Prognostic impact and late evolution of untreated moderate (2/4+) functional tricuspid regurgitation in patients undergoing aortic valve replacement
Maurizio Taramasso,Francesco Maisano,Michele De Bonis,Alberto Pozzoli,Davide Schiavi,Stefano Benussi,Antonio Grimaldi,Giovanni La Canna,Ottavio Alfieri +8 more
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TLDR
The aim of the present study was to evaluate the prognostic impact and late evolution of associated tricuspid regurgitation (TR) 2/4+ after aortic valve replacement (AVR).Abstract:
OBJECTIVES: The aim of the present study was to evaluate the prognostic impact and late evolution of associated tricuspid regurgitation (TR) 2/4+ after aortic valve replacement (AVR).
METHODS: We evaluated 61 patients who underwent AVR between 2003 and 2012 (35 for aortic stenosis [AS], 26 for aortic regurgitation [AR]) with associated untreated TR 2/4+. Patients with concomitant mitral disease were excluded. Median follow-up was 3.2 years. Serial echocardiographic and clinical data were collected and analyzed.
RESULTS: Mean age was 65 ± 13 years; 26% of the patients were in NYHA class III-IV. Left ventricular ejection fraction was 53 ± 11%. Comorbidity included: chronic obstructive pulmonary disease in 5%, chronic renal failure in 13%, coronary artery disease in 20%, history of stroke/TIA in 8%. Thirty-day mortality was 1.6%. Overall actuarial survival was 83 ± 6% at 6.5 years, with a freedom from cardiac death of 90 ± 5%. Freedom from TR ≥3+ was 86 ± 6% at 6.5 years. At last follow-up, 82% of the patients had TR 0-1/4+, 9% had TR 2/4+, 4.5% had TR 3/4+ and 4.5% had TR 4/4+. Occurrence of TR ≥ 3+ at follow-up was associated with increased cardiac mortality (HR 10.5; p = 0.009).
CONCLUSIONS: preoperative untreated TR 2/4+ improves or remains stable in the majority of patients. The poor outcomes associated with TR > 2+ suggest the need for better methods to identify subjects at risk for TR progression. doi: 10.1111/jocs.12656 (J Card Surg 2016;31:9-14).read more
Citations
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Journal ArticleDOI
Anatomy and Physiology of the Tricuspid Valve
TL;DR: This review of tricuspid valve and right heart anatomy is followed by a discussion of the possible pathophysiology of secondary (functional) tric Suspid regurgitation.
Journal ArticleDOI
Tricuspid Regurgitation: Predicting the Need for Intervention, Procedural Success, and Recurrence of Disease
Maurizio Taramasso,Mara Gavazzoni,Alberto Pozzoli,Gilles D. Dreyfus,Steven F. Bolling,Isaac George,Ioannis Kapos,Felix C. Tanner,Michel Zuber,Francesco Maisano,Rebecca T. Hahn +10 more
TL;DR: The authors explore the indications for intervention in tricuspid regurgitation according to current guidelines, the published research to support the expansion of these indications including the role of transcatheter interventions, and the risk factors for therapy failure, which may help define the appropriate patient population for treatment.
Journal ArticleDOI
Morphological Assessment of the Tricuspid Apparatus and Grading Regurgitation Severity in Patients With Functional Tricuspid Regurgitation: Thinking Outside the Box
Luigi P. Badano,Luigi P. Badano,Rebecca T. Hahn,Hugo Rodríguez-Zanella,Diego Araiza Garaygordobil,Roberto C. Ochoa-Jimenez,Denisa Muraru +6 more
TL;DR: Most of the parameters included in the current recommendations to assess FTR are derived from the experience and knowledge developed about the mitral valve and have been transferred from the left to the right side of the heart without accounting for differences in anatomy of the tricuspid and mitral apparatus.
Journal ArticleDOI
Revisit of Functional Tricuspid Regurgitation; Current Trends in the Diagnosis and Management
TL;DR: The anatomy, pathophysiology and the use of imaging techniques to assess patients with FTR are reviewed, as well as the various treatment options for FTR, including emerging transcatheter procedures.
Journal ArticleDOI
Predictors of Persistent Tricuspid Regurgitation after Transcatheter Aortic Valve Replacement in Patients with Baseline Tricuspid Regurgitation
Berhane Worku,Berhane Worku,Marie-Therese I. Valovska,Adham Elmously,Polydoros N. Kampaktsis,Catherine Castillo,Catherine Castillo,Shing-Chiu Wong,Arash Salemi +8 more
TL;DR: Outcomes in patients with moderate-severe tricuspid regurgitation (TR) undergoing transcatheter aortic valve replacement (TAVR) are analyzed to suggest that that TR is likely to persist after TAVR and is also indicative of a poor long-term outcome.
References
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Guidelines on the management of valvular heart disease (version 2012)The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)
Journal ArticleDOI
Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging
Patrizio Lancellotti,Christophe Tribouilloy,Andreas Hagendorff,Bogdan A. Popescu,Thor Edvardsen,Thor Edvardsen,Luc Pierard,Luigi P. Badano,José Luis Zamorano +8 more
TL;DR: It is crucial to provide standards that aim at establishing a baseline list of measurements to be performed when assessing regurgitation, and to integrate the quantification of the regurgitations, assessment of the valve anatomy and function, as well as the consequences of valvular disease on cardiac chambers.
Journal ArticleDOI
Secondary tricuspid regurgitation or dilatation: Which should be the criteria for surgical repair?
TL;DR: Remodeling annuloplasty of the tric Suspid valve based on tricuspid dilation improves functional status irrespective of the grade of regurgitation.
Journal ArticleDOI
Tricuspid Valve Tethering Predicts Residual Tricuspid Regurgitation After Tricuspid Annuloplasty
Shota Fukuda,Jong-Min Song,A. Marc Gillinov,Patrick M. McCarthy,Masao Daimon,Vorachai Kongsaerepong,James D. Thomas,Takahiro Shiota +7 more
TL;DR: Severe TV tethering predicted residual TR after TV annuloplasty, whereas preoperative TV annular dimension was not associated with outcome of TV annuoplasty.
Journal ArticleDOI
The Growing Clinical Importance of Secondary Tricuspid Regurgitation
Maurizio Taramasso,Hugo Vanermen,Francesco Maisano,Andrea Guidotti,Giovanni La Canna,Ottavio Alfieri +5 more
TL;DR: The anatomical basis, pathophysiology, therapeutic approach, and future perspectives with regard to the management of tricuspid regurgitation are explored.