Annals of cardiothoracic surgery最新文献

{"title":"The current state of isolated tricuspid valve surgery: how it complements transcatheter tricuspid valve interventions.","authors":"Ricky Patil, Matthew Kazaleh, Gorav Ailawadi","doi":"10.21037/acs-2026-1-0035-tvd","DOIUrl":"10.21037/acs-2026-1-0035-tvd","url":null,"abstract":"<p><p>Tricuspid valve insufficiency represents a prevalent health burden for many patients worldwide but remains highly undertreated. This is especially true for isolated tricuspid disease, where surgical intervention remains underutilized. Despite historically elevated periprocedural risk, isolated tricuspid valve surgery (iTVS) today can provide an effective and reliable solution to tricuspid disease. Successful iTVS requires careful evaluation of valve anatomy, pathophysiology, and patient risk profile. Available risk calculators can be useful tools in determining patient risk and surgical candidacy. Additionally, intervening within the treatment window before late right ventricular disease and distortion with end-organ damage is integral to success. The application of minimally invasive surgical approaches can further improve outcomes. Furthermore, tricuspid valve repair has been shown to improve long-term survival. For patients who are not candidates for surgery, transcatheter modalities have increased awareness and provide a promising treatment alternative for tricuspid regurgitation (TR) reduction and symptom control, albeit with limited durability data. Currently, surgical and transcatheter interventions address separate populations with distinct risk profiles. Hence, treatment success is dependent on matching the right patient with the right procedure. Patients with suitable anatomy and lower risk profiles should be considered for surgical approaches, particularly if repair may be feasible.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 3","pages":"32"},"PeriodicalIF":4.1,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248830","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":"Complementary use of 3-dimensional intracardiac echocardiography during complex tricuspid transcatheter edge-to-edge repair.","authors":"Varsha Subramaniam, Takayuki Onishi, Gilbert H L Tang, Lucy M Safi","doi":"10.21037/acs-2026-1-0036-tvd","DOIUrl":"10.21037/acs-2026-1-0036-tvd","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 3","pages":"43"},"PeriodicalIF":4.1,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248844","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":"Comparative prognostic performance of risk scores for 12-month mortality and rehospitalization after transcatheter tricuspid valve intervention.","authors":"Johannes Schlegl, Christoph Edlinger, Marwin Bannehr, Michael Lichtenauer, Tanja Kücken, Alexander Krutz, Vera Paar, Michael Neuß, Anja Haase-Fielitz, Christian Butter","doi":"10.21037/acs-2026-1-0029-tvd","DOIUrl":"10.21037/acs-2026-1-0029-tvd","url":null,"abstract":"<p><strong>Background: </strong>Interventional treatment of tricuspid regurgitation (TR) is a rapidly evolving field, but selecting patients most likely to benefit remains challenging. Currently, no dedicated or widely accepted risk score exists for transcatheter tricuspid valve interventions (TTVIs). In clinical practice, established scores such as Model for End-stage Liver Disease excluding INR (MELD-XI), European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), GLIDE (Gap, Location, Image quality, Density, and En-face tricuspid regurgitation morphology), Tricuspid Regurgitation Impact Score (TRI-SCORE), and TRIVALVE are applied to estimate the risk of mortality and rehospitalization. This study analyzed the prognostic performance of these risk scores for predicting 12-month outcomes following TTVI.</p><p><strong>Methods: </strong>In this prospective single-center cohort study, 60 consecutive patients undergoing either edge-to-edge repair (n=47) or heterotopic minimally invasive bicaval valve implantation (n=13) were enrolled. Five established risk scores [MELD-XI, EuroSCORE II, GLIDE (Gap, Location, Image quality, Density, and En-face tricuspid regurgitation morphology), TRI-SCORE, and TRIVALVE] were calculated prior to intervention according to their original definitions. The primary outcome was a composite of all-cause mortality or rehospitalization for heart failure at 12 months. Discriminatory ability was assessed using receiver operating characteristic (ROC) curves and the corresponding area under the curve (AUC). Using the score with the best performance, patients were additionally stratified into risk categories based on the optimal cut-off value derived from ROC analysis. Survival analyses were performed using the Kaplan-Meier method and compared using the log-rank test.</p><p><strong>Results: </strong>No procedure-related deaths occurred. In-hospital mortality was 2.8%. Thirteen patients (21.7%) were rehospitalized for decompensated heart failure, and 11 patients (18.3%) died during the 12-month follow-up period. Among all evaluated risk scores, the TRI-SCORE demonstrated the strongest prognostic performance for the primary endpoint (AUC 0.76, 95% confidence interval: 0.61-0.91; P=0.004) and significantly discriminated survival across predefined risk categories (log-rank P=0.002). All other scores showed lower predictive ability for 12-month mortality or rehospitalization (AUC ≤0.65).</p><p><strong>Conclusions: </strong>The TRI-SCORE demonstrated the best discriminatory capacity among the evaluated models for predicting 12-month mortality and rehospitalization after TTVI.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 3","pages":"38"},"PeriodicalIF":4.1,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248862","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 valve surgery in patients with concomitant left-sided valve disease.","authors":"Zara Dietze, Mateo Marin-Cuartas, Philipp Kiefer, Alexey Dashkevich, David Holzhey, Michael A Borger","doi":"10.21037/acs-2026-1-0037-tvd","DOIUrl":"10.21037/acs-2026-1-0037-tvd","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 3","pages":"41"},"PeriodicalIF":4.1,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248975","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":"Outcomes after tricuspid transcatheter edge-to-edge repair: a systematic review and meta-analysis.","authors":"Sara Bombace, Federico Fortuni, Edoardo Zancanaro, Valeria Maria De Luca, Florian Schlotter, Karl-Philipp Rommel, Michele Di Mauro, Angelo Squeri, Erberto Carluccio, Gianluigi Condorelli, Anna Sannino, Karl-Patrik Kresoja, Philipp Lurz","doi":"10.21037/acs-2026-0137-tvd","DOIUrl":"10.21037/acs-2026-0137-tvd","url":null,"abstract":"<p><strong>Background: </strong>Severe tricuspid regurgitation (TR) is associated with high morbidity and mortality. Tricuspid transcatheter edge-to-edge repair (T-TEER) improves TR severity and symptoms, yet survival benefit remains uncertain. This meta-analysis aims to evaluate 1-year outcomes after T-TEER and explore clinical and echocardiographic correlates of prognosis.</p><p><strong>Methods: </strong>A systematic search of PubMed/MEDLINE, Web of Science, and Scopus was conducted through June 2025. Studies enrolling ≥100 patients undergoing T-TEER and reporting 1-year outcomes were included. Primary endpoints were 1-year all-cause mortality, heart failure (HF) hospitalization, and persistence of New York Heart Association (NYHA) class III-IV. Early residual TR (≥3+), assessed at the earliest post-procedural time point within 30 days, was a secondary endpoint.</p><p><strong>Results: </strong>Ten studies, including 4,134 patients, were analyzed. At 1-year, pooled all-cause mortality was 14.0% [95% confidence interval (CI): 9.6-18.5%], HF hospitalization 16.9% (95% CI: 8.7-25.1%), and 30.9% of patients remained in NYHA class III-IV (95% CI: 22.1-39.7%). Early residual TR ≥3+ occurred in 19.1%. In meta-regression analysis, more contemporary recruitment periods were associated with lower 1-year mortality, whereas single-center design was associated with higher early residual TR ≥3+. Exploratory aggregate-level analyses suggested potential associations between comorbidity burden and mortality, right-sided dysfunction and HF hospitalization, and left-sided disease and persistent functional limitation.</p><p><strong>Conclusions: </strong>T-TEER effectively reduces TR and improves functional status; however, 1-year mortality and HF hospitalization remain substantial. More contemporary recruitment periods were associated with lower 1-year all-cause mortality, suggesting improved outcomes over time. Systemic comorbidity burden, right-sided disease, and concomitant left-sided disease may contribute to residual risk after T-TEER; however, these associations should be considered hypothesis-generating and require validation in individual patient-level datasets.</p><p><strong>Meta-analysis registration: </strong>CRD420251155094.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 3","pages":"30"},"PeriodicalIF":4.1,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248854","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":"Endoscopic removal of a papillary fibroelastoma of the tricuspid valve.","authors":"Victoria Ennen, Can Gollmann-Tepeköylü, Udo Wagner, Markus Theurl, Daniel Höfer, Nikolaos Bonaros","doi":"10.21037/acs-2026-1-0055-tvd","DOIUrl":"10.21037/acs-2026-1-0055-tvd","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 3","pages":"42"},"PeriodicalIF":4.1,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248876","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":"The pitfalls of transcatheter tricuspid valve repair: what we have learned in our last decade of experience.","authors":"Silvia Corona, Walid Ben-Ali, Stephan von Bardeleben","doi":"10.21037/acs-2025-1-58-tvd","DOIUrl":"10.21037/acs-2025-1-58-tvd","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 3","pages":"40"},"PeriodicalIF":4.1,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248851","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":"Outcomes of surgical tricuspid valve intervention after heart transplant.","authors":"Macit Bitargil, Mohammad Alomari, Osama Haddad, Si M Pham, Richard C Daly, Kevin P Landolfo, Pankaj Garg, Magdy M El-Sayed Ahmed, Parag C Patel, Basar Sareyyupoglu","doi":"10.21037/acs-2025-aw-37-tvd","DOIUrl":"10.21037/acs-2025-aw-37-tvd","url":null,"abstract":"<p><strong>Background: </strong>Tricuspid regurgitation (TR) is common following heart transplant (HTx). Data on the outcomes of tricuspid valve (TV) surgery after HTx is limited. This study evaluates the short- and long-term outcomes of TV surgery after HTx and identifies predictors of mortality.</p><p><strong>Methods: </strong>A retrospective analysis of all HTx recipients undergoing TV surgery between 2000-2019 within the Mayo Clinic Health System was performed. Demographic, echocardiographic, hemodynamic, and postoperative outcomes were collected. Survival was estimated using Kaplan-Meier analysis, and univariable Cox regression analysis was used to identify mortality-associated risk factors.</p><p><strong>Results: </strong>Forty-one patients (mean age 53.9±14.4 years) underwent TV surgery after HTx. Biopsy-related leaflet injury (22 patients) and annular dilation (16 patients) were the most common mechanisms of TR. Nine patients underwent TV surgery during the index hospitalization of HTx, while 32 patients were operated on during follow-up. After TV surgery, 5- and 10- year survival was 60.5% and 23.5%, respectively. There were 23 deaths (5 during the index hospitalization for TV surgery, while 18 died during follow-up). Preoperative predictors of mortality were elevated right atrial pressure (RAP), right ventricular end-diastolic pressure (RVEDP), and mean pulmonary artery pressure (mPAP), and international normalized ratio (INR), along with hypoalbuminemia (P<0.05). Postoperative predictors were right ventricular (RV) dysfunction, elevated RAP, RVEDP, mPAP, reduced pulmonary artery pulsatility index (PAPi), hyperbilirubinemia, and an elevated INR (all P<0.05).</p><p><strong>Conclusions: </strong>TV surgery after HTx is associated with significant early and late mortality. In HTx recipients, TV surgery should be performed before the onset of RV dysfunction and hepatic dysfunction.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 3","pages":"37"},"PeriodicalIF":4.1,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248848","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":"Contemporary practice patterns and outcomes of isolated tricuspid valve surgery in North America: systematic review with meta-analysis.","authors":"Timothy Lee, Sooyun Caroline Tavolacci, Percy Boateng, Ahmed El-Eshmawi","doi":"10.21037/acs-2026-0132-tvd","DOIUrl":"10.21037/acs-2026-0132-tvd","url":null,"abstract":"<p><strong>Background: </strong>Management of isolated tricuspid valve surgery has evolved over recent decades with respect to operative timing, surgical strategy, and perioperative care. However, a contemporary synthesis of North American outcomes and practice patterns is lacking.</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis of studies published between January 1, 2020, and August 30, 2025, reporting outcomes of isolated tricuspid valve surgery in North America. Outcomes assessed included operative mortality, temporal volume trends, repair <i>vs.</i> replacement outcomes, beating-heart techniques, and results from high-volume centers. Institutional outcomes were also reviewed.</p><p><strong>Results: </strong>Twelve studies met the inclusion criteria. Operative mortality ranged from 5% to 8% in national cohorts and was approximately 2% at reference centers, with a declining trend over time. Mortality was lower among endocarditis patients as well as patients with better functional status and normal right ventricular function. Procedure volumes peaked around 2017 and have since plateaued or modestly declined, coinciding with increased use of transcatheter therapies. At Mount Sinai Hospital, 107 patients underwent isolated tricuspid valve surgery since 2014; 46% were reoperations, 54% were performed on a beating heart, 34% underwent repair, and in-hospital mortality was 1.9%. In the pooled meta-analysis of contemporary North American studies, operative mortality following isolated tricuspid valve surgery was 6.4% [95% confidence interval (CI): 4.9-8.3%], with significantly lower mortality observed with tricuspid valve repair (TVr) compared with tricuspid valve replacement (TVR) [odds ratio (OR) =0.74; 95% CI: 0.58-0.95]. In addition, pooled meta-analysis showed that TVr was associated with a significantly reduced risk of new permanent pacemaker (PPM) implantation (OR =0.39; 95% CI: 0.32-0.47).</p><p><strong>Conclusions: </strong>Isolated tricuspid valve surgery is increasingly safe, especially among high-volume centers and carefully selected patients. Annual case volumes seem to have plateaued, likely due to the growing application of transcatheter therapies.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 3","pages":"31"},"PeriodicalIF":4.1,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248901","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":"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":4.1,"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}