Severe mitral (MR) and tricuspid regurgitation (TR) aggravate hemodynamic stress leading to congestive heart failure (HF) with impaired hepatic function, also known as cardio-hepatic syndrome (CHS). Current perioperative risk calculators do not sufficiently consider CHS and serum liver function parameters lack sensitivity to diagnose CHS. Indocyanine green (ICG) and its elimination (measured by the LIMON®-test) represents a dynamic and non-invasive test which correlates with the hepatic function. Nevertheless, its utility in the setting of transcatheter valve repair/replacement (TVR) to predict CHS and outcome remains unknown. Patients with baseline ICG plasma disappearance rate (PDR) <12.95%/min showed significantly increased 1-year mortality (HR: 1.54, 95%CI: 1.05 -2.25, p = 0.027) and lower NYHA class improvement (p = 0.05). Especially in the context of the recently stressed importance of a careful patient selection prior to the interdisciplinary treatment of VHD, the LIMON®-test may provide further real-time information on the patients’ cardiohepatic injury and prognosis.

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