Tricuspid Annular Geometry and Strain After Suture Annuloplasty in Acute Ovine Right Heart Failure

Malinowski, Marcin; Schubert, H.; Wodarek, Jeremy; Ferguson, Haley; Eberhart, Lenora; Langholz, David; Jaźwiec, Tomasz; Rausch, Manuel K.; Timek, Tomasz A.

doi:10.1016/j.athoracsur.2018.05.057

Cited by 24 publications

(21 citation statements)

References 29 publications

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“…Malinowski et al 19 reported that tricuspid annular dynamics and geometry were preserved after suture annuloplasty in acute ovine right heart failure model. Although there are some differences in situations (animal or human research, acute or chronic heart failure, suture or ring annuloplasty), their result and ours may imply that tricuspid annuloplasty itself may not affect annular kinetics.…”

Section: Discussionmentioning

confidence: 99%

Impact of tricuspid annuloplasty on postoperative changes in the right ventricular systolic and diastolic function: A retrospective cohort study

et al. 2020

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Objectives To elucidate the impact of regulation of tricuspid regurgitation (TR) using tricuspid annuloplasty on postoperative changes in right ventricular (RV) systolic and diastolic functions. Methods We enrolled 69 patients who underwent aortic or mitral valve surgery between July 2016 to March 2018 without recurrence. Patients with concomitant coronary artery bypass grafting or a history of previous cardiovascular surgery were excluded, remaining 45 patients enrolled. Patients were divided into two groups according to concomitant tricuspid annuloplasty (T: n = 12 vs non‐T: n = 33). RV global longitudinal strain (RVGLS), RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), and early tricuspid inflow velocity/early diastolic tricuspid annular velocity ratio (tricuspid E/e') were assessed as functional indices at preoperative, postoperative and 1‐year follow‐up periods. Results RVFAC deteriorated postoperatively but recovered at follow‐up in group T, whereas that in group non‐T showed gradual deterioration overtime. RVGLS and TAPSE showed similar temporary deterioration and recovery between groups. Tricuspid E in group T increased postoperatively and showed significant difference, which was kept until follow‐up period. Tricuspid e' decreased postoperatively, and recovered slightly in both groups. As a result, postoperative RV diastolic function (tricuspid E/e') showed significant difference between groups. This difference was maintained until follow‐up. Conclusions RV systolic function deteriorated postoperatively, but there was a tendency to improve at follow‐up regardless of tricuspid annuloplasty. RV diastolic function may potentially be impaired when TR was regulated by tricuspid annuloplasty.

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Section: Discussionmentioning

confidence: 99%

Impact of tricuspid annuloplasty on postoperative changes in the right ventricular systolic and diastolic function: A retrospective cohort study

et al. 2020

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“…The magnitude of those strains depended on the degree of cinching. As one would expect, we demonstrated that the septal annulus, which is not covered by the suture annuloplasty, undergoes only marginal compression …”

Section: Dynamics Of the Tricuspid Annulusmentioning

confidence: 99%

“…These data are based on least‐squares cubic spline approximation to sonomicrometry crystal coordinates collected in the beating ovine heart. Reproduced with permission from Malinowski et al…”

Section: Dynamics Of the Tricuspid Annulusmentioning

confidence: 99%

Biomechanics of the tricuspid annulus: A review of the annulus' in vivo dynamics with emphasis on ovine data

2019

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The tricuspid annulus forms the boundary between the tricuspid valve leaflets and their surrounding perivalvular tissue of the right atrioventricular junction. Its shape changes throughout the cardiac cycle in response to the forces from the contracting right heart myocardium and the blood‐valve interaction. Alterations to annular shape and dynamics in disease lead to valvular dysfunctions such as tricuspid regurgitation from which millions of patients suffer. Successful treatment of such dysfunction requires an in‐depth understanding of the normal shape and dynamics of the tricuspid annulus and of the changes following disease and subsequent repair. In this manuscript we review what we know about the shape and dynamics of the normal tricuspid annulus and about the effects of both disease and repair based on noninvasive imaging studies and invasive fiduciary marker‐based studies. We further show, by means of ovine data, that detailed engineering analyses of the tricuspid annulus provide regionally resolved insight into the kinematics of the annulus which would remain hidden if limiting analyses to simple geometric metrics.

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“…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).…”

Section: Introductionmentioning

confidence: 99%

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

Meador

Mathur

Sugerman

et al. 2020

Preprint

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ObjectivesWe set out to determine the tricuspid valve’s propensity to (mal)adapt in disease.BackgroundTricuspid regurgitation (TR) is generally considered secondary to right and/or left ventricular disease without organic failure. Interestingly, we and others have previously shown the mitral valve (mal)adapts in functional mitral regurgitation, which may warrant reconsideration of its functional etiology. Whether the tricuspid valve similarly (mal)adapts is mostly unknown.MethodsWe evaluated the (mal)adaptive response of tricuspid valve anterior leaflets (TVALs) from an ovine model in which over-pacing (19 ± 6 days) induced biventricular heart failure and TR (tachycardia-induced cardiomyopathy, TIC, n=33) and compared findings to those from a control group (n=17). In both groups, we performed proteomics, immunohistochemistry, histology, two-photon microscopy, collagen assays, leaflet thickness and morphology measurements, and biaxial mechanical tests.ResultsWe found metabolically active resident valvular cells in TIC TVALs which expressed activation and turnover markers. In TIC TVALs, we observed a 140% increase in collagen content (p=0.016), increased collagen dispersion regionally (p=0.017), a 130% increase in leaflet area (p=0.002), a 140% increase in thickness (p=0.006), and a 130% increase in radial stiffness (p=0.006).ConclusionsOur data suggest that TVALs (mal)adapt during TIC on all scales. This response is likely initiated by activated valvular cells, resulting in collagen turnover, and ultimately leading to thickening, area increase, and stiffening. Our data motivates future studies on the exact pathways leading to tricuspid (mal)adaptation and pharmacological therapeutic strategies for TR.Condensed AbstractIn most cases, tricuspid regurgitation is presumed to originate from valve extrinsic factors. We challenge this paradigm and hypothesize that the tricuspid valve maladapts, rendering the valve at least partially culpable for its dysfunction. As such, we set out to demonstrate that the tricuspid valve, indeed, maladapts in an ovine model of heart disease. In the anterior leaflets, we found alterations on the protein and cell-level, leading to maladaptation in the form of tissue growth, thickening, and stiffening. Our findings may initially motivate mechanistic pathway studies, and in the future, leaflet-targeted pharmacological therapeutic options for tricuspid regurgitation.

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Tricuspid Annular Geometry and Strain After Suture Annuloplasty in Acute Ovine Right Heart Failure

Cited by 24 publications

References 29 publications

Impact of tricuspid annuloplasty on postoperative changes in the right ventricular systolic and diastolic function: A retrospective cohort study

Impact of tricuspid annuloplasty on postoperative changes in the right ventricular systolic and diastolic function: A retrospective cohort study

Biomechanics of the tricuspid annulus: A review of the annulus' in vivo dynamics with emphasis on ovine data

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

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