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Impact of Massive or Torrential Tricuspid Regurgitation in Patients Undergoing Transcatheter Tricuspid Valve Intervention.

JACC. Cardiovascular interventions

Authors: Mizuki Miura, Hannes Alessandrini, Abdullah Alkhodair, Adrian Attinger-Toller, Luigi Biasco, Philipp Lurz, Daniel Braun, Eric Brochet, Kim A Connelly, Sabine de Bruijn, Paolo Denti, Florian Deuschl, Rodrigo Estevez-Loureiro, Neil Fam, Christian Frerker, Mara Gavazzoni, Jörg Hausleiter, Dominique Himbert, Edwin Ho, Jean-Michel Juliard, Ryan Kaple, Christian Besler, Susheel Kodali, Felix Kreidel, Karl-Heinz Kuck, Azeem Latib, Alexander Lauten, Vanessa Monivas, Michael Mehr, Guillem Muntané-Carol, Tamin Nazif, Georg Nickenig, Giovanni Pedrazzini, François Philippon, Alberto Pozzoli, Fabien Praz, Rishi Puri, Josep Rodés-Cabau, Ulrich Schäfer, Joachim Schofer, Horst Sievert, Gilbert H L Tang, Holger Thiele, Karl-Philipp Rommel, Alec Vahanian, Ralph Stephan Von Bardeleben, John G Webb, Marcel Weber, Stephan Windecker, Mirjam Winkel, Michel Zuber, Martin B Leon, Francesco Maisano, Rebecca T Hahn, Maurizio Taramasso

OBJECTIVES: The aim of this study was to assess the clinical outcome of baseline massive or torrential tricuspid regurgitation (TR) after transcatheter tricuspid valve intervention (TTVI).

BACKGROUND: The use of TTVI to treat symptomatic severe TR has been increasing rapidly, but little is known regarding the impact of massive or torrential TR beyond severe TR.

METHODS: The study population comprised 333 patients with significant symptomatic TR from the TriValve Registry who underwent TTVI. Mid-term outcomes after TTVI were assessed according to the presence of massive or torrential TR, defined as vena contracta width ≥14 mm. Procedural success was defined as patient survival after successful device implantation and delivery system retrieval, with residual TR ≤2+. The primary endpoint comprised survival rate and freedom from rehospitalization for heart failure, survival rate, and rehospitalization at 1 year.

RESULTS: Baseline massive or torrential TR and severe TR were observed in 154 patients (46.2%) and 179 patients (53.8%), respectively. Patients with massive or torrential TR had a higher prevalence of ascites than those with severe TR (27.3% vs. 20.4%, respectively; p = 0.15) and demonstrated a similar procedural success rate (83.2% vs. 77.3%, respectively; p = 0.21). The incidence of peri-procedural adverse events was low, with no significant between-group differences. Freedom from the composite endpoint was significantly lower in patients with massive or torrential TR than in those with severe TR, which was significantly associated with an increased risk for 1-year death of any cause or rehospitalization for heart failure (adjusted hazard ratio: 1.91; 95% confidence interval: 1.10 to 3.34; p = 0.022). Freedom from the composite endpoint was significantly higher in patients with massive or torrential TR when procedural success was achieved (69.9% vs. 54.2%, p = 0.048).

CONCLUSIONS: Baseline massive or torrential TR is associated with an increased risk for all-cause mortality and rehospitalization for heart failure 1 year after TTVI. Procedural success is related to better outcomes, even in the presence of baseline massive or torrential TR. (International Multisite Transcatheter Tricuspid Valve Therapies Registry [TriValve]; NCT03416166).

Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PMID: 32912460

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