Echocardiographic Imaging for Transcatheter Tricuspid Edge-to-Edge Repair.
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ABSTRACT:
SUBMITTER: Ro R
PROVIDER: S-EPMC7335573 | biostudies-literature | 2020 Mar
REPOSITORIES: biostudies-literature
Publications
Echocardiographic Imaging for Transcatheter Tricuspid Edge-to-Edge Repair.
Ro Richard R Tang Gilbert H L GHL Seetharam Karthik K Khera Sahil S Sharma Samin K SK Kini Annapoorna S AS Lerakis Stamatios S
Journal of the American Heart Association 20200224 5
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Project description:Significant tricuspid regurgitation (TR) is seen as a relevant contributor of cardiac morbidity and mortality. Transcatheter tricuspid valve replacement (TTVR) is a novel technique to treat this condition. We present the case of an 82-year-old lady who was admitted for recurrent right heart decompensation despite having undergone treatment with tricuspid edge-to-edge repair (TEER). The patient underwent transfemoral implantation of a 48 mm EVOQUE valve. Since the implanted Clip was not in the central part of the valve, it was pushed toward the valvular anulus by the expanded prothesis. Echocardiography showed a good result with no residual TR. Options for residual TR after T-TEER are very limited. TTVR might be suitable in selected patients with non-central Clip placement.
| S-EPMC11694554 | biostudies-literature
Project description:Transcatheter edge-to-edge repair (TEER) therapy is recommended by the American College of Cardiology/American Heart Association (ACC/AHA) guidelines for selected patients with symptomatic severe or moderate-severe mitral regurgitation (MR). Echocardiography, in particular transesophageal echocardiography (TEE), plays a critical role in procedural planning and guidance for TEER. Recent innovations and advances in TEE techniques including three-dimensional (3D) imaging, unlimited x-plane imaging, live 3D multiplanar reconstruction, as well as transillumination imaging with color Doppler and transparency rendering have further enhanced procedural imaging for TEER, especially for complex diseases including commissural defects, clefts, and multi-segment pathologies. This review discusses the technology of these advanced procedural imaging techniques and provides a "step-by-step" guide on how to apply them during the TEER procedure with a focus on their added values in treatment of complex valve lesions.
| S-EPMC8996060 | biostudies-literature
Project description: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.
| S-EPMC10219492 | biostudies-literature
Project description:Patients with severe symptomatic tricuspid regurgitation face a significant dilemma in treatment options, as the yearly mortality with medical therapy and the surgical mortality for tricuspid repair or replacement are high. Transcatheter edge-to-edge repair (TEER) for the tricuspid valve is becoming a viable option in patients, although procedural success is dependent on high-quality imaging. While transesophageal echocardiography remains the standard for tricuspid TEER procedures, intracardiac echocardiography (ICE) with three-dimensional (3D) multiplanar reconstruction (MPR) has many theoretical and practical advantages. The aim of this article was to describe the in vitro wet lab-based imaging work done to facilitate the best approach to 3D MPR ICE imaging and the procedural experience gained with 3D MPR ICE in tricuspid TEER procedures with the PASCAL device.
| S-EPMC10242583 | biostudies-literature
Project description:BackgroundA mismatch between tricuspid leaflet size and annular dilation is one of the morphological features tied to the development of tricuspid regurgitation (TR).AimsWe assessed the association of the leaflet-to-annulus index (LAI) with residual TR after transcatheter edge-to-edge repair (TEER).MethodsConsecutive patients who underwent TEER for TR were enrolled. Significant residual TR was defined as a post-procedural TR ≥3+, and patients were divided into two groups according to the amount of residual TR. The LAI was retrospectively calculated using procedural transoesophageal echocardiography and was defined as follows: (anterior leaflet length+septal leaflet length)/septolateral tricuspid annulus diameter.ResultsOf 140 patients, 43 patients had residual TR ≥3+ after TEER. The patients with residual TR ≥3+ had a lower LAI compared to those with residual TR <3+ (1.04±0.10 vs 1.13±0.09; p=0.001). In multivariable analysis, the LAI was associated with residual TR ≥3+ (odds ratio [OR] [per 0.1 increase]: 0.57; 95% confidence interval [95% CI]: 0.35-0.94; p=0.02), independent of baseline TR severity or coaptation gap size. Patients with residual TR ≥3+ had a higher incidence of the composite outcome, consisting of all-cause mortality and heart failure hospitalisation within one year after TEER (47.1% vs 26.6%, p=0.02). Residual TR ≥3+ was an independent predictor of the composite outcome within one year (hazard ratio: 2.04; 95% CI: 1.01-4.11; p=0.04).ConclusionsThe leaflet-to-annulus mismatch (i.e., LAI) is associated with residual TR ≥3+ after TEER for TR. A detailed echocardiographic analysis of the tricuspid valve will be conducive to identifing suitable subjects for TEER.
| S-EPMC9904375 | biostudies-literature
Project description:Residual and recurrent tricuspid regurgitation may occur frequently after surgical tricuspid valve repair. However, reoperation for tricuspid regurgitation is rare, although many patients are again highly symptomatic. Tricuspid transcatheter edge-to-edge repair (TEER) is a promising therapy for severe tricuspid regurgitation. Herein, we report a 77-year-old woman with recurrent symptomatic massive tricuspid regurgitation 2 years after sutured annuloplasty of the tricuspid valve. TEER was successfully performed using the TriClip® device and tricuspid regurgitation was reduced to a mild degree. In conclusion, tricuspid TEER is feasible following surgical suture annuloplasty. TEER is an alternative option for patients with a failed previous annuloplasty repair for tricuspid regurgitation to undergo a less invasive treatment rather than a potentially higher-risk reoperation.
| S-EPMC9650543 | biostudies-literature
Project description:BackgroundPrior studies investigating the impact of residual mitral regurgitation (MR), tricuspid regurgitation (TR), and elevated predischarge transmitral mean pressure gradient (TMPG) on outcomes after mitral transcatheter edge-to-edge repair (TEER) have assessed each parameter in isolation. We sought to examine the prognostic value of combining predischarge MR, TR, and TMPG to study long-term outcomes after TEER.Methods and resultsWe reviewed the records of 291 patients who underwent successful mitral TEER at our institution between March 2014 and June 2022. Using well-established outcomes-related cutoffs for predischarge MR (≥moderate), TR (≥moderate), and TMPG (≥5 mm Hg), 3 echo profiles were developed based on the number of risk factors present (optimal: 0 risk factors, mixed: 1 risk factor, poor: ≥2 risk factors). Discrimination of the profiles for predicting the primary composite end point of all-cause mortality and heart failure hospitalization at 2 years was examined using Cox regression. Overall, mean age was 76.7±10.6 years, 43.3% were women, and 53% had primary MR. Two-year event-free survival was 61%. Predischarge TR≥moderate, MR≥moderate, and TMPG≥5 mm Hg were risk factors associated with the primary end point. Compared with the optimal profile, there was an incremental risk in 2-year event-rate with each worsening profile (optimal as reference; mixed profile: hazard ratio (HR), 2.87 [95% CI, 1.71-5.17], P<0.001; poor profile: HR, 3.76 [95% CI, 1.84-6.53], P<0.001). Echocardiographic profile was statistically associated with the 2-year mortality end point (optimal as reference; mixed profile: HR, 3.55 [95% CI, 1.81-5.96], P<0.001; poor profile: HR, 3.39 [95% CI, 2.56-7.33], P=0.02).ConclusionsThe echocardiographic profile integrating predischarge TR, MR, and TMPG presents a novel prognostic stratification tool for patients undergoing mitral TEER.
| S-EPMC10944065 | biostudies-literature
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| S-EPMC10927448 | biostudies-literature
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| S-EPMC6200677 | biostudies-literature
Project description:BackgroundThe GLIDE Score is an anatomical scoring system designed to predict moderate residual tricuspid regurgitation (TR) immediately following transcatheter tricuspid edge-to-edge repair (T-TEER).ObjectivesThe purpose of this study was to evaluate the GLIDE Score's predictive capability for achieving a postprocedural TR grade of mild or better.MethodsThis retrospective analysis included 336 patients from a multicenter registry who underwent T-TEER between January 2017 and November 2022. Anatomical features were assessed using transesophageal echocardiography to calculate the GLIDE Score, which ranges from 0 to 5. The primary endpoint was a postprocedural TR grade of mild or better, assessed via periprocedural imaging. Outcomes were compared between patients with GLIDE Scores of 0 to 1 and those with scores ≥2 using logistic regression and ROC curve analysis.ResultsMedian age was 81 years, with no significant differences in BMI, EuroScore II, or NYHA Class across GLIDE Score cohorts. The GLIDE Score ≥2 cohort had a larger median RV basal diameter (48 mm vs 45 mm, P < 0.001) and more torrential TR cases (35.9% vs 3.1%, P < 0.001). Postprocedural mild TR was achieved in 74.7% of patients with a GLIDE Score of 0 to 1, versus 13.4% in the ≥2 cohort (P < 0.001). Ordinal regression analysis found a strong correlation between the GLIDE Score and postprocedural TR severity (coefficient = 1.41, t = 12.92), with an AUC to predict mild TR of 0.87 (95% CI: 0.83-0.90).ConclusionsThe GLIDE Score is a valuable tool for predicting postprocedural TR severity in T-TEER patients, guiding patient selection and refining treatment strategies.
| S-EPMC11905155 | biostudies-literature