Objective To investigate the effects of different types of tricuspid regurgitation, implantation positions, and device models on the treatment outcomes of K-Clip for tricuspid regurgitation using numerical simulations. Methods Three-dimensional reconstruction of the heart model was performed based on CT images. Two different regurgitation orifices were obtained by modifying the standard parameterized tricuspid valve leaflets and chordae tendineae. The effects of different K-Clip models at different implantation positions (posterior leaflet midpoint, anterior-posterior commissure, anterior leaflet midpoint, posterior septal commissure) were simulated using commercial explicit dynamics software Ls-Dyna. Conclusion For the two types of regurgitation in this study, clipping at the posterior leaflet midpoint resulted in a better reduction of the regurgitation orifice (up to 75% reduction in area). Higher clamping forces were required for implantation at the anterior leaflet midpoint and posterior septal commissure, which was unfavorable for the smooth closure of the clipping components. There was no statistical difference in the treatment outcomes between the 18T and 16T K-Clip components, and the 16T component required less clamping force. Therefore, the use of the 16T K-Clip component is recommended.
Transcatheter aortic valve implantation (TAVI) is an important alternative in treating high-risk patients with aortic valve regurgitation. Transcatheter tricuspid valve implantation (TTVI) is also an important treatment option for high-risk patients with tricuspid regurgitation. We reported a 72-year male patient who underwent TAVI due to severe aortic valve regurgitation using a J-Valve. During a two-year follow-up, the patient developed secondary tricuspid regurgitation to atrial fibrillation, and subsequently received TTVI using a LuX-Valve. Following the interventions, the patient's symptoms were significantly improved, and echocardiography indicated good hemodynamic performance of both transcatheter heart valves. This case highlights the feasibility and effectiveness of performing multiple valve implantations via transcatheter approaches in high-risk elderly patients.
ObjectiveTo explore the feasibility of goat tricuspid regurgitation (TR) model by one chordae tendineae cutter via right anterior-lateral minimal incision.MethodsTR model was established in 6 goats with a self-made tricuspid valve chordae tendineae cutter. The goats were placed in a left lateral position and procedure was performed via a right anterior-lateral minimal thoracotomy in the fourth intercostal. Under the guidance of transesophageal ultrasound and digital subtraction angiography, the chordae tendineae of anterior leaflet was cut until moderate to severe regurgitation was confirmed. Echocardiography and laboratory examinations were performed preoperatively, immediately and 3 months after surgery. Additionally, all goats were sacrificed to clarify pathological evaluation.ResultsTR was successfully established in 6 goats. The right atrium pressure increased significantly immediately after surgery (P<0.05). During a follow-up of 3 months, the progression of TR was aggravated (P<0.05), and the annular diameter increased from 2.15±0.23 cm to 2.65±0.20 cm. Overall, there was no statistically significant change in transvalvular gradient and velocity between preoperation and postoperation. Laboratory test results showed no abnormalities between preoperation and postoperation. Autopsy evaluation demonstrated obvioue chordae tendineae transection of the anterior leaflet.ConclusionIt is feasible to establish TR model via a right minimal anterior lateral thoracotomy in the fourth intercostal space. This novel TR goats model will allow investigation of transcatheter interventional device and serve as a chronic model in the future.
Objective To compare and evaluate the short-term outcomes of 3 different tricuspid valve plasty for functional tricuspid regurgitation (TR) in patients with rheumatic heart disease. Methods Between October 2010 and June 2011, 148 patients with rheumatic heart disease undergoing left heart valve replacement and tricuspid valve plasty for functional TR were enrolled in the study. There were 32 males and 116 females with an average age of 47.5 years (range, 15-66 years). The patients were divided into 3 groups depending on tricuspid valve plasty: Cosgrove-Edwards annuloplasty ring group (annuloplasty ring group, 58 cases), Kay annuloplasty group (Kay group, 61 cases), and DeVega annuloplasty group (DeVaga group, 29 cases). There was no significant difference in general data among groups (P gt; 0.05), except more severe TR degree, higher atrial fibrillation, and higher radiofrequency ablation in annuloplasty ring group (P lt; 0.05). Perioperative data were recorded. The heart function was evaluated according to the standard of New York Heart Association (NYHA). Echocardiography (ECG) was used to record the TR class during perioperative period and follow-up. Results After operation, 1 case in Kay group and 1 case in annuloplasty ring group were dead because of low cardiac output syndrome. Pneumonia happened in 2 cases of Kay group and in 1 case of annuloplasty ring group; re-operation was performed in 1 case of annuloplasty ring group because of sternal dehiscence. There was no significant difference in perioperative complication among 3 groups (P=0.840). The TR degree was significantly improved at discharge when compared with preoperative degree in 3 groups (P lt; 0.001). A total of 146 patients were followed up 6-12 months (mean, 7.3 months). The NYHA grade of 3 groups at last follow-up was improved when compared with preoperative grade (P lt; 0.001), but no significant difference among 3 groups (χ2=0.120, P=0.942). The TR degree at last follow-up was all improved in 3 groups when compared with preoperative degree (P lt; 0.001); the improved efficiency showed significant difference among 3 groups (χ2=26.827, P=0.000), it was significantly better in annuloplasty ring group than in the other 2 groups (P lt; 0.001), but no significant difference between DeVega group and Kay group (Z=1.467, P=0.142). Conclusion The early improved efficiency of TR after Cosgrove-Edwards annuloplasty is superior to that of Kay annuloplasty and DeVega annuloplasty.
ObjectiveTo explore the clinical effect of LuX-Valve implantation in patients with severe tricuspid regurgitation (TR) and review articles about similar devices.MethodsWe reported the data of a 58-year-old male patient with severe TR, who was hospitalized on March 17th, 2020 because of “abdominal distention and edema for 5 years”, and then received LuX-Valve implantation in the Department of Cardiovascular Surgery of Changhai Hospital, Naval Medical University. Articles about transcatheter tricuspid valve replacement were reviewed in PubMed according to the key words including “transcatheter tricuspid valve replacement” “TTVR” and “transcatheter tricuspid valve intervention”.ResultsThe patient with severe TR received LuX-Valve implantation under general anesthesia and the guidance of digital subtraction angiography and transesophageal echocardiography. The patient’s TR was totally corrected after implantation and postoperative one-month follow-up showed well clinical effects. The result of literature review showed that there were two similar devices and both had been implanted in TR patients.ConclusionLuX-Valve is an effective and reliable transcatheter tricuspid valve replacement device.
A 23-year-old male patient was diagnosed with congenitally corrected transposition of the great arteries (ccTGA) at the age of 3 during a routine physical examination. Due to the absence of significant symptoms, the patient was managed conservatively with follow-up without surgical treatment. He developed chest tightness one year prior to admission, with symptom exacerbation in the recent month. Echocardiography demonstrated significantly worsened morphological tricuspid regurgitation. The patient presented to Guangdong Provincial People’s Hospital for surgical evaluation. Given the patient’s age and clinical presentation, a totally thoracoscopic morphological tricuspid valve replacement was performed. Postoperative assessment showed good prosthetic valve function, with no regurgitation or paravalvular leakage; the electrocardiogram confirmed sinus rhythm without atrioventricular block. Extubation occurred within 12 hours postoperatively, and the patient was transferred from the intensive care unit (ICU) on postoperative day 2. At the three-month follow-up, the patient was asymptomatic and had resumed normal activities. This report describes the first case of a totally thoracoscopic morphological tricuspid valve replacement in a ccTGA patient in China. This initial experience suggests that the totally thoracoscopic approach for morphological tricuspid valve replacement in ccTGA patients is a feasible, safe, and effective minimally invasive option associated with rapid recovery.
This article reports a case of transjugular transcatheter tricuspid valve replacement (TTVR) for persistent severe tricuspid regurgitation after transcatheter mitral valve replacement. The patient was an 80 year old female who underwent transcatheter mitral valve replacement at the Department of Cardiology, West China Hospital, Sichuan University, two months before admission. After the surgery, her condition worsened due to unimproved tricuspid regurgitation and right heart failure. After admission, the patient underwent transjugular TTVR under general anesthesia. With the assistance of cardiac ultrasound and X-ray fluoroscopy, an artificial valve was successfully implanted, and tricuspid regurgitation was relieved. The patient’s surgery went smoothly, and the condition improved significantly 25 days after surgery. The patient was discharged 34 days after surgery.
ObjectiveTo investigate the effect of concomitant tricuspid valve repair during mitral valve surgery on the early and mid-term prognosis of the tricuspid valve and right heart function in the patients with moderate or less tricuspid regurgitation. MethodsA retrospective study of 461 patients with mitral valve disease requiring cardiac surgery combined with moderate or less tricuspid regurgitation in our hospital from 2011 to 2014 was done. They were 309 males and 152 females with a median age of 53.00 (44.00, 60.00) years. According to whether they received tricuspid valve repair (Kay’s annuloplasty, DeVega’s annuloplasty or annular ring implantation), the patients were divided into a mitral valve surgery only group (a nTAP group, n=289) and a concomitant tricuspid valve repair group (a TAP group, n=172). At the same time, 43 patients whose tricuspid valve annulus diameter was less than 40 mm in the TAP group were analyzed in subgroups. ResultsThe median follow-up duration was 3.00 years (range from 0.10 to 9.30 years). There was no perioperative death. Three months after surgery, the anteroposterior diameter of the right ventricle in the TAP group was significantly improved compared with that in the nTAP group [–1.00 (–3.00, 1.00) mm vs. 0.00 (–0.20, 2.00) mm, P=0.048]. Three years after surgery, the improvement of right ventricular anteroposterior diameter in the TAP group was still significant compared with the nTAP group [–1.00 (–2.75, 2.00) mm vs. 2.00 (–0.75, 4.00) mm, P=0.014], and the patients in the TAP group were less likely to develop moderate or more tricuspid regurgitation (3.64% vs. 35.64%, P<0.001). Annuloplasty ring implantation was more effective in preventing regurgitation progression (P=0.044). For patients with a tricuspid annulus diameter less than 40 mm, concomitant tricuspid valve repair was still effective in improving the anteroposterior diameter of the right ventricle in the early follow-up (P=0.036). Conclusion Concomitant tricuspid valve repair for patients with moderate or less tricuspid regurgitation during mitral valve surgery can effectively improve the tricuspid valve and right heart function in the early and mid-term after surgery. Annuloplasty ring implantation is more effective in preventing regurgitation progression. Patients whose tricuspid annulus diameter is less than 40 mm can also benefit from concomitant tricuspid repair.
Objective To analyze and explore the risk factors of secondary tricuspid regurgitation (TR) after left-sided valve surgery (left cardiac valve replacement or valvuloplasty) using meta-analysis, so as to provide evidence for clinical diagnosis and treatment of secondary TR. Methods We electronically searched databases including PubMed, MEDLINE, CBM, CNKI, VIP, for literature on the risk factors of secondary TR after left-sided valve surgery from 1995 to 2012. According to the inclusion and exclusion criteria, we screened literature, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.0 software. Results A total of 6 case-control studies were included, involving 437 patients and 2 102 controls. The results of meta-analysis showed that, the risk factors of progressive exacerbation of secondary TR after left-sided valve surgery included preoperative atrial fibrillation (OR=3.90, 95%CI 3.00 to 5.07; adjusted OR=3.04, 95%CI 2.21 to 4.16), age (MD=5.36, 95%CI 3.49 to 7.23), huge left atrium (OR=5.17, 95%CI 3.12 to 8.57; adjusted OR=1.91, 95%CI 1.49 to 2.44) or left atrium diameter (MD=4.85, 95%CI 3.18 to 6.53), degradation of left heart function (OR=2.97, 95%CI 1.73 to 5.08), rheumatic pathological change (OR=3.06, 95%CI 1.66 to 4.68), preoperative TR no less than 2+ (OR=3.52, 95%CI 1.26 to 9.89), and mitral valve replacement (MVR) (OR=2.35, 95%CI 1.68 to 3.30). Sex (OR=1.54, 95%CI 0.94 to 2.52) and preoperative pulmonary arterial hypertension (OR=1.28, 95%CI 0.77 to 2.12) were not associated with secondary TR after left-sided valve surgery. Conclusion The risk factors of progressive exacerbation of secondary TR after left-sided valve surgery include preoperative atrial fibrillation, age, huge left atrium or left atrium diameter, degradation of left heart function, rheumatic pathological change, preoperative TR no less than 2+, and MVR. Understanding these risk factors helps us to improve the long-time effectiveness of preventing and treating TR after left-sided valve surgery.