TY - JOUR
T1 - 1-Year Outcomes After Edge-to-Edge Valve Repair for Symptomatic Tricuspid Regurgitation
T2 - Results From the TriValve Registry
AU - Mehr, Michael
AU - Taramasso, Maurizio
AU - Besler, Christian
AU - Ruf, Tobias
AU - Connelly, K. A.
AU - Weber, Marcel
AU - Yzeiraj, Ermela
AU - Schiavi, Davide
AU - Mangieri, Antonio
AU - Vaskelyte, L.
AU - Alessandrini, Hannes
AU - Deuschl, Florian
AU - Brugger, Nicolas
AU - Ahmad, H.
AU - Biasco, L.
AU - Orban, Mathias
AU - Deseive, S.
AU - Braun, Daniel
AU - Rommel, Karl Philipp
AU - Pozzoli, Alberto
AU - Frerker, Christian
AU - Näbauer, Michael
AU - Massberg, Steffen
AU - Pedrazzini, Giovanni
AU - Tang, Gilbert H.L.
AU - Windecker, Stephan
AU - Schäfer, Ulrich
AU - Kuck, Karl Heinz
AU - Sievert, H.
AU - Denti, P.
AU - Latib, A.
AU - Schofer, Joachim
AU - Nickenig, G.
AU - Fam, Neil
AU - von Bardeleben, Stephan
AU - Lurz, Philipp
AU - Maisano, Francesco
AU - Hausleiter, Jörg
N1 - Publisher Copyright:
© 2019 American College of Cardiology Foundation
PY - 2019/8/12
Y1 - 2019/8/12
N2 - 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.
AB - 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.
KW - TR
KW - edge-to-edge repair
KW - heart failure
KW - structural heart disease
KW - tricuspid valve interventional repair
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U2 - 10.1016/j.jcin.2019.04.019
DO - 10.1016/j.jcin.2019.04.019
M3 - Article
C2 - 31395215
AN - SCOPUS:85069820960
SN - 1936-8798
VL - 12
SP - 1451
EP - 1461
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 15
ER -