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

JACC. Cardiovascular interventions

Authors: Michael Mehr, Maurizio Taramasso, Christian Besler, Tobias Ruf, Kim A Connelly, Marcel Weber, Ermela Yzeiraj, Davide Schiavi, Antonio Mangieri, Laura Vaskelyte, Hannes Alessandrini, Florian Deuschl, Nicolas Brugger, Hasan Ahmad, Luigi Biasco, Mathias Orban, Simon Deseive, Daniel Braun, Karl-Philipp Rommel, Alberto Pozzoli, Christian Frerker, Michael Näbauer, Steffen Massberg, Giovanni Pedrazzini, Gilbert H L Tang, Stephan Windecker, Ulrich Schäfer, Karl-Heinz Kuck, Horst Sievert, Paolo Denti, Azeem Latib, Joachim Schofer, Georg Nickenig, Neil Fam, Stephan von Bardeleben, Philipp Lurz, Francesco Maisano, Jörg Hausleiter

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.

Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PMID: 31395215

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