the time of left‐sided valve surgery should take into consideration not only annular size, but also tethering severity and RV remodeling.

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Pathogenic structural heart changes in early tricuspid regurgitation

Cited by 69 publications

References 45 publications

Impact of tricuspid regurgitation on postoperative outcomes after non-cardiac surgeries

Impact of tricuspid regurgitation on postoperative outcomes after non-cardiac surgeries

Mechanics of the Tricuspid Valve—From Clinical Diagnosis/Treatment, In-Vivo and In-Vitro Investigations, to Patient-Specific Biomechanical Modeling

Late tricuspid regurgitation and right ventricular remodeling after tricuspid annuloplasty

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