Uncertainties and challenges in surgical and transcatheter tricuspid valve therapy: a state-of-the-art expert review

Chang, Chun Chin; Veen, Kevin M; Hahn, Rebecca T.; Bogers, Ad J.J.C.; Latib, Azeem; Oei, Frans B S; Abdelghani, Mohammad; Modolo, Rodrigo; Ho, Siew Yen; Abdel‐Wahab, Mohamed; Fattouch, Khalil; Bosmans, Johan; Çalışkan, Kadir; Taramasso, Maurizio; Serruys, Patrick W.; Bax, Jeroen J.; Mieghem, Nicolas M D A van; Takkenberg, Johanna J.M.; Lurz, P; Modine, Thomas; Soliman, Osama Ibrahim Ibrahim

doi:10.1093/eurheartj/ehz614

Cited by 47 publications

(33 citation statements)

References 95 publications

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“…Late TR after mitral valve replacement is often isolated and occurs in the absence of significant left heart disease [ 1 ] . However, in TR, isolated TV surgery is only recommended in symptomatic patients or patients who had progressed RV dilatation [ 21 ] . As a result, isolated TVR to correct TR is a difficult problem due to the late referral and manifestations of damaged RV function.…”

Section: Discussionmentioning

confidence: 99%

Mid-Term Outcome after Tricuspid Valve Replacement

Cheng¹,

Mo²,

Wang³

et al. 2020

Braz J Cardiovasc Surg

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Objective To evaluate the mid-term survival rate after tricuspid valve replacement (TVR). Methods We retrospectively studied 110 consecutive patients who underwent TVR from January 2007 to November 2017. A survival analysis was performed with the Kaplan-Meier method and the log-rank test. Results The median survival was 65.81 months. Mean age was 50 (range 39 to 59) years. Forty-eight patients (43.6%) were male, and 62 patients (56.4%) were female. Most of the patients (78.5%) were categorized into the New York Heart Association (NYHA) functional classes III/IV. Seventy-two patients (65.5%) had isolated TVR. Six-three patients (57.3%) had previously undergone heart surgery. The Kaplan-Meier survival rates at one year, three years, and five years were 59.0%±5%, 52.0%±6%, and 48.0%±6%, respectively. A Cox regression analysis demonstrated that the risk factors for mid-term mortality were advanced NYHA class (hazard ratio [HR] 2.430, 95% confidence interval [CI] 1.099-5.375, P =0.028), need for continuous renal replacement therapy (CRRT) treatment (HR 3.121, 95% CI 1.610-6.050, P =0.001), and need for intra-aortic balloon pump (IABP) treatment (HR 3.356, 95% CI 1.072-10.504, P =0.038). Conclusion In TVR, impaired cardiac function before the operation and a need for CRRT or IABP treatment after the operation is independently associated with increased mid-term mortality.

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Section: Discussionmentioning

confidence: 99%

Mid-Term Outcome after Tricuspid Valve Replacement

Cheng¹,

Mo²,

Wang³

et al. 2020

Braz J Cardiovasc Surg

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“…NaviGate, TriSol, Cavi/BiCavi), or neochordae repair (e.g. Tricentro, TricValve) [21]. Most are still under investigation and are being tested in different phases of research.…”

Section: Introductionmentioning

confidence: 99%

The impact of tricuspid annular geometry on outcome after percutaneous edge-to-edge repair for severe tricuspid regurgitation

et al. 2021

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Background: Percutaneous tricuspid repair using the edge-to-edge technique is a novel treatment option. More data are needed to better understand which aspects predict a favorable outcome Methods: Twenty high-risk patients (78.6 ± 8.3 years, EUROScore II 9.1 ± 7.7%, STS score 8.8 ± 4.3) with severe symptomatic tricuspid regurgitation (TR) were treated with the MitraClip ® system. All patients underwent standardized pre-, peri-, and post-procedural evaluation. Acute success was defined as successful edge-to-edge repair with TR reduction of ≥ 1 grade and survival until hospital discharge.Results: Fifteen (75%) patients showed acute success until discharge and 12 (60%) at 30-day follow-up. In 5 (25%) patients repair failed due to either unsuccessful clip implantation (n = 2), single leaflet device attachment (n = 1), TR reduction < 1 grade (n = 1), or in-hospital death (n = 1). Comparing patients with successful procedure versus those with failed repair revealed similar comorbidities but more severe right heart failure, lower left ventricular ejection fraction, worse renal function, and higher diuretic equivalent doses in the failed repair group. No differences in conventional echocardiographic parameters for TR severity but more dilated tricuspid annulus geometry (tricuspid valve [TV] annulus, coaptation depth, tenting area) in the failed repair group were observed. The success rate of non-central/nonanteroseptal jet location was only 25%. Conclusions:Tricuspid annulus geometry assessment may be of crucial importance and seems to impact procedural outcomes in patients undergoing edge-to-edge TV repair. Further investigations including advanced imaging are needed to better understand and treat this complex valve disease.

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“…Moderate-to-severe secondary tricuspid regurgitation (TR) is associated with an 2-fold increase of all-cause mortality typically attributed to progressive right ventricular (RV) failure. 1 Despite accumulating evidence that underscores the adverse clinical prognosis of relevant TR, there are still major uncertainties with respect to the optimal timing of surgery and best operative technique. 2 A recent report from the Society of Thoracic Surgeons database summarizing more than 50,000 patients undergoing surgery of the tricuspid valve demonstrates that annuloplasty is the primary surgical strategy and that 80% of tricuspid valve repairs are performed at the time of left-sided valve surgery.…”

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confidence: 99%