Special Issue "Transcatheter Mitral and Tricuspid Valve Repair: Advances and Challenges"

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 15 August 2022 | Viewed by 5600

Special Issue Editors

Dr. Leor Perl
E-Mail Website
Guest Editor
1.The Division of Cardiology, Rabin Medical Center, 39 Jabotinsky Street, Petach-Tikva, Israel
2.The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
Interests: mitral regurgitation; transcatheter mitral valve repair; transcatheter mitral valve replacement; coronary artery disease; acute coronary syndrome; percutaneous coronary intervention; platelet aggregation inhibitors; endothelial function; medical device innovation
Dr. Rodrigo Estévez-Loureiro
E-Mail Website
Guest Editor
Interventional Cardiology Unit, University Hospital Alvaro Cunqueiro, c/ Clara Campoamor 342, 36213 Vigo, Spain
Interests: transcatheter valve therapy; MitraClip; LAA occlusion; structural heart interventions
Dr. Xavier Freixa
E-Mail Website
Guest Editor
1. Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
2. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Interests: LAA occlusion; transcatheter mitral valve repair; trasncatheter tricuspid valve repair; TAVR
Dr. Dabit Arzamendi
E-Mail Website
Guest Editor
Departamento de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Interests: structural heart disease intervention; cardiac imaging; cardiac imaging research
Dr. Dan Haberman
E-Mail Website
Guest Editor
1. The Heart Institute, Kaplan Medical Center, Rehovot, Israel
2. Hebrew University and Hadassah Medical School, Jerusalem, Israel.
Interests: mitral regurgitation; transcatheter mitral valve interventions; transcatheter tricuspid valve interventions; acute coronary syndrome; percutaneous coronate intervention; medical device innovations

Special Issue Information

Dear Colleagues,

Mitral regurgitation is the most common valvular abnormality, thought to affect over 2% of the world population, and is the second most frequent indication for valve surgery, following aortic stenosis. Data concerning tricuspid regurgitation is limited, but we know that this “forgotten valve” has immense independent impact on patient prognosis. Advancements in the diagnosis, medical management, and percutaneous therapy of both mitral and tricuspid regurgitation in recent years have completely changed the way we are able to manage these patients. However, there is much yet to learn on the future of transcatheter mitral and tricuspid valve repair.

We are very excited to serve as the Guest Editors for a Special Issue of the Journal of Clinical Medicine and invite you to submit novel research publications related to transcatheter therapies of both mitral and tricuspid regurgitation. We would like to invite state-of-the-art reviews as well as original research articles in this area to be considered for inclusion in this Issue. Such manuscripts could focus on the identification of mitral and tricuspid regurgitation, risk stratification, the interventional treatment methods and outcomes (with special focus on novel technologies), medical therapy before and after intervention, and more.

Dr. Leor Perl
Dr. Rodrigo Estévez-Loureiro
Dr. Xavier Freixa
Dr. Dabit Arzamendi
Dr. Dan Haberman
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • mitral regurgitation
  • tricuspid regurgitation
  • transcatheter mitral regurgitation repair
  • transcatheter tricuspid regurgitation repair
  • novel technologies
  • percutaneous valve repair

Published Papers (7 papers)

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Research

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Article
Novel Computed Tomography Variables for Assessing Tricuspid Valve Morphology: Results from the TRIMA (Tricuspid Regurgitation IMAging) Study
J. Clin. Med. 2022, 11(10), 2825; https://doi.org/10.3390/jcm11102825 - 17 May 2022
Viewed by 572
Abstract
Background: Computed tomography (CT) is the recommended imaging technique for defining the anatomical suitability for current transcatheter technologies and planning tricuspid valve (TV) intervention. The aim of the Tricuspid Regurgitation IMAging (TRIMA) study was to assess the geometrical characteristics of the TV complex [...] Read more.
Background: Computed tomography (CT) is the recommended imaging technique for defining the anatomical suitability for current transcatheter technologies and planning tricuspid valve (TV) intervention. The aim of the Tricuspid Regurgitation IMAging (TRIMA) study was to assess the geometrical characteristics of the TV complex using novel CT parameters. Methods: This prospective, single-center study enrolled 22 consecutive patients with severe tricuspid regurgitation, who underwent a cardiac CT study dedicated to the right chambers. The following variables were obtained: annulus area and perimeter, septal-lateral and antero-posterior diameters, tenting height, and anatomical regurgitant orifice area. Moreover, the following novel annular parameters were assessed: distance between commissures, distance between TV centroid and commissures, and angles between centroid and commissures. Results: A significant phasic variability during the cardiac cycle existed for all variables except for eccentricity, angles, and distance between the postero-septal and antero-posterior commissure and distance between the centroid and antero-posterior commissure. There was a significant relationship between the TV annulus area and novel annular parameters, except for annular angles. Additionally, novel annular variables were found to predict the annulus area. Conclusions: These novel additional variables may provide an initial platform from which the complexity of the TV annular morphology can continue to be better understood for further improving transcatheter therapies. Full article
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Article
Tricuspid Structural Valve Deterioration Treated with a Transcatheter Valve-in-Valve Implantation: A Single-Center Prospective Registry
J. Clin. Med. 2022, 11(9), 2667; https://doi.org/10.3390/jcm11092667 - 09 May 2022
Viewed by 405
Abstract
The valve-in-valve (ViV) technique is an emerging alternative for the treatment of bioprosthetic structural valve deterioration (SVD) in the tricuspid position. We report on the outcomes of patients treated by a transcatheter tricuspid valve-in-valve (TT-ViV) implantation for symptomatic SVD in the tricuspid position [...] Read more.
The valve-in-valve (ViV) technique is an emerging alternative for the treatment of bioprosthetic structural valve deterioration (SVD) in the tricuspid position. We report on the outcomes of patients treated by a transcatheter tricuspid valve-in-valve (TT-ViV) implantation for symptomatic SVD in the tricuspid position during the years 2010–2019 at our center. Three main outcomes were examined during the follow-up period: TT-ViV hemodynamic data per echocardiography, mortality and NYHA functional class. Our cohort consisted of 12 patients with a mean age 65.4 ± 11.9 years, 83.3% male. The mean time from initial valve intervention to TT-ViV was 17.4 ± 8.7 years. The indications for TT-ViV were varied (41.7% for predominant regurgitation, 33.3% for predominant stenosis and 25.0% with a mixed pathology). All patients were treated with a balloon-expandable device. The mean follow-up was 3.4 ± 1.3 years. Tricuspid regurgitation was ≥ moderate in 57.2% of patients prior to the procedure and this decreased to 0% following the procedure. The mean transtricuspid valve gradients mildly decreased from the mean pre-procedural values of 9.0 mmHg to 7.0 mmHg at one month following the procedure (p = 0.36). Mortality at one year was 8.0% (95% CI 0–23). At the baseline, 4 patients (33.3%) were in NYHA functional class III/IV; this was reduced to 2 patients (18.2%) at the one year follow-up and both were in NYHA III. The TT-ViV procedure offered a safe, feasible and less invasive treatment option for patients with SVD in our detailed cohort. Full article
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Article
Percutaneous Mitral Valve Repair in Patients with Severe Mitral Regurgitation and Acute Decompensated Heart Failure
J. Clin. Med. 2021, 10(24), 5849; https://doi.org/10.3390/jcm10245849 - 13 Dec 2021
Viewed by 965
Abstract
The role of percutaneous mitral valve repair (PMVr) in management of high-risk patients with severe mitral regurgitation (MR) and acute decompensated heart failure (ADHF) is undetermined. We screened all patients who underwent PMVr between October 2015 and March 2020. We evaluated immediate, 30-day, [...] Read more.
The role of percutaneous mitral valve repair (PMVr) in management of high-risk patients with severe mitral regurgitation (MR) and acute decompensated heart failure (ADHF) is undetermined. We screened all patients who underwent PMVr between October 2015 and March 2020. We evaluated immediate, 30-day, and 1-year outcomes in patients who underwent PMVr during hospitalization due to ADHF as compared to elective patients. From a cohort of 237 patients, we identified 46 patients (19.4%) with severe MR of either functional or degenerative etiology who underwent PMVr during index hospitalization due to ADHF, including 17 (37%) critically ill patients. Patients’ mean age was 75.2 ± 9.8 years, 56% were males. There were no differences in background history between ADHF and elective patients. Patients with ADHF were at higher risk for surgery, reflected in higher mean EuroSCORE II, compared with elective patients. After PMVr, we observed higher 30-day mortality rate in ADHF patients as compared to the elective group (10.9% vs. 3.1%, respectively, p = 0.042). One-year mortality rate was similar between the groups (21.7% vs. 17.9%, p = 0.493). Clinical and echocardiographic follow-up showed improvement of NYHA functional class and sPAP reduction in both groups ((54 ± 15 mmHg to 50 ±15 in the elective group (p = 0.02), 58 ± 13 mmHg to 52 ± 12 in the ADHF group (p = 0.02)). PMVr could be an alternative option for treatment of patients with severe MR and ADHF. Full article
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Article
Impact of Post-Procedural Change in Left Ventricle Systolic Function on Survival after Percutaneous Edge-to-Edge Mitral Valve Repair
J. Clin. Med. 2021, 10(20), 4748; https://doi.org/10.3390/jcm10204748 - 16 Oct 2021
Cited by 1 | Viewed by 551
Abstract
Objectives: To investigate how the changes of left ventricle ejection fraction (LVEF) between admission and discharge affected the long-term outcome in patients who underwent percutaneous edge-to-edge mitral valve repair for secondary mitral regurgitation. Background: An acute impairment of LVEF after surgical repair of [...] Read more.
Objectives: To investigate how the changes of left ventricle ejection fraction (LVEF) between admission and discharge affected the long-term outcome in patients who underwent percutaneous edge-to-edge mitral valve repair for secondary mitral regurgitation. Background: An acute impairment of LVEF after surgical repair of mitral regurgitation, known as afterload mismatch, has been associated with increased all-cause mortality. Afterload mismatch after percutaneous edge-to-edge mitral valve repair has been postulated to be a transient phenomenon. Methods: This study is based on a single-center, retrospective, observational registry of patients who underwent percutaneous edge-to-edge mitral valve repair with the MitraClip (Abbot Vascular) system for the treatment of symptomatic, moderate-to-severe mitral regurgitation. We included data on 399 patients who underwent percutaneous edge-to-edge mitral valve repair for secondary mitral regurgitation. Expert echocardiographers assessed LVEF before the procedure and at discharge. The patients were divided into three groups according to the difference of periprocedural LVEF measurements: unchanged (n = 318), improved (n = 40), and decreased (n = 41) LVEF. Results: The median follow-up time was 2.0 years. When adjusted for gender, NYHA class and estimated glomerular filtration rate, decreased postprocedural LVEF was associated with an increased risk of death (adjusted HR 2.05, 95% CI 1.26–3.34) and increased postprocedural LVEF with a reduced risk of death (adjusted HR 0.47, 95% CI 0.24–0.91) compared to unchanged LVEF. Conclusion: Among patients who underwent percutaneous edge-to-edge mitral valve repair, decreased postprocedural LVEF was associated with increased mortality, while improved LVEF was associated with lower mortality compared to unchanged LVEF. Full article
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Article
Initial Results after the Implementation of an Edge-To-Edge Transcatheter Tricuspid Valve Repair Program
J. Clin. Med. 2021, 10(18), 4252; https://doi.org/10.3390/jcm10184252 - 19 Sep 2021
Cited by 1 | Viewed by 760
Abstract
Transcatheter tricuspid valve repair (TTVr) has emerged as an alternative for the treatment of severe tricuspid regurgitation (TR). We report our initial experience with an edge-to-edge TTVr system in a high-volume institution. Methods: We included consecutive patients who underwent edge-to-edge TTVr systems. The [...] Read more.
Transcatheter tricuspid valve repair (TTVr) has emerged as an alternative for the treatment of severe tricuspid regurgitation (TR). We report our initial experience with an edge-to-edge TTVr system in a high-volume institution. Methods: We included consecutive patients who underwent edge-to-edge TTVr systems. The primary efficacy endpoint was a reduction in the TR of at least one grade. The primary safety endpoint was procedure-related clinical serious adverse events. Results: A total of 28 patients underwent TTVr with edge-to-edge systems. All patients presented with at least severe TR with a high impact on quality of life (82% of patients in NYHA class ≥ III). The Triclip system was the most used device (89%). The primary efficacy endpoint was met in all patients. Only one patient experienced a procedural complication (femoral pseudoaneurysm). At three-month follow-up, 83% of patients were in NYHA I or II (18% baseline vs. 83% 3 months follow-up; p < 0.001). Echocardiography follow-up showed residual TR ≤ 2 in 79% of patients (paired p < 0.001). At the maximum follow-up (median follow up = 372 days), no patients had died. Conclusions: Edge-to-edge TTVr systems seem to represent a very valid alternative to prevent morbidity and mortality associated with TR as depicted by the favorable efficacy and safety. Full article
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Review

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Review
Caval Valve Implantation (CAVI): An Emerging Therapy for Treating Severe Tricuspid Regurgitation
J. Clin. Med. 2021, 10(19), 4601; https://doi.org/10.3390/jcm10194601 - 07 Oct 2021
Cited by 3 | Viewed by 900
Abstract
Severe tricuspid regurgitation remains a challenging heart-valve disease to effectively treat with high morbidity and mortality at mid-term. Currently guideline-directed medical treatment is limited to escalating dose of diuretics, and the rationale and timing of open-heart surgery remains controversial. Emerging percutaneous therapies for [...] Read more.
Severe tricuspid regurgitation remains a challenging heart-valve disease to effectively treat with high morbidity and mortality at mid-term. Currently guideline-directed medical treatment is limited to escalating dose of diuretics, and the rationale and timing of open-heart surgery remains controversial. Emerging percutaneous therapies for severe tricuspid regurgitation continue to show promising results in early feasibility studies. However, randomized trial data is lacking. Additionally, many patients are deemed unsuitable for these emerging therapies due to anatomical or imaging constraints. Given the technical simplicity of the bicaval valve implantation (CAVI) technique compared to other transcatheter devices, CAVI is postulated as a suitable alternative for a wide variety of patients affected with severe+ tricuspid regurgitation. In this review we illustrate the current evidence and ongoing uncertainties of CAVI, focusing on the novel CAVI-specific devices. Full article
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Review
Transcatheter Tricuspid Valve-in-Valve Procedure—An Illustrative Case Report and Review
J. Clin. Med. 2021, 10(17), 4004; https://doi.org/10.3390/jcm10174004 - 04 Sep 2021
Viewed by 600
Abstract
Severe tricuspid commitment is no longer understood as merely a marker of disease but is now widely thought of as a significant contributor to cardiac morbidity and mortality. However, isolated tricuspid valve surgery remains rare and to this day continues to be associated [...] Read more.
Severe tricuspid commitment is no longer understood as merely a marker of disease but is now widely thought of as a significant contributor to cardiac morbidity and mortality. However, isolated tricuspid valve surgery remains rare and to this day continues to be associated with the highest surgical risk among all valve procedures and high operative mortality rates, especially in reoperations. Therefore, the development of tricuspid transcatheter procedures is as necessary as it was for the other valves a couple of years ago. Recently, multiple percutaneous therapies have been developed for the management of severe tricuspid disease, initially only repair and more recently replacement, thus creating a new branch for the management of patients who have already undergone surgery and who present with dysfunctional bioprostheses. The purpose of this review and report is to demonstrate current and possible future challenges, and to show that the valve-in-valve procedure of the tricuspid valve is feasible and safe, and now can be performed in all its range, in the smallest to the largest sizes of presentation, without incurring the untoward risks of conventional surgery. Full article
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Initial Results After the Implementation of an Edge-To-Edge Transcatheter Tricuspid Valve Repair Program
Authors: Pedro Luis Cepas-Guillen; Juan Carlos de la Fuente Mancera; Joan Guzman Bofarull; Marta Farrero; Ander Regueiro; Salvatore Brugaletta; Cristina Ibañez; Laura Sanchis; Marta Sitges; Manel Sabaté; Xavier Freixa
Affiliation: Hospital Clínic de Barcelona
Abstract: Abstract: Transcatheter tricuspid valve repair (TTVr) has emerged as an alternative for the treatment of severe tricuspid regurgitation (TR). We report our initial experience with an edge-to-edge TTVr system in a high-volume institution. Methods: We included consecutive patients who underwent edge-to-edge TTVr systems. The primary efficacy endpoint was the reduction of the TR of at least 1 grade. The primary safety endpoint was procedure-related clinical serious adverse events. Results: A total of 28 patients underwent TTVr with edge-to-edge systems. All patients presented, at least, severe TR with a high impact in quality of life (82% of patients in NYHA class ≥ III). The Triclip system was the most used device (89%). The primary efficacy endpoint was met in all patients. Only one patient experienced a procedural complication (femoral pseudoaneurysm). At 3-months follow-up, 83% of patients were in NYHA I or II (18% baseline vs. 83% 3-months fol-low-up; p < 0.001). Echocardiography follow-up showed residual TR ≤2 in 79% of patients (paired p < 0.001). At the maximum follow-up (median follow up = 372 days), no patients died during fol-low-up. Conclusions: Edge-to-edge TTVr systems seem to represent a very valid alternative to prevent morbidity and mortality associated with TR as depicted by the favorable effective and safety.

Title: Transcatheter Tricuspid Valve-in-Valve – Illustrative Case Report and Literature Review
Authors: Marcio Jose da Costa Montenegro; Edgard Freitas Quintella; Luiz Kohn; Maximiliano Otero Lacoste; Gustavo Leite Lycurgo; Leonardo Hadid; Dany David Kruczan; Ricardo Zajdenverg; Hugo de Castro Sabino; Paulo Antônio Marra da Motta
Affiliation: Instituto Estadual de Cardiologia Aloysio de Castro
Abstract: Severe tricuspid commitment is no longer thought of as merely a marker of disease but is now widely thought of as a significant contributor to cardiac morbidity and mortality. However, isolated TV surgery remains rare and to this day continues to be associated with the highest surgical risk among all valve procedures and high operative mortality rates, especially in reoperations. Therefore, the development of tricuspid transcatheter procedures is as necessary, as it was for the other valves a couple of years ago. Recently, multiple percutaneous therapies have been developed for the management of severe tricuspid disease, initially only repair and more recently replacement, thus creating a new branch for the management of patients who have already undergone surgery and who present with dysfunctional bioprostheses. The purpose of this review and report is to demonstrate current and possible future challenges, and to show that the Valve-in-Valve procedure of the tricuspid valve is feasible and safe, and now, can be performed in all its range, since the smallest to the largest sizes of presentation without incurring the untoward risks of conventional surgery.

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