Roles of Cardiac Computed Tomography in Guiding Transcatheter Tricuspid Valve Interventions

Layoun, Habib; Schoenhagen, Paul; Wang, Tom Kai Ming; Puri, Rishi; Kapadia, Samir; Harb, Serge C.

doi:10.1007/s11886-021-01547-7

Cited by 7 publications

(6 citation statements)

References 39 publications

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“…Furthermore, from a practical standpoint, identifying patients with a higher risk of worse clinical outcomes following TVS could allow for the more widespread use of Several TTVI technologies targeting different structures of the tricuspid valve apparatus are currently available. 36 For example, edge-to-edge repair using the TriClip system (Abbott Vascular, Santa Clara, California, USA), which effectively bridge the septal and one of the mural leaflets together is a valid alternative. 37 Also, multiple devices targeting the annulus have been developed.…”

Section: Discussionmentioning

confidence: 99%

Imaging and haemodynamic parameters associated with clinical outcomes following isolated tricuspid valve surgery

et al. 2022

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IntroductionIsolated tricuspid valve surgery (TVS) may be associated with high morbidity and mortality. The aim of this study was to investigate the association of preoperative imaging and haemodynamic data derived from echocardiography (ECHO), cardiac magnetic resonance (CMR) and right heart catheterisation (RHC) with postoperative outcomes following TVS.MethodsIn a retrospective cohort study, patients who underwent isolated TVS at our institution between 2012 and 2020 were screened and followed up to 1 year. We only included those who had all three tests before surgery: ECHO, CMR and RHC. Patients with congenital heart disease, infective endocarditis and those who underwent concomitant valve or pericardial surgery were excluded. The primary outcome was a composite of mortality and congestive heart failure at 1 year. Time-to-event analyses at 1 year and Cox proportional hazards regression analyses were performed.ResultsA total of 60 patients were included (mean age of 60±14 years, 63% women), of whom 67% underwent TV repair. The primary outcome occurred in 16 patients (27%) with a 1-year mortality of 7%. It was associated with ECHO-derived right ventricular (RV) free wall strain and RHC-derived RV systolic and diastolic as well as mean pulmonary pressures. On multivariable Cox regression analysis, only RV systolic and diastolic pressures were significantly associated with the primary outcome at 1 year (HRs=5.9 and 3.4, respectively, p<0.05).ConclusionBaseline invasive haemodynamic assessment could have a strong association with clinical outcomes and help risk-stratify patients undergoing isolated TVS.

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Section: Discussionmentioning

confidence: 99%

Imaging and haemodynamic parameters associated with clinical outcomes following isolated tricuspid valve surgery

et al. 2022

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“…Finally, CCT can predict the ideal fluoroscopic projections to be intra-procedurally used and generate projection images, which can be exported and used to support intraprocedural fluoroscopy with fusion imaging for guiding treatments, which is critical for reducing procedure times and radiation exposure [43].…”

Section: Cardiac Computed Tomographymentioning

confidence: 99%

“…Optimal fluoroscopic angles vary on a patient-by-patient basis and their identification reduces procedure time, radiation exposure, contrast medium volume, and acute kidney injury risk, and avoids complications such as device malpositioning by facilitating coaxial device deployment [63]. Moreover, CCT data can be stored and used for intraprocedural fusion imaging with fluoroscopy [43].…”

Section: Fluoroscopymentioning

confidence: 99%

“…While fluoroscopy is a 2D planar imaging modality affected by parallax and requiring multiple viewing angles to obtain accurate 3D spatial data, multi-slice computed tomography (MSCT) is not affected by parallax and allows preserved spatial resolution in all imaging planes [63]. MSCT multiplanar reconstructions can therefore be used to pre-select optimal fluoroscopic viewing angles for the intraprocedural guidance of transcatheter TV interventions [43], selecting the angles that provide maximal separation among the structures of interest. The ideal projection curve (IPC) describes the TV annulus's fluoroscopic angulations, including its en-face view and perpendicular "in-plane" views.…”

Section: Fluoroscopymentioning

confidence: 99%

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Advances in Imaging for Tricuspid Transcatheter Edge-to-Edge Repair: Lessons Learned and Future Perspectives

Prandi

Belli

Illuminato

et al. 2023

JCM

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Severe tricuspid valve (TV) regurgitation (TR) has been associated with adverse long-term outcomes in several natural history studies, but isolated TV surgery presents high mortality and morbidity rates. Transcatheter tricuspid valve interventions (TTVI) therefore represent a promising field and may currently be considered in patients with severe secondary TR that have a prohibitive surgical risk. Tricuspid transcatheter edge-to-edge repair (T-TEER) represents one of the most frequently used TTVI options. Accurate imaging of the tricuspid valve (TV) apparatus is crucial for T-TEER preprocedural planning, in order to select the right candidates, and is also fundamental for intraprocedural guidance and post-procedural follow-up. Although transesophageal echocardiography represents the main imaging modality, we describe the utility and additional value of other imaging modalities such as cardiac CT and MRI, intracardiac echocardiography, fluoroscopy, and fusion imaging to assist T-TEER. Developments in the field of 3D printing, computational models, and artificial intelligence hold great promise in improving the assessment and management of patients with valvular heart disease.

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“…To our knowledge, this is the first detailed report assessing the VC anatomic characteristics as they pertain to TTVI on cardiac CT, which is typically used for procedural planning. 3 Procedural evaluation for CAVI also requires the presence of significant caval reflux for proper valve function after implantation. Earlier heterotopic therapies mainly involved the IVC with complications including residual leaks, improper sizing, and device embolization and thrombosis.…”

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confidence: 99%

Venae Cavae Anatomic Characteristics in Severe Tricuspid Regurgitation: Implications for Transcatheter Interventions

et al. 2023

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Roles of Cardiac Computed Tomography in Guiding Transcatheter Tricuspid Valve Interventions

Cited by 7 publications

References 39 publications

Imaging and haemodynamic parameters associated with clinical outcomes following isolated tricuspid valve surgery

Imaging and haemodynamic parameters associated with clinical outcomes following isolated tricuspid valve surgery

Advances in Imaging for Tricuspid Transcatheter Edge-to-Edge Repair: Lessons Learned and Future Perspectives

Venae Cavae Anatomic Characteristics in Severe Tricuspid Regurgitation: Implications for Transcatheter Interventions

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