Transcatheter Tricuspid Valve Intervention in Patients with Right Ventricular Dysfunction or Pulmonary Hypertension: Insights from the TriValve Registry

Guillem Muntané-Carol, Maurizio Taramasso, Mizuki Miura, Mara Gavazzoni, Alberto Pozzoli, Hannes Alessandrini, Azeem Latib, Adrian Attinger-Toller, Luigi Biasco, Daniel Braun, Eric Brochet, Kim A. Connelly, Sabine De Bruijn, Paolo Denti, Florian Deuschl, Edith Lubos, Sebastian Ludwig, Daniel Kalbacher, Rodrigo Estevez-Loureiro, Neil FamChristian Frerker, Edwin Ho, Jean Michel Juliard, Ryan Kaple, Susheel Kodali, Felix Kreidel, Claudia Harr, Alexander Lauten, Julia Lurz, Vanessa Monivas, Michael Mehr, Tamin Nazif, Georg Nickening, Giovanni Pedrazzini, François Philippon, Fabien Praz, Rishi Puri, Ulrich Schäfer, Joachim Schofer, Horst Sievert, Gilbert H.L. Tang, Martin Andreas, Marco Russo, Holger Thiele, Matthias Unterhuber, Dominique Himbert, Marina Urena, Ralph Stephan Von Bardeleben, John G. Webb, Marcel Weber, Stephan Windecker, Mirjam Winkel, Michel Zuber, Jörg Hausleiter, Philipp Lurz, Francesco Maisano, Martin B. Leon, Rebecca T. Hahn, Josep Rodés-Cabau

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background: Scarce data exist on patients with right ventricular dysfunction (RVD) or pulmonary hypertension (PH) undergoing transcatheter tricuspid valve intervention. This study aimed to determine the early and midterm outcomes and the factors associated with mortality in this group of patients. Methods: This subanalysis of the multicenter TriValve (Transcatheter Tricuspid Valve Therapies) registry included 300 patients with severe tricuspid regurgitation with RVD (n=244), PH (n=127), or both (n=71) undergoing transcatheter tricuspid valve intervention. RVD was defined as a tricuspid annular plane systolic excursion <17 mm, and PH as an estimated pulmonary artery systolic pressure ≥50 mm Hg. Results: Mean age of the patients was 77±9 years (54% women). Procedural success was 80.7%, and 9 patients (3%) died during the hospitalization. At a median follow-up of 6 (interquartile range, 2-12) months, 54 patients (18%) died, and the independent associated factors were higher gamma-glutamyl transferase values at baseline (hazard ratio, 1.02 for each increase of 10 u/L [95% CI, 1.002-1.04]), poorer renal function defined as an estimated glomerular filtration rate <45 mL/min (hazard ratio, 2.3 [95% CI, 1.22-4.33]), and the lack of procedural success (hazard ratio, 2.11 [95% CI, 1.17-3.81]). The grade of RVD and the amount of PH at baseline were not found to be predictors of mortality. Most patients alive at follow-up improved their functional class (New York Heart Association I-II in 66% versus 7% at baseline, P<0.001). Conclusions: In patients with severe tricuspid regurgitation and RVD/PH, transcatheter tricuspid valve intervention was associated with high procedural success and a relatively low in-hospital mortality, along with significant improvements in functional status. However, about 1 out of 5 patients died after a median follow-up of 6 months, with hepatic congestion, renal dysfunction, and the lack of procedural success determining an increased risk. These results may improve the clinical evaluation of transcatheter tricuspid valve intervention candidates and would suggest a closer follow-up in those at increased risk. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03416166.

Original languageEnglish (US)
Pages (from-to)184-192
Number of pages9
JournalCirculation: Cardiovascular Interventions
DOIs
StateAccepted/In press - 2021

Keywords

  • blood pressure
  • hypertension, pulmonary
  • mortality
  • pulmonary artery
  • tricuspid valve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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