Short-Term Clinical Outcomes of Transcatheter Tricuspid Valve Repair With the Third-Generation MitraClip XTR System

Ruf, T.; Hahn, Rebecca T.; Kreidel, Felix; Beiras-Fernández, Andrés; Hell, Michaela; patrick, GOLDSTEIN; Silva, Jaqueline Grace da Roche e; Vosseler, Markus; Geyer, Martin; Tamm, Alexander; Münzel, Thomas; Bardeleben, Ralph Stephan von

doi:10.1016/j.jcin.2021.03.033

Cited by 59 publications

(26 citation statements)

References 22 publications

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“…8 In our observational study we showed similar results regarding reduction in TR and NYHA classification compared to previously published studies. 11,12 Severe TR is associated with tricuspid annular dilation and leads to volume overload and increased RA and RV diastolic pressures. 13 RA pressure elevation in patients with severe TR is associated with a large systolic wave (v-wave).…”

Section: Discussionmentioning

confidence: 99%

Continuous atrial pressure monitoring via steerable guide catheter in transcatheter mitral and tricuspid edge‐to‐edge repair

Rottländer

Beucher

Ghaddioui

et al. 2022

Cathet Cardio Intervent

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Transcatheter edge‐to‐edge repair (TEER) has emerged to address severe mitral and tricuspid valve regurgitation in patients who are at high perioperative risk for open‐heart surgery. No clinical data is available for continuous left and right atrial pressure monitoring using the steerable guiding catheter (SGC) during TEER. In a prospective single‐center study, 40 patients with severe mitral (n = 20) or tricuspid (n = 20) regurgitation underwent TEER with the registration of atrial pressure via the SGC. All patients had successful TEER using the PASCAL Ace repair system, while atrial pressure was monitored continuously via the SGC. Simultaneous right or left atrial pressure monitoring via the SGC and a pigtail catheter during mitral and tricuspid TEER showed excellent reliability for SGC pressure registration. While for mitral TEER the beneficial effects of continuous atrial pressure monitoring are well known, we further evaluated the outcome of patients with tricuspid TEER. Echocardiographic and clinical results after tricuspid TEER showed a reduction of quantitative echocardiographic tricuspid regurgitation parameters and improved New York Heart Association classification after 3‐month follow‐up. Also, qualitative tricuspid valve assessment showed improved tricuspid regurgitation classification postimplantation and at 3‐month follow‐up. Furthermore, right atrial pressure was reduced by 37.6% and mean right atrial pressure by 30.6% after successful tricuspid TEER using the PASCAL Ace device. Continuous atrial pressure monitoring using the SGC of the PASCAL Ace repair system is reliable during mitral and tricuspid TEER. Furthermore, successful tricuspid TEER leads to reduced right atrial pressure.

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Section: Discussionmentioning

confidence: 99%

Continuous atrial pressure monitoring via steerable guide catheter in transcatheter mitral and tricuspid edge‐to‐edge repair

Rottländer

Beucher

Ghaddioui

et al. 2022

Cathet Cardio Intervent

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“…His bundle pacing may be a future modality in this group 137 . For appropriately selected patients with HFrEF, refractory symptoms despite maximally titrated GDMT, and significant functional mitral (and potentially tricuspid) regurgitation, transcatheter edge‐to‐edge repair (TEER) should be considered in accordance with extant HF and valvular heart disease guidelines 22,138‐140 . Further, although the recent REDUCE LAP‐HF II trial did not show the benefit of an interatrial shunt device among patients with symptomatic HF with LVEF ≥ 40%, prespecified subgroup analysis disclosed benefit among patients with a peak exercise pulmonary vascular resistance of <1.74 Wood units, potentially representing a responder group meriting dedicated prospective evaluation 140 .…”

Section: Hospitalization For Worsening Hfmentioning

confidence: 99%

“…137 For appropriately selected patients with HFrEF, refractory symptoms despite maximally titrated GDMT, and significant functional mitral (and potentially tricuspid) regurgitation, transcatheter edge-to-edge repair (TEER) should be considered in accordance with extant HF and valvular heart disease guidelines. 22,[138][139][140] Further, although the recent REDUCE LAP-HF II trial did not show the benefit of an interatrial shunt device among patients with symptomatic HF with LVEF ≥ 40%, prespecified subgroup analysis disclosed benefit among patients with a peak exercise pulmonary vascular resistance of <1.74 Wood units, potentially representing a responder group meriting dedicated prospective evaluation. 140 Finally, invasive remote monitoring techniques, such as implantable wireless pulmonary arterial pressure sensors (e.g., Cardio-MEMS), CIED-based hemodynamic monitors, and novel wearable biosensors can provide near-real-time diagnostic information enabling long-term avoidance of HF rehospitalization and associated morbidity.…”

Section: Omecamtiv Mecarbil May Have Uniquely Favorable Properties In...mentioning

confidence: 99%

“…22,[138][139][140] Further, although the recent REDUCE LAP-HF II trial did not show the benefit of an interatrial shunt device among patients with symptomatic HF with LVEF ≥ 40%, prespecified subgroup analysis disclosed benefit among patients with a peak exercise pulmonary vascular resistance of <1.74 Wood units, potentially representing a responder group meriting dedicated prospective evaluation. 140 Finally, invasive remote monitoring techniques, such as implantable wireless pulmonary arterial pressure sensors (e.g., Cardio-MEMS), CIED-based hemodynamic monitors, and novel wearable biosensors can provide near-real-time diagnostic information enabling long-term avoidance of HF rehospitalization and associated morbidity. 142,143 Wireless pulmonary arterial pressure sensors offer potential protection against rehospitalization among symptomatic patients with HFrEF, but optimal patient selection and costeffectiveness remain unclear.…”

Section: Omecamtiv Mecarbil May Have Uniquely Favorable Properties In...mentioning

confidence: 99%

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Evolving therapeutic strategies for patients hospitalized with new or worsening heart failure across the spectrum of left ventricular ejection fraction

Ostrominski

Vaduganathan

2022

Clinical Cardiology

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Heart failure (HF) is a chronic, progressive, and increasingly prevalent syndrome characterized by stepwise declines in health status and residual lifespan. Despite significant advancements in both pharmacologic and nonpharmacologic management approaches for chronic HF, the burden of HF hospitalization—whether attributable to new‐onset (de novo) HF or worsening of established HF—remains high and contributes to excess HF‐related morbidity, mortality, and healthcare expenditures. Owing to a paucity of evidence to guide tailored interventions in this heterogeneous group, management of acute HF events remains largely subject to clinician discretion, relying principally on alleviation of clinical congestion, as‐needed correction of hemodynamic perturbations, and concomitant reversal of underlying trigger(s). Following acute stabilization, the subsequent phase of care primarily involves interventions known to improve long‐term outcomes and rehospitalization risk, including initiation and optimization of disease‐modifying pharmacotherapy, targeted use of adjunctive therapies, and attention to contributing comorbid conditions. However, even with current standards of care many patients experience recurrent HF hospitalization, or after admission incur worsening clinical trajectories. These patterns highlight a persistent unmet need for evidence‐based approaches to inform in‐hospital HF care and call for renewed focus on urgent implementation of interventions capable of ameliorating risk of worsening HF. In this review, we discuss key contemporary and emerging therapeutic strategies for patients hospitalized with de novo or worsening HF.

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“…Recently, it has been demonstrated that the absence of central/anteroseptal TR jet location, larger coaptation gap, larger tricuspid tenting area and larger effective regurgitant orifice area (EROA) predict procedural failure and, in turn, affect survival 29 . Cut‐off values for coaptation gap may vary according to clip type (NTR or XTR) while the specific cut‐off value for EROA predicting procedural failure was reported to be 70 mm 2 , which is between massive and torrential TR, according to the new proposed scheme 32,67 . This suggests that in most cases, treated patients belong to the more than severe TR category, when probably it is too late to improve survival significantly.…”

Section: Too Early Too Late: the ‘Right’ Timing For Intervention In T...mentioning

confidence: 99%

Challenges and future perspectives of transcatheter tricuspid valve interventions: adopt old strategies or adapt to new opportunities?

Russo

Taramasso

Pedicino

et al. 2021

European J of Heart Fail

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Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease and is associated with an increased risk of cardiovascular events and death at long-term follow-up. Functional TR accounts for over 90% of TR and is mainly due to annular or right ventricular dilatation. Most often, TR is observed in patients with left-sided valvular heart disease (with or without previous surgical correction) and pulmonary hypertension. Isolated TR is less frequent, though burdened by high surgical mortality. This, together with an incomplete understanding of the disease, has brought to a significant undertreatment in spite of the growing evidence of the impact of severe TR on mortality. Moreover, uncertainties about the appropriate timing for intervention and the predictors of procedural success have contributed to limit TR treatment. Transcatheter tricuspid valve replacement or repair interventions represent novel and less invasive alternatives to surgery and have shown early promising results. The purpose of this review is to provide a complete and updated overview of TR pathology with a special focus on current percutaneous treatment options, future challenges and directions.

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Short-Term Clinical Outcomes of Transcatheter Tricuspid Valve Repair With the Third-Generation MitraClip XTR System

Cited by 59 publications

References 22 publications

Continuous atrial pressure monitoring via steerable guide catheter in transcatheter mitral and tricuspid edge‐to‐edge repair

Continuous atrial pressure monitoring via steerable guide catheter in transcatheter mitral and tricuspid edge‐to‐edge repair

Evolving therapeutic strategies for patients hospitalized with new or worsening heart failure across the spectrum of left ventricular ejection fraction

Challenges and future perspectives of transcatheter tricuspid valve interventions: adopt old strategies or adapt to new opportunities?

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