Search Results (85)

Background and Clinical Significance: Carcinoid heart disease (CHD) is an uncommon valvular manifestation of neuroendocrine tumours, usually affecting right-sided cardiac valves. Left-sided involvement is rare and is generally associated with bronchopulmonary carcinoid, right-to-left shunting, or markedly elevated circulating vasoactive substances. Therapeutic decision-making is particularly challenging in advanced disease when severe tricuspid regurgitation occurs in patients at prohibitive surgical risk. Case Presentation: We report the case of a 61-year-old male patient with progressive dyspnoea, abdominal distension, lower-limb oedema, facial flushing, and 15 kg of unintentional weight loss. Transthoracic and transoesophageal echocardiography demonstrated torrential tricuspid regurgitation caused by thickened, retracted, and immobile leaflets, with additional mitral and aortic valve involvement, raising strong suspicion of CHD. An agitated-saline contrast study demonstrated delayed right-to-left shunting without patent foramen ovale, suggesting an extracardiac, likely intrapulmonary, shunt. Somatostatin receptor PET/CT identified a pancreatic lesion with metastatic disease, and bone marrow biopsy confirmed neuroendocrine tumour infiltration. Owing to prohibitive surgical risk, as reflected by a Tricuspid Regurgitation Impact Score (TRI-SCORE) with an estimated in-hospital mortality of 65%, unfavourable tricuspid anatomy for repair, and refractory venous congestion, heterotopic bicaval valve implantation was performed (TricValve system -P&F). Discussion: This case highlights the role of echocardiography in recognising the characteristic phenotype of CHD, detecting occult right-to-left shunting, and supporting selection of a palliative transcatheter intervention. It also illustrates the value of a multimodality diagnostic strategy integrating echocardiography, functional oncological imaging, and histopathology in tumour-related cardiac disease. Conclusions: In selected inoperable patients with advanced carcinoid-related tricuspid regurgitation, heterotopic bicaval valve implantation may represent a feasible strategy for reducing venous congestion and improving functional status. Full article

Transcatheter structural heart interventions, including aortic, mitral and tricuspid valve replacement or repair, and patent foramen ovale, atrial septal defect, and left atrial appendage closure, have dramatically expanded over the past two decades, providing substantial improvements in both clinical outcomes and quality of life. These interventions are performed in a high-risk patient population, which is at risk for both thrombotic and bleeding complications. The introduction of prosthetic devices into the arterial or venous circulation under heterogeneous hemodynamic conditions inevitably increases the risk for thrombotic events and thromboembolic complications. Consequently, the selection of antithrombotic therapy (AT) regimen and its duration is complex and should be tailored to each patient’s risk profile, balancing the expected risk and benefits. This state-of-the-art review critically examines the thrombotic risks inherent to transcatheter structural heart interventions, synthesizes available evidence and current guidelines recommendations on antithrombotic management, and defines persisting gaps in knowledge while discussing the most relevant ongoing clinical trials. Full article

Background/Objectives: Totally endoscopic mitral valve repair reduces surgical trauma and accelerates recovery but can be technically challenging, particularly for precise annuloplasty suturing. The VirtuoSEW^® (LSI Solutions, Victor, NY 14564m, USA) automated annular suturing system was developed to standardize and simplify suture placement. This study was an early evaluation of this technology’s safety, efficacy, and feasibility in totally endoscopic microInvasive mitral valve repair (µMVr). Methods: We conducted a retrospective observational study of 20 patients with severe mitral valve disease of various etiologies. All patients underwent mitral valve repair using the VirtuoSEW^® system for automated placement of annuloplasty sutures, combined with leaflet resection or chordal management as appropriate. Postoperative outcomes were assessed at one month using echocardiography and clinical evaluation. Perioperative and postoperative complications and early mortality were systematically recorded. Results: VirtuoSEW^®-assisted mitral valve repair was safe and effective, achieving complete elimination of severe mitral regurgitation in all patients (N = 20, 100%). Annuloplasty rings included Physio-ring (N = 12, 60%), Memo 3D (N = 4, 20%), and Memo 4D (N = 4, 20%), combined with leaflet repair techniques: leaflet plication (N = 5, 25%), neochordae implantation (N = 7, 35%), sliding plasty (N = 2, 10%), commissural repair (N = 1, 5%), and hemibutterfly repair (N = 1, 5%). Concomitant procedures included: tricuspid valve repair (N = 1, 5%) and atrial septal defect closure (N = 1, 5%). Mitral annulus diameter decreased from 42.0 ± 5.3 mm to 34.2 ± 2.2 mm (p = 0.001). Mean total surgery, cardiopulmonary bypass, and aortic cross-clamp times were 170.3 ± 21.3, 143.4 ± 21.5, and 80.4 ± 7.9 min, respectively. ICU stay was 1.0 ± 0.2 days, with a hospital stay of 8.0 ± 1.9 days. No perioperative complications—including bleeding (N = 0, 0%), stroke (N = 0, 0%), infections (N = 0, 0%), or 30-day mortality (N = 0, 0%)—occurred. Conclusions: µMVR invasive mitral valve repair using the VirtuoSEW^® system is safe, effective, and reproducible, as well as compatible with almost all repair techniques, providing complete restoration of valve competence with no early device-related complications. To our knowledge, this is the first clinical study reporting outcomes with this device, supporting its potential to streamline mitral repair and improve procedural efficiency. Full article

Background: Transcatheter tricuspid edge-to-edge repair (T-TEER) is the most widely used treatment option for patients with tricuspid regurgitation (TR). In real-world practice, a substantial proportion of referred patients are not eligible for T-TEER or do not achieve an adequate early TR reduction and may therefore require alternative transcatheter tricuspid valve interventions (TTVI)—orthotopic or heterotopic tricuspid valve implantation. The aim of the study was to characterize patients with severe TR referred for transcatheter treatment, and identify patients in whom alternative TTVI strategies may be required. Methods: The CAPTURE Study (NCT 06838611) enrolls consecutive patients referred for TR treatment. All patients undergo clinical and echocardiographic assessment to determine eligibility for T-TEER. Candidates for alternative TTVI strategies were defined as patients disqualified from T-TEER due to anatomical ineligibility or those with unsuccessful T-TEER, defined as next-day TTE showing TR more than moderate. This pilot analysis includes patients enrolled from November 2023 to December 2024. Results: 147 patients were enrolled, 77 (52.4%) patients were qualified for T-TEER and the procedure was performed in 71 (48.3%) patients, with successful TR reduction in 55 cases (77.5% of treated patients); a subset of 34 patients (23.1%) was identified as potential candidates for alternative TTVI strategies. These patients exhibited more advanced TR (torrential TR 76.5% vs. 18.2%; p < 0.001) and right heart failure symptoms (ascites 44.1% vs. 12.7%; p < 0.001). Additionally, they had significantly higher bilirubin concentration (1.09 [1.20] mg/dL vs. 0.61 [0.42] mg/dL; p = 0.003), lower hemoglobin level (11.8 [1.7] g/dL vs. 12.3 [1.7] g/dL; p = 0.017) and platelet count (161.0 [51.0] × 109/L vs. 183.0 [79.0] × 109/L; p = 0.015), suggesting an increased bleeding risk. Conclusions: In this preliminary single-center real-world cohort, approximately half of the patients with severe TR were eligible for T-TEER, whereas more than 20% emerged as potential candidates for alternative TTVI strategies. This subgroup was characterized by more advanced right-sided remodeling and laboratory features suggestive of hepatic dysfunction and increased bleeding risk, which may have important implications for Heart Team decision-making and procedural planning. Full article

Background: Transcatheter edge-to-edge repair (TEER) has emerged as an established treatment option for patients with severe mitral (MR) and tricuspid regurgitation (TR) who are at high surgical risk. Patients referred for TEER frequently present with advanced comorbidities, including cirrhosis or chronic liver disease (CLD). Hepatic dysfunction, driven by chronic venous congestion and impaired cardiac output, represents a key yet underrecognized determinant of prognosis in this population. The impact of TEER on hepatic function and outcomes in patients with advanced liver disease remains incompletely defined. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO. A comprehensive literature search of PubMed, Scopus, Web of Science, and the Cochrane Library was performed up to 16 January 2026, without language restrictions. Studies evaluating mitral or tricuspid TEER in adult patients with cirrhosis, chronic or advanced liver disease, congestive hepatopathy, or cardiohepatic syndrome were included. Hepatic function was assessed using biochemical markers, clinical diagnoses, or composite scores such as Model for End-Stage Liver Disease (MELD) score and Model for End-Stage Liver Disease Excluding INR (MELD-XI). A qualitative synthesis was performed due to heterogeneity in study design and outcome reporting. Results: Twelve studies were included, comprising prospective and retrospective cohorts, registry-based analyses, mechanistic studies, and one illustrative case report. Six studies evaluated mitral TEER (M-TEER) and six tricuspid (T-TEER). Across both valve interventions, impaired baseline hepatic function was consistently associated with increased mortality and adverse clinical outcomes. MELD and MELD-XI scores emerged as robust prognostic markers following both M-TEER and T-TEER. Successful reduction in valvular regurgitation was associated with stabilization or improvement of hepatic parameters in selected patients, particularly after T-TEER. However, advanced cardiohepatic syndrome and limited hepatic reserve were linked to poor outcomes despite procedural success. Conclusions: Hepatic dysfunction is a powerful determinant of prognosis in patients undergoing M-TEER and T-TEER. While TEER may improve hepatic congestion and liver-related parameters in selected patients, outcomes are highly dependent on baseline hepatic reserve and global hemodynamic status. A personalized approach integrating hepatic assessment into patient selection and risk stratification is essential to optimize outcomes in this complex and growing population. Full article

The presence and impact of tricuspid valve (TV) prolapse in patients with mitral valve (MV) prolapse and severe mitral regurgitation (MR) have not been widely reported. The aim of our study was to describe the prevalence of TV prolapse, and the associated echocardiography features, in a large cohort of patients with MV prolapse undergoing surgery, and to explore its potential clinical impact. A total of 803 patients were included, of which 87 (11%) were diagnosed with TV prolapse, while 716 (89%) patients showed no TV prolapse. Patients with TV prolapse were more often diagnosed with Barlow’s disease compared to patients without TV prolapse, and also had more frequently significant TR, a larger right chamber size and TV annulus; they also underwent concomitant TV annuloplasty more often. During follow-up, there was no difference in terms of TR progression or all-cause mortality after surgery between the patients with or without TV prolapse. In conclusion, TV prolapse was associated with a more severe phenotype in terms of baseline cardiac remodeling and TR severity in our large study cohort of MV prolapse patients undergoing MV repair. However, when successfully treated, TV prolapse was not associated with worse outcomes after surgery, also in terms of TR progression. Full article

Background and Objectives: Minimally invasive surgery (MIS) has become a cornerstone approach in cardiac surgery. A debate persists regarding the optimal aortic clamp occlusion strategy, with limited comparative data. The two principal strategies, which are transthoracic cross-clamping (TTCC) and endo-aortic balloon occlusion (EABO), offer distinct advantages, but comparative clinical data remain limited. This study compares the two techniques in terms of procedural safety and early outcome. Materials and Methods: This single-center retrospective study included consecutive adult patients undergoing elective MIS via video-assisted right mini-thoracotomy between 2012 and 2018 for mitral valve surgery. Tricuspid repair, atrial fibrillation and redo surgery were included in the final cohort. Aortic occlusion was performed with transthoracic cross-clamping (TTCC) or endo-aortic balloon occlusion (EABO). Primary endpoints were intra-operative complications and the rate of conversion to full sternotomy; secondary outcomes were overall mortality and Society of Thoracic Surgeons (STS)-defined comorbidities. Results: A total of 163 patients were analyzed (TTCC: n = 99, 60%; EABO: n = 64, 40%). While both techniques demonstrated equivalent safety profiles (overall mortality: 0%), EABO was associated with higher conversion to full sternotomy [(n = 7, 10.9%) vs. TTCC (n = 1, 1.3%), p = 0.016]. In a generalized estimation equations (GEE) model, no patient-level covariate predicted conversion, suggesting technical or procedural factors as the primary contributors. In addition, EABO was associated with longer cross-clamp time [median: 87 min (IQR: 73, 100) vs. TTCC median: 77 min (IQR: 65.5, 87.5), p = 0.03]. Stroke, acute kidney injury, respiratory failure, reoperation and wound infection did not differ significantly; also, hospital stay was similar between groups. Conclusions: In this single-center series, EABO showed longer operative times and a higher conversion rate to sternotomy, but without excess mortality or major complications. This may be correlated with the initial learning phase and redo cases; further comparison is needed to assess the benefits of EABO. Full article

Tricuspid regurgitation (TR) in patients with transvalvular cardiac implantable electronic device (CIED) leads is increasingly encountered as transcatheter tricuspid valve interventions (TTVI) expand, yet integrated guidance for managing this “two-device problem” remains limited. We performed a focused synthesis of contemporary evidence, organizing findings around mechanisms and diagnosis of TR in the setting of CIED leads, lead–device interactions across TTVI platforms, and clinical trade-offs of transvenous lead extraction (TLE) versus lead preservation or jailing. CIED-associated TR can arise from lead–leaflet impingement, leaflet injury, fibrotic adhesion, pacing-induced remodeling, or infection; true CIED-induced TR accounts for a minority of clinically significant TR, yet progression of TR after lead implantation occurs in 7–45% of patients, and moderate-to-severe TR in CIED populations is associated with 1.6- to 2.5-fold increased mortality risk. Lead conflict and lifetime consequences differ by TTVI modality: repair approaches are generally more lead-tolerant, whereas valve replacement creates obligate lead jailing with implications for lead performance, future extraction feasibility, and infection management. Management of TR with transvalvular CIED leads requires integrated Heart Team planning that anticipates downstream device needs. Standardized TR phenotyping, lead-aware TTVI selection, valve-sparing rhythm-device strategies, and structured post-procedural surveillance may improve outcomes; prospective studies are needed to define optimal extract-versus-jail pathways. Full article

Intracardiac echocardiography (ICE) is increasingly recognized as a valuable imaging modality in structural heart interventions, offering high-resolution, real-time visualization from within the cardiac chambers. Originally developed for electrophysiologic procedures, ICE has expanded its use across a broad spectrum of structural interventions, including atrial septal defect (ASD) and patent foramen ovale (PFO) closure, left atrial appendage occlusion (LAAO), transseptal puncture guidance, transcatheter edge-to-edge repair (TEER), balloon mitral valvuloplasty, and both mitral and tricuspid valve therapies. This review outlines the current role and technical principles of ICE, with an emphasis on catheter design, image acquisition protocols, and the emerging potential of 3D ICE. Comparisons with transesophageal echocardiography (TEE) and fluoroscopy are discussed, highlighting ICE’s ability to support minimally invasive, sedation-sparing procedures while maintaining procedural precision. We provide a focused analysis of ICE-guided applications in specific clinical scenarios, emphasizing its role in anatomical assessment, device navigation, and intra-procedural monitoring. Data from recent clinical studies and registries are reviewed to assess safety, feasibility, and outcomes. Practical considerations including operator learning curve, workflow integration, and limitations such as cost and field of view are also addressed. Lastly, we explore future directions including advanced 3D imaging, fusion imaging, artificial intelligence integration, and robotic catheter systems. Full article

Tricuspid regurgitation (TR) has historically been undertreated despite its strong association with morbidity and mortality. Surgical correction of isolated TR is not routinely performed and has shown limited survival benefit, leaving a substantial unmet need for minimally invasive therapies. Transcatheter edge-to-edge repair (T-TEER) has emerged as a promising therapeutic option for patients with symptomatic severe or greater (≥severe) TR who are unsuitable for surgery. Recent randomized trials, including the TRILUMINATE Pivotal and the Tri-FR study, and real-world registries consistently demonstrate significant improvements in TR severity, functional status, and quality of life following T-TEER. Although benefits in hard clinical endpoints such as mortality or heart failure hospitalizations remain less conclusive, growing evidence suggests potential prognostic advantage in selected patients, particularly those with preserved or mid-range right ventricular function. Anatomical suitability, RV performance, and optimized patient selection are crucial determinants of success. As ongoing large-scale trials continue to evaluate long-term outcomes, T-TEER currently occupies a therapeutic space between palliative intervention and disease-modifying therapy, providing substantial symptom relief with the potential for broader clinical benefit. This review summarizes current evidence, patient selection strategies, and perspectives on the evolving role of T-TEER in the management of severe TR. Full article

Background: Tricuspid regurgitation (TR) is a common valvular heart disease that often causes disabling symptoms. Caval valve implantation with the TricValve system is one of the transcatheter treatment options proposed for TR symptom reduction. With this prospective registry, we aim to summarize our early experience with TricValve system implantation. Methods: Registry participants, selected out of patients who were referred for TR treatment but who were not eligible for the transcatheter tricuspid edge-to-edge valve repair (T-TEER), were qualified for the caval valve implantation following a HeartTeam discussion. Results: Four patients (four women; median age 71 years; 67.5–77 years) in whom a one-year follow-up was completed were included in the study. The patients were highly symptomatic in the NYHA class III despite intensive diuretic treatment; all of them were considered a high-mortality risk during conventional cardiac surgery. The TricValve system was successfully implanted in all patients. At 6-month follow-up, we observed a reduction in symptoms in three out of four patients. Up to 12 months, only one patient survived, with a reduction in symptoms of NYHA class II; two patients died because of heart failure; one died due to a progression in neoplastic disease. Conclusions: In highly symptomatic TR patients who were not eligible for the T-TEER and who had a prohibitive risk of cardiac surgery, TricValve implantation led to a reduction in symptoms in a 6-month perspective. Long-term survival was limited mainly by heart failure progression and severe concomitant disorders. Further studies are needed to fully elucidate the role of caval valve implantation in the treatment of TR patients. Full article

Primary tricuspid regurgitation (TR) is an underrecognized valve disease characterized by structural abnormalities of the tricuspid valve (TV) apparatus, including leaflet prolapse, flail, rheumatic degeneration, carcinoid involvement and congenital malformations such as Ebstein’s anomaly. Historically neglected and often misclassified as functional, primary TR has recently gained attention due to advances in multimodality imaging and increased awareness of its pathophysiological complexity and adverse outcomes. A major challenge that remains is the accurate diagnosis of primary TR, as well as the optimal timing for intervention, particularly in asymptomatic patients. While surgical repair or replacement has been the traditional approach, recent developments in transcatheter therapies, such as tricuspid edge-to-edge repair, have broadened the therapeutic landscape for patients considered at high surgical risk. In this context, personalized medicine has emerged as a central paradigm in the management of this valvular disease. Tailored therapeutic decisions should include anatomical, functional, and clinical parameters, as well as patient-specific risk factors such as age and comorbidities. Advanced imaging modalities, including 3D echocardiography and cardiac magnetic resonance, are essential for guiding this individualized approach. This review summarizes the current understanding of the etiology, pathophysiology, diagnostic tools, and treatment strategies for primary TR, highlighting the critical role of personalized treatment pathways in optimizing clinical outcomes. Full article

Objectives: The purpose of this study was to determine whether concomitant tricuspid valve repair (TVr) at the time of left ventricular assist device (LVAD) implantation improves outcomes in patients with ≥moderate tricuspid regurgitation (TR) and to evaluate the prognostic value of preoperative right ventricular (RV) strain. Methods: In a retrospective analysis of 100 LVAD recipients (44 TVr; 56 No-TVr), preoperative (preop) and postoperative (postop) clinical, echocardiographic, and hemodynamic variables, including pulmonary vascular resistance (PVR) and pulmonary artery pulsatility index (PAPI), were analyzed. RV free wall strain (RV-FWS) and RV fractional area change (RV-FAC) were measured by speckle tracking. Early right heart failure (RHF) was modeled with multivariable logistic regression, and 2-year mortality was assessed with Fine–Gray competing risk regression. Preoperative and three-month measurements were compared within each of the 100 patients. Results: Baseline invasive hemodynamics, RV-FWS, and RV-FAC were similar between the TVr and No-TVr groups. TVr at the time of LVAD implantation reduced postoperative TR grade, but it did not improve RV-FWS or RV-FAC at 3 months. The No-TVr patients were more often discharged home and had lower 30-day readmissions. PVR was comparable preoperatively and at 3 months postoperatively. In adjusted analyses, preop PVR, PAPI, and TVr were not independently associated with early RHF, whereas decreased preoperative RV-FWS and lower preop RV-FAC independently predicted higher 2-year mortality. Conclusions: In LVAD recipients with ≥moderate TR, concomitant TVr lowers postoperative TR severity but does not improve early RHF, RV strain-based remodeling, or 2-year mortality. Preoperative RV deformation metrics, rather than preoperative PVR or PAPI, independently predict survival following LVAD implantation with or without TVr. Full article

Objectives: To optimise surgical treatment of mitral valve disease (MVD), a better understanding of gender-based differences is required. In this study, we analyse the gender-based differences among patients undergoing mitral valve surgery. Methods: Between January 2019 and December 2024, 809 consecutive patients were admitted to our centre for surgery for MVD. We analysed the patient characteristics, surgical details, postoperative and short-term outcomes of these patients. Results: Females (31.8%) undergoing mitral valve (MV) surgery were older (p < 0.001). Females had a higher rate of atrial fibrillation (p < 0.001), Rheumatoid arthritis (RA) (p = 0.002) and malignancy (p = 0.030). Furthermore, females were more often admitted to the intensive care unit (ICU) preoperatively (p = 0.037). Among these patients, 419 patients underwent isolated MV surgery. Furthermore, males underwent minimally invasive MV surgery more often (p = 0.004). Females had higher rates of combined MVD (p < 0.001) and combined MS (p < 0.001). Males had higher rates of severe mitral regurgitation (MR) (p = 0.041) and Left Atrium (LA) dilation (p = 0.004). Females exhibited higher rates of severe Tricuspid Regurgitation (TR) (p = 0.032) and pulmonary hypertension (p < 0.001). males had higher rates of posterior mitral leaflet (PML) prolapse (p < 0.001) and Flail leaflets (p < 0.001). Males underwent mitral valve repair (MVr) more often (p = 0.002). Early MACCE were reported in 5.1% of the patients. Freedom from major adverse cardiac and cerebrovascular events (MACCE) was comparable at 1 year and three years (p = 0.548). Prognosis and freedom from events were comparable between genders. Conclusions: Mitral valve disease presents differently across genders. There exist fundamental differences in the pathophysiological processes and presentation of mitral valve disease. Mitral valve surgery can be carried out with low mortality and morbidity rates irrespective of gender. Full article

Tricuspid valve diseases are an increasing cause of cardiovascular mortality, peaking in the eighth decade of life. More than 75% of severe tricuspid regurgitations are recognized via functional mechanisms, often secondary to left heart disease and pulmonary hypertension. Surgical risk for isolated correction of tricuspid regurgitation, both repair or replacement, is associated with prohibitive risk mainly in elderly patients, with several comorbidities and right ventricular dysfunction. In the past decade, different percutaneous devices have been developed to treat a large group of high-surgical-risk patients. Early diagnosis and careful patient selection are essential to improving prognosis in severe TR. Potential treatment options may vary in different stages of disease. The current available results from present studies have proven the safety and effectiveness of these devices under proper clinical indications, although selection bias and non-randomization in most investigations at present do not allow for definite indications. Ideal anatomic and clinical parameters to predict interventional success are in continuous evolution and need definite standardization. We report three cases in which different percutaneous techniques were employed for treatment when surgery was not suitable. The literature is discussed for each condition. Despite promising results in terms of safety and success rate, further randomized studies are needed to better understand which patients may be subject to long-term effects on survival and quality of life. Full article