Annals of cardiothoracic surgery最新文献

{"title":"Comparison of biplanar- with 3D-vena contracta and vena contracta area for the assessment of tricuspid valve regurgitation by intraoperative transesophageal echocardiography.","authors":"Rajni Singh, Massimiliano Meineri, Waseem Zakhary, Sophia Sgouropoulou, Joerg Ender, Anna Flo Forner","doi":"10.21037/acs-2025-1-72-tvd","DOIUrl":"https://doi.org/10.21037/acs-2025-1-72-tvd","url":null,"abstract":"<p><strong>Background: </strong>Tricuspid regurgitation (TR) is often incidentally detected at intraoperative transesophageal echocardiography (TEE), resulting in possible changes in the surgical plan. The aim of this study was to compare 2D and 3D measurements of TR vena contracta width (VCW) and the degree of TR severity using TEE from the three standard mid-esophageal (ME) views.</p><p><strong>Methods: </strong>In a prospective observational study, we analyzed 3D and 2D TEE datasets from 30 adult patients undergoing elective tricuspid valve (TV) repair. 2D and 3D TEE color flow Doppler (CFD) loops of the TV in the three standard ME views (4Chamber, RV inflow-outflow (inflow) and modified bicaval) were recorded immediately after induction of anesthesia. VCW from single views and the average of the measurement of biplane VCW (2D biplane VCW) from each standard view were compared with the maximum and minimum diameters of the 3D vena contracta area (VCA) and their average (3D average VCW). TR severity classification was compared between 2D biplane VCW and 3D average VCW and VCA. Correlation between measurements was analyzed using Pearson coefficient and agreement assessed using the Bland-Altman method. Cohen's Kappa correlation was used to assess TR severity concordance.</p><p><strong>Results: </strong>Biplane VCW in all three ME views underestimated 3D average VCW measurement, with VCW from ME inflow view showing the best agreement. VCW measurements in single standard views systematically underestimated the maximum 3D VCA diameter. We detected very good agreement in TR grading between 3D average VCW and 3D VCA, and an underestimation by 2D biplane VCW (moderate agreement for inflow and fair for the other views). Intra- and inter-observer correlation when repeating 2D measurements was more reliable than that for 3D measurements.</p><p><strong>Conclusions: </strong>Our study shows that 2D biplane VCW from the ME inflow view best agrees with 3D average VCW and allows the most accurate classification of TR severity compared to 3D average VCW.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 2","pages":"23"},"PeriodicalIF":3.1,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic significance of right ventricular-pulmonary artery coupling in patients undergoing tricuspid valve surgery.","authors":"Jagdip Kang, Antonio Mutarelli, Svitlana Bielichenko, Abdellaziz Dahou, Jacob P Dal-Bianco, Michael A Borger, Nathaniel B Langer, David D'Alessandro, Judy Hung, Thoralf M Sundt, Evin Yucel, Serguei Melnitchouk","doi":"10.21037/acs-2025-aw-18-tvd","DOIUrl":"https://doi.org/10.21037/acs-2025-aw-18-tvd","url":null,"abstract":"<p><strong>Background: </strong>The accurate evaluation of right ventricular function and its response to correction of tricuspid valve pathology are challenging. This retrospective study evaluated the predictive value of right ventricular-pulmonary arterial (RV-PA) coupling in patients undergoing isolated or combined tricuspid and mitral valve surgery.</p><p><strong>Methods: </strong>Patients at Massachusetts General Hospital who underwent isolated tricuspid or combined tricuspid and mitral valve surgery between January 2013 and June 2024 with available preoperative transthoracic echocardiography images were included. The RV-PA coupling ratio was calculated by dividing the tricuspid annular plane systolic excursion (TAPSE) by PA systolic pressure. The optimal cut-off value for this ratio was determined using the maximal log-rank test. The primary outcome was mid-term survival, while secondary outcomes included in-hospital mortality, intensive care unit (ICU) stay duration, hospital stay, and prolonged postoperative inotrope use.</p><p><strong>Results: </strong>A total of 264 patients were followed for a median of 23 months (interquartile range, 7.0-48.0 months). The optimal RV-PA coupling ratio linked to mortality was 0.339 mm/mmHg. Patients with an RV-PA coupling ratio of ≤0.339 mm/mmHg had significantly higher all-cause mortality (25.5% <i>vs.</i> 10.0%; P<0.002), longer median ICU stay (4.0 <i>vs.</i> 3.0 days; P<0.001), longer median hospital stay (11.5 <i>vs.</i> 9.0 days; P=0.002), increased need for inotropic support (45.7% <i>vs.</i> 21.8%; P<0.001), and higher in-hospital mortality (10.6% <i>vs.</i> 2.9%). In multivariable Cox regression analysis, an RV-PA coupling ratio >0.339 mm/mmHg was linked to a reduced risk of all-cause mortality (hazard ratio 0.09, P=0.003). TAPSE and RV free-wall strain showed no association with mortality.</p><p><strong>Conclusions: </strong>Echocardiography-derived RV-PA coupling is a robust, independent predictor of adverse outcomes in patients undergoing tricuspid valve surgery, particularly in those undergoing combined procedures. It captures a critical dimension of RV physiology not fully appreciated by standard measures and may serve as a powerful tool in surgical risk stratification and patient selection.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 2","pages":"22"},"PeriodicalIF":3.1,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tricuspid transcatheter edge-to-edge repair in patients with cardiac implantable electronic device leads.","authors":"Vandan Upadhyaya, Perry Wengrofsky, Sung-Han Yoon, Craig Basman, Ryan Kaple","doi":"10.21037/acs-2026-02-tvd","DOIUrl":"https://doi.org/10.21037/acs-2026-02-tvd","url":null,"abstract":"<p><p>Cardiac implantable electronic devices (CIEDs) are frequently encountered in patients undergoing transcatheter edge-to-edge repair (TEER) for severe tricuspid regurgitation (TR), with a prevalence exceeding 30%. Transvalvular leads introduce unique anatomic and procedural challenges, including imaging shadowing, leaflet tethering, device-lead interaction, and risk of entanglement during repair. Successful intervention requires careful preprocedural assessment of tricuspid valve anatomy, mechanism of TR, inferior vena cava (IVC) alignment, and the spatial relationship of right atrial, coronary sinus, right ventricular, or leadless systems to the tricuspid apparatus. This manuscript describes a structured intraoperative approach to managing CIED leads during tricuspid TEER (tTEER). The strategy incorporates multi-site femoral venous access, stiff-wire straightening techniques to correct IVC offset, and the use of a steerable sheath to achieve controlled intracardiac lead manipulation. Step-by-step technical considerations are detailed, including lead tethering, commissural repositioning, and controlled release following device deployment. This approach aims to standardize management of CIED-related challenges and provide a reproducible technique for safe and effective tTEER in this complex cohort.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 2","pages":"27"},"PeriodicalIF":3.1,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to mirror tricuspid transcatheter edge-to-edge repair (TEER) to mitral TEER in terms of procedural imaging and device workflow: a step-by-step primer.","authors":"Takayuki Onishi, Gilbert H L Tang, Stamatios Lerakis, Annapoorna S Kini, Sahil Khera, Lucy M Safi","doi":"10.21037/acs-2025-aw-27-tvd","DOIUrl":"https://doi.org/10.21037/acs-2025-aw-27-tvd","url":null,"abstract":"<p><p>Transcatheter edge-to-edge repair (TEER) has emerged as a pivotal therapy for mitral and tricuspid regurgitation in patients at high surgical risk. Although anatomical similarities between the mitral and tricuspid valves have allowed the use of the same clip delivery system (CDS) for both procedures, important anatomical differences and imaging challenges necessitate distinct procedural strategies. In this keynote lecture, we compare the technical aspects and imaging guidance of mitral and tricuspid TEER and highlight key maneuvers that optimize procedural success and safety. We focus on the Abbott MitraClip and TriClip systems given both are Food and Drug Administration (FDA) approved in the United States and we have extensive experience with both systems. This stepwise procedural review outlines the nuances of CDS manipulation in both mitral and tricuspid TEER, emphasizing directional response, trajectory optimization, clip alignment, leaflet grasping, and deployment techniques. Differences in imaging requirements and catheter steering are addressed with reference to transesophageal echocardiography (TEE), intracardiac echocardiography (ICE), and fluoroscopic landmarks. CDS flexion and advancement from the atrium to the valve follow similar principles in both TEER procedures; however, CDS rotation produces opposite directional effects relative to the septum. In mitral TEER, the CDS is steered from lateral to medial, whereas in tricuspid TEER, it is directed from septal to lateral. Using the Abbott MitraClip system, trajectory and orientation adjustments rely primarily on the M and + knobs for mitral TEER, and on the F and S/L knobs for tricuspid TEER. ICE serves as a critical adjunct to TEE in tricuspid TEER due to limited acoustic windows. Grasp optimization involves leaflet-specific torque and individual gripper manipulation. Mitral and tricuspid TEER require distinct navigation strategies and imaging approaches, but can be standardized and mirrored in parallel for better understanding between both procedures. Mastery of these valve-specific techniques, along with continued innovation in imaging and CDS design, will be essential to improving the safety and efficacy of tricuspid TEER.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 2","pages":"20"},"PeriodicalIF":3.1,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive tricuspid valve surgery after failed transcatheter tricuspid valve repair.","authors":"Serdar Akansel, Markus Kofler, Martina Dini, Stephan Jacobs, Volkmar Falk, Jörg Kempfert","doi":"10.21037/acs-2025-aw-53-tvd","DOIUrl":"https://doi.org/10.21037/acs-2025-aw-53-tvd","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 2","pages":"28"},"PeriodicalIF":3.1,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pitfalls of transcatheter tricuspid valve replacement: lessons from a decade of experience.","authors":"Neil P Fam, Kitae Kim","doi":"10.21037/acs-2025-aw-43-tvd","DOIUrl":"https://doi.org/10.21037/acs-2025-aw-43-tvd","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 2","pages":"26"},"PeriodicalIF":3.1,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transjugular transcatheter tricuspid valve replacement.","authors":"Mi Chen, Ralph Stephan von Bardeleben, Thomas Modine","doi":"10.21037/acs-2025-aw-42-tvd","DOIUrl":"https://doi.org/10.21037/acs-2025-aw-42-tvd","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 2","pages":"29"},"PeriodicalIF":3.1,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Features and short-term outcomes of real-world transcatheter tricuspid valve repair <i>vs.</i> replacement in Asia-Pacific.","authors":"Vyanne Hei Tung Chan, Krissada Meemook, Ching-Wei Lee, Angel Lai, Chun-Chin Chang, Tawai Ngernsritrakul, Surakiat Leelasithorn, Kevin Ka-Ho Kam, Bryan P Yan, Alex Pui-Wai Lee, Gilbert H L Tang, Yat-Yin Lam, Adam S H Sung, Kent Chak-Yu So","doi":"10.21037/acs-2025-aw-45-tvd","DOIUrl":"https://doi.org/10.21037/acs-2025-aw-45-tvd","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter therapies for tricuspid regurgitation (TR), including tricuspid transcatheter edge-to-edge repair (T-TEER) and transcatheter tricuspid valve replacement (TTVR), have shown promising safety and efficacy in clinical trials. However, real-world data in the Asia-Pacific (APAC) region remain limited. This descriptive study evaluates the clinical characteristics, procedural details, and 30-day outcomes of T-TEER and TTVR in patients with severe TR in the APAC region.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 174 patients with severe symptomatic TR treated between 2017 and 2025 at four centers in Hong Kong, Taiwan, and Thailand. Patients underwent T-TEER or TTVR (heterotopic or orthotopic). The primary outcome was TR reduction to ≤ moderate at 30 days. Secondary outcomes included procedural complications, adverse events, reinterventions, and symptom improvement.</p><p><strong>Results: </strong>Of the total cohort, 136 patients underwent T-TEER and 38 underwent TTVR. The TTVR group had more severe TR [median effective regurgitant orifice (ERO) area: 0.85 <i>vs.</i> 0.57 cm², P=0.001], a larger coaptation gap (median: 9.7 <i>vs.</i> 4.7 mm, P<0.001), and more posteroseptal TR origin (P<0.001). Combined mitral valve intervention was more common in the T-TEER group (50/136 <i>vs.</i> 1/38, P<0.001). At 30 days, TR reduction to ≤ moderate was achieved more frequently with TTVR (100.0%) compared with T-TEER (74.0%, P=0.001). Both groups showed significant symptomatic improvement, with 93.7% and 96.2% achieving New York Heart Association (NYHA) class I/II, respectively. TTVR was associated with higher inpatient major adverse events (15.8% <i>vs.</i> 2.2%, P=0.003), longer hospital stays (median: 15 <i>vs.</i> 5 days, P<0.001), and a greater decline in platelet count (-77,500/µL <i>vs.</i> -23,000/µL, P<0.001).</p><p><strong>Conclusions: </strong>In the APAC region, TTVR is primarily reserved for patients with unfavorable anatomy for T-TEER. Both interventions improve TR and symptoms, but TTVR carries higher procedural risks and longer hospitalization. This comparison was exploratory and hypothesis-generating. These findings emphasize regional practice patterns and the need for long-term comparative studies to optimize treatment strategies.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 2","pages":"21"},"PeriodicalIF":3.1,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term outcomes of commercial transcatheter tricuspid valve intervention: a systematic review and meta-analysis.","authors":"Dominic K Y Ng, David Downes, Rohan Gupta, Yianni Droungas, Katie Nguyen, Ashley R Wilson-Smith","doi":"10.21037/acs-2025-aw-39-tvd","DOIUrl":"https://doi.org/10.21037/acs-2025-aw-39-tvd","url":null,"abstract":"<p><strong>Background: </strong>Severe tricuspid regurgitation (TR) is associated with increased all-cause mortality and morbidity. Isolated tricuspid valve surgery is uncommon due to high perioperative mortality and typically co-morbid patients. Transcatheter tricuspid interventions are an increasingly common therapeutic option becoming available for this high-risk patient cohort. This systematic review and meta-analysis sought to determine the short-term outcomes of these patients.</p><p><strong>Methods: </strong>Four databases were searched from their inception to August 2025. All studies reporting 1-year mortality and New York Heart Association (NYHA) class pre- and post-intervention were identified. Studies utilizing non-commercially available devices were excluded. Relevant data were extracted, and meta-analysis was conducted using a random-effects model.</p><p><strong>Results: </strong>Thirteen studies were included, encompassing a total of 1,589 patients. The aggregate mean age was 78.0 years. Thirty-day mortality was 1.8%, with 1-year mortality and heart failure hospitalization rates at 9.9% and 20.1%, respectively. At 1-year, TR was moderate or less in 66.5% of patients, and 81.1% of patients reported NYHA I or II status.</p><p><strong>Conclusions: </strong>Transcatheter tricuspid interventions provide sustained symptomatic benefit and reduction in TR at one year.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 2","pages":"17"},"PeriodicalIF":3.1,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous mechanical aspiration in tricuspid valve infective endocarditis.","authors":"Abdallah El Sabbagh, Kevin Landolfo, Evin Yucel, Nadira Hamid, Larry M Baddour, Sanjum S Sethi","doi":"10.21037/acs-2025-aw-41-tvd","DOIUrl":"https://doi.org/10.21037/acs-2025-aw-41-tvd","url":null,"abstract":"<p><p>Tricuspid valve infective endocarditis (TVIE) is increasing, largely driven by rising injection drug use and the expanding use of cardiac implantable electronic devices (CIEDs). Percutaneous mechanical aspiration (PMA) has emerged as a viable catheter-based therapy to achieve source control through vegetation debulking in patients with a suboptimal response to antimicrobial therapy or those deemed at high risk for surgery. An expanding literature has demonstrated favorable feasibility and promising outcomes, and recent societal guidelines recognized PMA as a therapeutic option for carefully selected cases. Optimal results rely on multidisciplinary evaluation, rigorous patient selection, appropriate device choice, and meticulous procedural technique. This review summarizes the growing evidence base, outlines patient selection and technical considerations, and highlights future directions for PMA in the management of TVIE.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 2","pages":"19"},"PeriodicalIF":3.1,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}