Key result
Kay bicuspidization repair increased cardiac output in an ex vivo model of severe functional tricuspid regurgitation, though it also reduced valve opening area and elevated viscous energy loss.
Why the study?
Kay bicuspidization has been adapted in percutaneous therapies for severe functional tricuspid regurgitation, but its clinical outcome remains uncertain.
Does Kay bicuspidization repair improve right ventricular hemodynamics and tricuspid valve area metrics in an ex vivo model of severe functional tricuspid regurgitation?
Does Kay bicuspidization repair improve right ventricular hemodynamics and tricuspid valve area metrics in an ex vivo model of severe functional tricuspid regurgitation?
In an ex vivo model of severe functional tricuspid regurgitation, Kay bicuspidization repair effectively reduced regurgitation and increased cardiac output, but resulted in elevated right ventricular viscous energy loss and kinetic energy during diastole.
Answers are grounded in this paper and cite their sources.
Kay bicuspidization may enhance output in severe FTR ex vivo; leaves open clinical translation amid reduced orifice area and energy loss.
There has been a resurgence of interest in the treatment of severe functional tricuspid regurgitation (FTR) due to the awareness of its poor outcomes and potential percutaneous therapies. Kay bicuspidization has been adapted in percutaneous therapies but its clinical outcome remains uncertain. The present study evaluates the efficacy of Kay repair in a novel ex vivo pulsatile system. Porcine tricuspid valve (TV) (n = 3) was extracted and incorporated into a patient-specific silicon right ventricle (RV) emulating severe FTR, on which Kay repair was subsequently performed. TV area metrics and RV hemodynamic assessment by means of stereo-scopic particle image velocimetry were quantified in both FTR and post-repair conditions. Bicuspidization led to significant increase in cardiac output although the overall increment due to this approach alone was generally small, possibly due to existence of residual TR and the large reduction in TV opening area. Kinetic energy and viscous loss levels were increased post-repair, especially during diastolic filling. Main vortex structures generally maintained post-procedural. However, there was enhanced swirling motion in larger RV domain. Although this might reduce mural-thrombus risk, the relatively more complex vortex phenomenon likely resulted in elevated viscous loss observed and may potentially impact long-term adaptation. The RV hemodynamic alteration after tricuspid repair could be used to predict the success of these future transcatheter solutions.
No takes yet. Share an insight, caveat, or question.
Nguyen et al. (2019) studied Severe functional tricuspid regurgitation (n=9). Kay bicuspidization repair vs. Severe functional tricuspid regurgitation (pre-repair) was evaluated on Cardiac output (p=0.00499). Kay bicuspidization repair increased cardiac output in an ex vivo model of severe functional tricuspid regurgitation, though it also reduced valve opening area and elevated viscous energy loss.
Synapse has enriched 10 related papers. Consider them for comparative context: