Transcatheter Edge-to-Edge Tricuspid Repair for Severe Tricuspid Regurgitation Reduces Hospitalizations for Heart Failure

Mathias Orban, Karl Philipp Rommel, Edwin C. Ho, Matthias Unterhuber, Alberto Pozzoli, Kim A. Connelly, Simon Deseive, Christian Besler, Geraldine Ong, Daniel Braun, Jeremy Edwards, Mizuki Miura, Gökhan Gülmez, Lukas Stolz, Mara Gavazzoni, Michel Zuber, Martin Orban, Michael Nabauer, Francesco Maisano, Holger ThieleSteffen Massberg, Maurizio Taramasso, Neil P. Fam, Philipp Lurz, Jörg Hausleiter

Research output: Contribution to journalArticlepeer-review

27 Scopus citations

Abstract

Objectives: The goal of this study was to evaluate the effect of transcatheter edge-to-edge tricuspid valve repair (TTVR) for severe tricuspid regurgitation (TR) on hospitalization for heart failure (HHF) and HF-related endpoints. Background: Patients with severe TR need effective therapies beyond conservative treatment. The impact of TTVR on HHF and HF-related endpoints is unknown. Methods: Isolated TTVR was performed in 119 patients. Assessments were conducted of New York Heart Association functional class, 6-min walk distance, Minnesota Living with Heart Failure Questionnaire scores, N-terminal pro–B-type natriuretic peptide level, and medication. HHFs were analyzed in the preceding 12 months before and until the longest available follow-up after TTVR. Results were compared with those of 114 patients who underwent combined mitral and tricuspid valve repair. Results: Procedural success with a reduction to moderate or less TR and no in-hospital death was achieved in 82% of patients. With a median follow-up of 360 days (interquartile range: 187 to 408 days), a durable TR reduction to moderate or less was achieved in 72% of patients (p < 0.001). TTVR reduced the annual rate of HHF by 22% (1.21 to 0.95 HHF/patient-year; p = 0.02), with concomitant clinical improvement in New York Heart Association functional class (patients in class II or lower: 9% to 67%; p < 0.001), 6-min walk distance (+39 m; p = 0.001), and Minnesota Living with Heart Failure Questionnaire score (−6 points; p = 0.02). N-terminal pro–B-type natriuretic peptide level decreased numerically by 783 pg/ml. Diuretic dose before TTVR was increased, but HF medication did not change after TTVR. Procedural success was associated with improved 1-year survival (79% vs. 60%; p = 0.04) and event-free-survival (death + first HHF: 67% vs. 40%; p = 0.001). Transcatheter mitral and tricuspid valve repair–treated patients had comparable outcomes. Conclusions: TTVR for severe TR is associated with a reduction of HHF and improved clinical outcomes.

Original languageEnglish (US)
Pages (from-to)265-276
Number of pages12
JournalJACC: Heart Failure
Volume8
Issue number4
DOIs
StatePublished - Apr 2020
Externally publishedYes

Keywords

  • heart failure
  • MitraClip
  • PASCAL
  • percutaneous edge-to-edge repair
  • right heart
  • transcatheter tricuspid valve repair
  • tricuspid regurgitation
  • tricuspid valve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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