Resumen: Consenso internacional para la nomenclatura y clasificación de la válvula aórtica bicúspide congénita y su aortopatía, con fines clínicos, quirúrgicos, intervencionistas y de investigación / Summary: International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes

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Abstract This consensus of nomenclature and classification for congenital bicuspid aortic valve and its aortopathy is evidence-based and intended for universal use by physicians (both pediatricians and adults), echocardiographers, advanced cardiovascular imaging specialists, interventional cardiologists, cardiovascular surgeons, pathologists, geneticists, and researchers spanning these areas of clinical and basic research. In addition, as long as new key and reference research is available, this international consensus may be subject to change based on evidence-based data1.

[Smoking cessation rate after passage in a smoking cessation clinic in patients referred by a respiratory medicine department]. / Taux de sevrage tabagique après prise en charge ambulatoire dans un centre d'aide aux fumeurs (CAF) chez des patients référés par un service de Pneumologie.

Responsible for a significant morbidity and mortality, smoking remains a major public health issue. Smoking cessation clinics are an integral part of the fight against smoking. This retrospective study, carried out between January 2022 and January 2023 on 106 patients who attended the smoking cessation clinics in the Respiratory Department of the University Hospital of Liège, was designed to assess patient cessation rates at 6 months and 1 year, and to identify any factors predicting success or failure. Our data showed a cessation rate of 25 % at 6 months and 19 % at 1 year. Age was slightly more advanced in those who succeeded in smoking cessation at one year (p = 0.05). The obtained cessation rate strongly supports the utility of our smoking cessation clinic for patients wishing to quit smoking.

Responsable d'une morbi-mortalité importante, le tabagisme reste un enjeu, non négligeable, de santé publique. Les consultations d'aide au sevrage font partie intégrante des moyens mis en œuvre pour lutter contre le tabagisme dans une optique de prévention. Cette étude rétrospective, menée entre janvier 2022 et janvier 2023, auprès de 106 patients ayant fréquenté les consultations de tabacologie du Service de Pneumologie du CHU de Liège, avait pour objectifs d'évaluer les taux de sevrage des patients à 6 mois et à 1 an et d'identifier d'éventuels facteurs prédictifs de succès, ou d'échec, au sein de l'échantillonnage étudié. L'analyse des données a démontré un taux de sevrage de 25 % à 6 mois et de 19 % à 1 an. L'analyse des facteurs démographiques montre une moyenne d'âge plus élevée chez les patients qui réussissent leur sevrage à 1 an (p = 0,05). Le taux de sevrage obtenu atteste de la pertinence et de la nécessité de notre accompagnement auprès des patients désireux de cesser de fumer.

[Promoting smoking cessation for patients treated by coronary angioplasty at Liege CHU]. / Aide au sevrage tabagique des patients traités par angioplastie coronaire au CHU de Liège.

Smoking cessation appears to be the response that provides the best cost/benefit ratio among cardiovascular prevention actions. However, hospitalization precisely offers a strategic opportunity to initiate smoking cessation. This work evaluates the assistance in smoking cessation of patients treated by coronary angioplasty at the University Hospital of Liege over the last 6 years. It aims to provide food for thought regarding optimal management of smoking. Analysis of data showed a withdrawal rate of 55 % at year one. Strengthening motivation (with motivational interviewing and conversational hypnosis), the use of nicotine replacement and participation in cardiac rehabilitation have been identified as factors in consolidating abstinence. This work attests to the relevance and necessity of the intervention of a tobacco specialist in hospitalization and outpatient settings to ensure follow-up and improve the success rate of smoking cessation.

Le sevrage tabagique apparaît comme la réponse qui permet le meilleur rapport coût/bénéfice parmi les actions de prévention cardiovasculaire. Or, l'hospitalisation offre précisément une opportunité stratégique pour initier l'arrêt du tabagisme. Ce travail évalue l'aide au sevrage tabagique des patients traités par angioplastie coronaire au CHU de Liège durant ces 6 dernières années. Il vise à nourrir la réflexion quant à une prise en charge optimale du tabagisme. L'analyse des données a montré un taux de sevrage de 55 % à un an. Le renforcement de la motivation (avec l'entretien motivationnel et l'hypnose conversationnelle), l'utilisation d'une substitution nicotinique et la participation à la revalidation cardiaque ont été identifiés comme des facteurs de consolidation de l'abstinence. Ce travail atteste de la pertinence et de la nécessité de l'intervention d'un tabacologue en hospitalisation et en ambulatoire pour assurer un suivi et améliorer la réussite du sevrage tabagique.

[Secondary prevention of cardiovascular diseases : targeting all the cardiovascular risk factors]. / Prévention secondaire des maladies cardiovasculaires : cibler l'ensemble des facteurs de risque.

This article focuses on the secondary prevention of cardiovascular (CV) diseases, namely the prevention of recurrence in subjects with a personal history of CV event, and the prevention of a first event in patients identified as at very high risk. For all these patients at very high risk, treatment is primarily based on the application of hygienic and dietary measures, including increasing the volume of physical activity, modifying the diet, and obtaining, if necessary, weight loss, as well as stopping smoking. This strategy has proven its benefits in terms of reducing morbidity and mortality. In addition, these patients must receive pharmacological treatment, whose the additional benefits are proven. The article details the pharmacological classes that are currently recommended, as well as the optimal management of CV risk factors and the therapeutic targets to be achieved.

Cet article s'intéresse à la prévention secondaire des maladies cardio-vasculaires (CV), c'est-à-dire la prévention de la récidive chez les sujets ayant une histoire personnelle d'événement CV, et la prévention d'un premier événement chez les patients identifiés comme à très haut risque. Pour tous ces patients à très haut risque, la prise en charge est, avant tout, basée sur l'application de mesures hygiéno-diététiques, incluant l'augmentation du volume d'activité physique, la modification du régime alimentaire et l'obtention si nécessaire d'une perte pondérale, ainsi que l'arrêt du tabac. Cette stratégie a prouvé ses bénéfices en termes de réduction de la morbidité et de la mortalité. En outre, ces patients doivent recevoir un traitement pharmacologique, dont les bénéfices additionnels sont prouvés. L'article détaille les classes pharmacologiques recommandées actuellement, ainsi que la prise en charge optimale des facteurs de risque CV et les cibles thérapeutiques à atteindre.

[Patient with type 2 diabetes and coronary heart disease developing heart failure]. / Vignette thérapeutique de l'étudiant. Patient avec un diabète de type 2, une coronaropathie et une insuffisance cardiaque.

Patients with type 2 diabetes (T2D) are frequently exposed to comorbidities, mainly cardiovascular complications. Thus, a polypharmacy is often mandatory, targeting not only T2D but also comorbidities such as coronary artery disease and heart failure. Interestingly, some drugs improve glucose control, cardiovascular prognosis and heart failure outcome. This versatility may cause trouble regarding prescriptions by practitioners, especially because of the restricted conditions for the reimbursement in Belgium. This clinical vignette aims at discussing the path of pharmacotherapy for a patient with T2D who suffers from a myocardial infarction and subsequently develops a heart failure. It will mainly focus on the place of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporters 2 (gliflozins) as well as the potential of their combination in this context, considering the current restrictions for the reimbursement.

Le patient avec un diabète de type 2 (DT2) est souvent exposé à diverses comorbidités, notamment cardiovasculaires. Dès lors, une polymédication est souvent nécessaire, ciblant le DT2 lui-même, mais aussi les comorbidités comme une coronaropathie et une insuffisance cardiaque. De façon intéressante, certaines médications améliorent à la fois le contrôle glycémique, le pronostic cardiovasculaire et le devenir de l'insuffisance cardiaque. Cette polyvalence peut jeter le trouble en ce qui concerne les prescriptions chez les praticiens, notamment en lien avec les conditions restrictives de remboursement en Belgique. Cette vignette clinique a pour but d'illustrer le cheminement de la pharmacothérapie d'un patient avec un DT2 qui présente un infarctus du myocarde puis, secondairement, une insuffisance cardiaque. Elle ciblera surtout la place des agonistes des récepteurs du glucagon-like peptide-1 et des inhibiteurs des cotransporteurs sodium-glucose de type 2 (gliflozines), et expliquera l'intérêt de leur combinaison dans ce contexte en tenant compte des conditions actuelles de remboursement.

Infective Endocarditis in Belgium: Prospective Data in Adults from the ESC EORP European Endocarditis Registry.

(1) Background: infective endocarditis (IE) is a significant health concern associated with important morbidity and mortality. Only limited, often monocentric, retrospective data on IE in Belgium are available. This prospective study sought to assess the clinical characteristics and outcomes of Belgian IE patients in the ESC EORP European endocarditis (EURO-ENDO) registry; (2) Methods: 132 IE patients were identified based on the ESC 2015 criteria and included in six tertiary hospitals in Belgium; (3) Results: The average Belgian IE patient was male and 62.8 ± 14.9 years old. The native valve was most affected (56.8%), but prosthetic/repaired valves (34.1%) and intracardiac device-related (5.3%) IE are increasing. The most frequently identified microorganisms were S. aureus (37.2%), enterococci (15.5%), and S. viridans (15.5%). The most frequent complications were acute renal failure (36.2%) and embolic events (23.6%). Cardiac surgery was effectively performed when indicated in 71.7% of the cases. In-hospital mortality occurred in 15.7% of patients. Predictors of mortality in the multivariate analysis were S. aureus (HR = 2.99 [1.07-8.33], p = 0.036) and unperformed cardiac surgery when indicated (HR = 19.54 [1.91-200.17], p = 0.012). (4) Conclusion: This prospective EURO-ENDO ancillary analysis provides valuable contemporary insights into the profile, treatment, and clinical outcomes of IE patients in Belgium.

[Mavacamten (Camzyos ®) : first myosin modulator for obstructive hypertrophic cardiomyopathy treatment]. / Le médicament du moisMavacamten (Camzyos®) : premier inhibiteur réversible de l'ATP-ase de la myosine pour le traitement des cardiomyopathies hypertrophiques obstructives.

Mavacamten (Camzyos®) is a myosin modulator which reduces the interactions between myosin and actin. These are overly activated in hypertrophic cardiomyopathy (HCM), a source of exaggerated ventricular contractility, energy loss, and impairment of diastolic function (relaxation). The Food and Drug Administration (FDA) and the European Medication Agency (EMA) approved mavacamten for the treatment of symptomatic obstructive HCM (NYHA class II or III) in adult patients in 2022 and 2023, respectively. The medication is not yet reimbursed in Belgium. As seen in its clinical development studies, mavacamten reduces the intraventricular gradient, improves functional capacity and reduces symptoms. It also seems to be an innovative alternative to septal reduction. Mavacamten is usually very well tolerated knowing that, through its mechanism of action, it causes a dose-dependent and reversible reduction in left ventricular ejection fraction, which must therefore be closely monitored. The good tolerance and the effectiveness of mavacamten seem to be maintained over time. Consequently, the recent European Society of Cardiology Updated Guidelines on cardiomyopathy (ESC 09/2023) already recommend mavacamten in the pharmacological management of obstructive HCM.

Le mavacamten (Camzyos®) est un modulateur de la myosine qui diminue les interactions entre la myosine et l'actine. En effet, celles-ci sont trop activées dans la cardiomyopathie hypertrophique (CMH), source de contractilité ventriculaire exagérée, de déperdition énergétique et de troubles de la fonction diastolique (relaxation). Le mavacamten est approuvé par la Food and Drug Administration (FDA 2022) et l'European Medication Agency (EMA 2023) pour le traitement de la CMH obstructive (CMHO) symptomatique (classe NYHA II ou III) chez les patients adultes. Il n'est pas encore remboursé en Belgique. Les études pivots de son développement clinique ont montré que le mavacamten réduit le gradient intraventriculaire, améliore la capacité fonctionnelle et diminue les symptômes. Il semble aussi représenter une alternative innovante à la réduction septale. Le mavacamten est généralement très bien toléré, sachant que, par son mécanisme d'action, il entraîne une diminution dose-dépendante et réversible de la fraction d'éjection ventriculaire gauche, qui devra donc être surveillée étroitement. Sa bonne tolérance et son efficacité semblent se maintenir au cours du temps. En conséquence, les récentes recommandations de la Société Européenne de Cardiologie (ESC 2023) à propos des cardiomyopathies recommandent déjà le mavacamten dans l'arsenal pharmacologique de la prise en charge des CMHO.

[Cardio-oncology and cardio-obstetrics : crucial role of a multidisciplinary approach]. / Cardio-oncologie et cardio-obstétrique : importance d'une approche multidisciplinaire.

In this clinical case, we describe the cardio-oncological history and the complexity of the management of a patient presenting a breast cancer diasgnosed during pregnancy followed by a postpartum cardiomyopathy. A multidisciplinary approach is mandatory.

Dans ce cas clinique, nous décrivons l'histoire cardio-oncologique et la complexité de prise en charge d'une patiente présentant un cancer mammaire découvert lors d'une grossesse, puis, une cardiomyopathie du post-partum. Une approche multidisciplinaire s'avère indispensable.

Mild Cardiotoxicity and Continued Trastuzumab Treatment in the Context of HER2-Positive Breast Cancer.

Breast cancer is the leading cause of cancer death in women worldwide. Trastuzumab, the main HER2-targeted treatment, faces limitations due to potential cardiotoxicity. The management of patients with mild cardiotoxicity on trastuzumab remains uncertain, resulting in treatment discontinuation and negative oncological outcomes. This retrospective study analyzed 23 patients who experienced decreased left ventricular function during trastuzumab treatment. During the 18-month follow-up period, two patients (9%) had severe declines in function, leading to treatment cessation, and one patient (4%) developed heart failure symptoms. However, 21 patients showed mild, reversible myocardial dysfunction without significant differences in final ventricular function compared to a control group (58.4% vs. 61.7%, respectively; p = 0.059). The declines in function were most pronounced at nine months but improved at twelve and eighteen months. Various echocardiographic parameters changed significantly over time. As predictors of severe cardiotoxicity, we identified the following: LVEF before initial chemotherapy (p = 0.022), as well as baseline LVEF before treatment with trastuzumab (p = 0.007); initial left ventricular end systolic volume (p = 0.027); and the initial global longitudinal strain (p = 0.021) and initial velocity time integral in the left ventricular outflow track (p = 0.027). In conclusion, the continuation of trastuzumab should be considered for most patients with mild cardiotoxicity, with close cardiac monitoring and cardioprotective measures. However, identifying the patients at risk of developing severe cardiotoxicity is necessary. According to our data, the initial LVEF and GLS levels appear to be reliable predictors.

Efficacy and User Experience of a Novel X-Ray Shield on Operator Radiation Exposure During Cardiac Catheterization: A Randomized Controlled Trial.

BACKGROUND: Radiation shielding is mandatory during cardiac catheterization, but there is a need to improve efficacy and ease of use. METHODS: The aim of the study was to assess the shielding effect and user feedback for a novel flexible multiconfiguration x-ray shield (FMX). The 0.5-mm Pb equivalent FMX can be selectively configured to accommodate for variations in patient morphology, access site, and type of procedure with maintained visualization, vascular access, and shielding. To evaluate efficacy, relative operator dose (operator dose indexed for given dose) was measured during 103 consecutive procedures randomized in a 1:1 proportion to the current routine setup or FMX+routine. User feedback was collected on function, relevance, and likelihood of adoption into clinical practice. RESULTS: Median relative operator dose was 3.63 µSv/µGy·m2×10-3 (IQR, 2.62-6.37) with routine setup and 0.57 µSv/µGy·m2×10-3 (IQR, 0.27-1.06) with FMX+routine, which amounts to an 84.4% reduction (P<0.001). For 500 procedures/year, this corresponds to an estimated yearly dose reduction from 3.6 to 0.7 mSv. User feedback regarding size, functionality, ease of use, likely to use, critical issues, shielding, draping, procedure time, vascular access, patient discomfort, and risk was 99% positive. No critical issues were identified. There was no significant difference in patient radiation exposure. CONCLUSIONS: The FMX reduces radiation exposure considerably. The FMX represents an effective and attractive solution for radiation protection that can easily be implemented in existing workflow. FMX has potential for general use with maintained visualization, vascular access, and shielding in routine cardiac catheterization.

ACC/AHA and ESC/EACTS Guidelines for the Management of Valvular Heart Diseases: JACC Guideline Comparison.

Valvular heart disease (VHD) is common and poses important challenges from the standpoints of diagnosis and therapeutic management. Clinical practice guidelines have been developed to help health care professionals to overcome these challenges and provide optimal management to patients with VHD. The American College of Cardiology, in collaboration with the American Heart Association, and the European Society of Cardiology, in collaboration with the European Association for Cardio-Thoracic Surgery, recently updated their guidelines on the management of VHD. Although these 2 sets of guidelines are generally concordant, there are some substantial differences between these guidelines, which may have significant implications for clinical practice. This review prepared on behalf of the EuroValve Consortium describes the consistencies and discrepancies between the guidelines and highlights the gaps in these guidelines and the future research perspectives to fill these gaps.

Structure of multidisciplinary heart teams, a survey-based heart team study.

OBJECTIVES: Multidisciplinary approach is well established in various disciplines, with evidence highlighting improved patient outcomes. The objective of this survey was to determine the real-world practice of heart teams across Europe. METHODS: The survey was drafted after a consensus opinion from the authors. The survey was sent to cardiac surgeons and cardiologists identified through electronic search. The survey link and the information sheet were sent through email followed by survey completion reminders. The survey responses were cumulated and analysed. RESULTS: Among 2188 invited clinicians, 220 clinicians from 26 countries took part in the survey (response rate 10%). The completion rate for the survey questions was 85%. A total of 140 (64%) were cardiac surgeons and 80 (36%) were cardiologists. The heart team meeting frequency was weekly according to 104 (55%) respondents. This was conducted face to face according to 139 (73%) of the responses. Eighty-seven (56%) of the respondents reported 10-20% of patients undergoing percutaneous coronary intervention were discussed at the heart team meeting. Seventy-nine (47%) respondents had ad hoc percutaneous coronary intervention institutional guidelines. Fifty-four (32%) respondents reported an audit process for the heart team decisions. CONCLUSIONS: This survey suggests that there is marked variability in the infra-structure and execution of heart teams in different institutions. The results of the survey suggest a need to formulate guidelines on the composition and execution of heart teams which may result in an increase in transparency of decision-making within different institutions in reporting and comparing outcomes.

Predictors of embolism and death in left-sided infective endocarditis: the European Society of Cardiology EURObservational Research Programme European Infective Endocarditis registry.

BACKGROUND AND AIMS: Even though vegetation size in infective endocarditis (IE) has been associated with embolic events (EEs) and mortality risk, it is unclear whether vegetation size associated with these potential outcomes is different in left-sided IE (LSIE). This study aimed to seek assessing the vegetation cut-off size as predictor of EE or 30-day mortality for LSIE and to determine risk predictors of these outcomes. METHODS: The European Society of Cardiology EURObservational Research Programme European Infective Endocarditis is a prospective, multicentre registry including patients with definite or possible IE throughout 2016-18. Cox multivariable logistic regression analysis was performed to assess variables associated with EE or 30-day mortality. RESULTS: There were 2171 patients with LSIE (women 31.5%). Among these affected patients, 459 (21.1%) had a new EE or died in 30 days. The cut-off value of vegetation size for predicting EEs or 30-day mortality was >10 mm [hazard ratio (HR) 1.38, 95% confidence interval (CI) 1.13-1.69, P = .0015]. Other adjusted predictors of risk of EE or death were as follows: EE on admission (HR 1.89, 95% CI 1.54-2.33, P < .0001), history of heart failure (HR 1.53, 95% CI 1.21-1.93, P = .0004), creatinine >2 mg/dL (HR 1.59, 95% CI 1.25-2.03, P = .0002), Staphylococcus aureus (HR 1.36, 95% CI 1.08-1.70, P = .008), congestive heart failure (HR 1.40, 95% CI 1.12-1.75, P = .003), presence of haemorrhagic stroke (HR 4.57, 95% CI 3.08-6.79, P < .0001), alcohol abuse (HR 1.45, 95% CI 1.04-2.03, P = .03), presence of cardiogenic shock (HR 2.07, 95% CI 1.29-3.34, P = .003), and not performing left surgery (HR 1.30 95% CI 1.05-1.61, P = .016) (C-statistic = .68). CONCLUSIONS: Prognosis after LSIE is determined by multiple factors, including vegetation size.

The MANTRA study: a new umbrella concept prospectively applied to assess implantable medical devices for heart valve procedures.

BACKGROUND: Clinical evidence is commonly obtained through individual trials that are time-, cost- and resource-consuming, and which often leave unanswered clinically relevant questions. Umbrella studies have been developed to address the need for more efficient and flexible trial structures, predominantly for cancer treatments. The umbrella concept foresees data collection within a unifying trial structure, to which one or more substudies may be added at any time to address product- or therapy-specific questions. To our knowledge, the umbrella concept has not yet been used in the medical device area, but it may offer similar advantages as in other settings, particularly in areas where multiple therapies are available within one large treatment area. METHODS: The MANTRA study (NCT05002543) is a prospective, global, post-marketing clinical follow-up study. The aim is to collect safety and device performance data covering the Corcym cardiac surgery portfolio for the treatment of aortic, mitral, and tricuspid valve diseases. The study uses a master protocol that outlines the main common parameters, and the specific questions are addressed in three substudies. The primary endpoints are device success at 30 days. Secondary endpoints include safety- and device performance-related data at 30 days, 1 year, and then annually through to 10 years. All endpoints are defined according to the more recent guidelines for heart valve procedures. Additionally, procedure and hospitalization information are collected, including Enhanced Recovery after Surgery in sites using such protocols, and patient outcome measures such as New York Heart Association classification and quality-of-life questionnaires. RESULTS: The study started in June 2021. Enrollment in all three substudies is ongoing. CONCLUSIONS: The MANTRA study will provide contemporary information on the long-term outcomes of medical devices for the treatment of aortic, mitral, and tricuspid heart valve diseases in routine clinical practice. The umbrella approach adopted in the study has the potential of longitudinally assessing long-term efficacy of the devices and the flexibility to investigate new research questions as they arise.

Infective endocarditis in adult patients with congenital heart disease.

BACKGROUND: Congenital Heart Disease (CHD) predisposes to Infective Endocarditis (IE), but data about characterization and prognosis of IE in CHD patients is scarce. METHODS: The ESC-EORP-EURO-ENDO study is a prospective international study in IE patients (n = 3111). In this pre-specified analysis, adult CHD patients (n = 365, 11.7%) are described and compared with patients without CHD (n = 2746) in terms of baseline characteristics and mortality. RESULTS: CHD patients (73% men, age 44.8 ± 16.6 years) were younger and had fewer comorbidities. Of the CHD patients, 14% had a dental procedure before hospitalization versus 7% in non-CHD patients (p < 0.001) and more often had positive blood cultures for Streptococcus viridans (16.4% vs 8.8%, p < 0.001). As in non-CHD patients, IE most often affected the left-sided valves. For CHD patients, in-hospital mortality was 9.0% vs 18.1% in non-CHD patients (p < 0.001), and also, during the entire follow-up of 700 days, survival was more favorable (log-rank p < 0.0001), even after adjustment for age, gender and major comorbidities (Hazard Ratio (HR) 0.68; 95%CI 0.50-0.92). Within the CHD population, multivariable Cox regression revealed the following effects (HR and [95% CI]) on mortality: fistula (HR 6.97 [3.36-14.47]), cerebral embolus (HR 4.64 [2.08-10.35]), renal insufficiency (HR 3.44 [1.48-8.02]), Staphylococcus aureus as causative agent (HR 2.06 [1.11-3.81]) and failure to undertake surgery when indicated (HR 5.93 [3.15-11.18]). CONCLUSIONS: CHD patients with IE have a better outcome in terms of all-cause mortality. The observed high incidence of dental procedures prior to IE warrants further studies about the current use, need and efficacy of antibiotic prophylaxis in CHD patients.

Evaluation and management of cancer patients presenting with acute cardiovascular disease: a Clinical Consensus Statement of the Acute CardioVascular Care Association (ACVC) and the ESC council of Cardio-Oncology-part 2: acute heart failure, acute myocardial diseases, acute venous thromboembolic diseases, and acute arrhythmias.

Advances in treatment, common cardiovascular (CV) risk factors and the ageing of the population have led to an increasing number of cancer patients presenting with acute CV diseases. These events may be related to cancer itself or cancer treatment. Acute cardiac care specialists must be aware of these acute CV complications and be able to manage them. This may require an individualized and multidisciplinary approach. The management of acute coronary syndromes and acute pericardial diseases in cancer patients was covered in part 1 of a clinical consensus document. This second part focusses on acute heart failure, acute myocardial diseases, venous thromboembolic diseases and acute arrhythmias.

Clinical and Echocardiographic Outcomes of Transcatheter Tricuspid Valve Interventions: A Systematic Review and Meta-Analysis.

Background: Medically managed tricuspid regurgitation (TR) has detrimental outcomes. Transcatheter tricuspid valve interventions (TTVIs) represent an alternative to surgery in high-risk patients; however, only early experiences exist. Aim: The aim of this study was to analyze the clinical and echocardiographic outcomes of TTVI. Methods: MEDLINE, ISI Web of Science, and SCOPUS databases were searched for studies published up to June 2021. Studies reporting data on outcome post-TTVIs were included. This study was designed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) requirements. The primary endpoint was all-cause mortality at 30-day and 1-year post-TTVI. Results: Out of 2,718 studies, 27 were included. Notably, 30-day and 1-year all-cause mortalities were 5% (95% confidence interval [CI]: 4-8%, p < 0.001) and 25% (95% CI: 12-45%, p = 0.016). Procedural success was associated with a 58% risk reduction in 1-year mortality vs. lack thereof (odds ratio 0.42, 95% CI: 0.27-0.66, p < 0.001). TTVI is associated with a significant reduction in TR severity (TR EROA, mean difference [MD] 0.31 cm2; 95% CI: 0.23-0.39 cm2, p < 0.001; regurgitant volume, MD 23.54 ml; 95% CI: 17.4-29.68 ml, p = 0.03) and increase in forward stroke volume (FSV, MD 3.98 ml; 95% CI: 0.11-7.86 ml, p = 0.04). Conclusion: TTVI significantly reduces TR severity and increases FSV and is associated with improved survival at 1 year compared with patients without procedural success. Long-term outcomes compared with medical therapy await the results of ongoing pivotal trials; nonetheless, TTVIs appear to be a promising alternative to surgery for TR.