Outcomes After Current Transcatheter Tricuspid Valve Intervention: Mid-Term Results From the International TriValve Registry

Maurizio Taramasso, Hannes Alessandrini, Azeem Latib, Masahiko Asami, Adrian Attinger-Toller, Luigi Biasco, Daniel Braun, Eric Brochet, Kim A. Connelly, Paolo Denti, Florian Deuschl, Andrea Englmeier, Neil Fam, Christian Frerker, Jörg Hausleiter, Dominique Himbert, Edwin Ho, Jean Michel Juliard, Ryan Kaple, Felix KreidelKarl Heinz Kuck, Marco Ancona, Alexander Lauten, Philipp Lurz, Michael Mehr, Tamin Nazif, Georg Nickening, Giovanni Pedrazzini, Alberto Pozzoli, Fabien Praz, Rishi Puri, Josep Rodés-Cabau, Ulrich Schäfer, Joachim Schofer, Horst Sievert, Kolja Sievert, Gilbert H.L. Tang, Felix C. Tanner, Alec Vahanian, John G. Webb, Stephan Windecker, Ermela Yzeiray, Michel Zuber, Francesco Maisano, Martin B. Leon, Rebecca T. Hahn

Research output: Contribution to journalArticlepeer-review

90 Scopus citations

Abstract

Objectives: A large, prospective international registry was developed to evaluate the initial clinical applications of transcatheter tricuspid valve intervention (TTVI) with different devices. Background: TTVI for native tricuspid valve dysfunction has been emerging during the last few years as an alternative therapeutic option to serve a large high-risk population of patients with severe symptomatic tricuspid regurgitation (TR). Methods: The TriValve Registry included 312 high-risk patients with severe TR (76.4 ± 8.5 years of age; 57% female; EuroSCORE II 9 ± 8%) at 18 centers. Interventions included repair at the level of the leaflets (MitraClip, Abbott Vascular, Santa Clara, California; PASCAL Edwards Lifesciences, Irvine, California), annulus (Cardioband, Edwards Lifesciences; TriCinch, 4tech, Galway, Ireland; Trialign, Mitraling, Tewksbury, Massachusetts), or coaptation (FORMA, Edwards Lifesciences) and replacement (Caval Implants, NaviGate, NaviGate Cardiac Structures, Lake Forest, California). Clinical outcomes were prospectively determined during mid-term follow-up. Results: A total of 108 patients (34.6%) had prior left heart valve intervention (84 surgical and 24 transcatheter, respectively). TR etiology was functional in 93%, and mean annular diameter was 46.9 ± 9 mm. In 75% of patients the regurgitant jet was central (vena contracta 1.1 ± 0.5; effective regurgitant orifice area 0.78 ± 0.6 cm 2 ). Pre-procedural systolic pulmonary artery pressure was 41 ± 14.8 mm Hg. Implanted devices included: MitraClip in 210 cases, Trialign in 18 cases, TriCinch first generation in 14 cases, caval valve implantation in 30 cases, FORMA in 24 cases, Cardioband in 13 cases, NaviGate in 6 cases, and PASCAL in 1. In 64% of the cases, TTVI was performed as a stand-alone procedure. Procedural success (defined as the device successfully implanted and residual TR ≤2+) was 72.8%. Greater coaptation depth (odds ratio: 24.1; p = 0.002) was an independent predictor of reduced device success. Thirty-day mortality was 3.6% and was significantly lower among patients with procedural success (1.9% vs. 6.9%; p = 0.04); Actuarial survival at 1.5 years was 82.8 ± 4% and was significantly higher among patients who had procedural success achieved. Conclusions: TTVI is feasible with different technologies, has a reasonable overall procedural success rate, and is associated with low mortality and significant clinical improvement. Mid-term survival is favorable in this high-risk population. Greater coaptation depth is associated with reduced procedural success, which is an independent predictor of mortality.

Original languageEnglish (US)
Pages (from-to)155-165
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume12
Issue number2
DOIs
StatePublished - Jan 28 2019
Externally publishedYes

Keywords

  • transcatheter tricuspid valve intervention
  • tricuspid regurgitation
  • tricuspid valve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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