1-Year Outcomes After Edge-to-Edge Valve Repair for Symptomatic Tricuspid Regurgitation: Results From the TriValve Registry

Michael Mehr, Maurizio Taramasso, Christian Besler, Tobias Ruf, K. A. Connelly, Marcel Weber, Ermela Yzeiraj, Davide Schiavi, Antonio Mangieri, L. Vaskelyte, Hannes Alessandrini, Florian Deuschl, Nicolas Brugger, H. Ahmad, L. Biasco, Mathias Orban, S. Deseive, Daniel Braun, Karl Philipp Rommel, Alberto PozzoliChristian Frerker, Michael Näbauer, Steffen Massberg, Giovanni Pedrazzini, Gilbert H.L. Tang, Stephan Windecker, Ulrich Schäfer, Karl Heinz Kuck, H. Sievert, P. Denti, A. Latib, Joachim Schofer, G. Nickenig, Neil Fam, Stephan von Bardeleben, Philipp Lurz, Francesco Maisano, Jörg Hausleiter

Research output: Contribution to journalArticlepeer-review

67 Scopus citations

Abstract

Objectives: The purpose of this study was to evaluate procedural and 1-year clinical and echocardiographic outcomes of patients treated with tricuspid edge-to-edge repair. Background: Transcatheter edge-to-edge repair has been successfully performed in selected patients with symptomatic tricuspid regurgitation (TR) and high risk for surgery, but outcome data are sparse. Methods: This analysis of the multicenter international TriValve (Transcatheter Tricuspid Valve Therapies) registry included 249 patients with severe TR treated with edge-to-edge repair in compassionate and/or off-label use. Clinical and echocardiographic outcomes were prospectively collected and retrospectively analyzed. Results: In 249 patients (mean age 77 ± 9 years; European System for Cardiac Operative Risk Evaluation II score 6.4% [interquartile range: 3.9% to 13.9%]), a successful procedure with TR reduction to grade ≤2+ was achieved in 77% by placement of 2 ± 1 tricuspid clips. Concomitant treatment of severe TR and mitral regurgitation was performed in 52% of patients. At 1-year follow-up, significant and durable improvements in TR severity (TR ≤2+ in 72% of patients) and New York Heart Association functional class (≤II in 69% of patients) were observed. All-cause mortality was 20%, and the combined rate of mortality and unplanned hospitalization for heart failure was 35%. Predictors of procedural failure included effective regurgitant orifice area, tricuspid coaptation gap, tricuspid tenting area, and absence of central or anteroseptal TR jet location. Predictors of 1-year mortality were procedural failure, worsening kidney function, and absence of sinus rhythm. Conclusions: Transcatheter tricuspid edge-to-edge repair can achieve TR reduction at 1 year, resulting in significant clinical improvement. Predictors of procedural failure and 1-year mortality identified here may help select patients who will benefit most from this therapy.

Original languageEnglish (US)
Pages (from-to)1451-1461
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume12
Issue number15
DOIs
StatePublished - Aug 12 2019
Externally publishedYes

Keywords

  • TR
  • edge-to-edge repair
  • heart failure
  • structural heart disease
  • tricuspid valve interventional repair

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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