Doff B McElhinney1, Jamil A Aboulhosn2, Danny Dvir3, Brian Whisenant4, Yulin Zhang5, Andreas Eicken6, Flavio Ribichini7, Aphrodite Tzifa8, Michael R Hainstock9, Mary H Martin10, Ran Kornowski11, Stephan Schubert12, Azeem Latib13, John D R Thomson14, Alejandro J Torres15, Jeffery Meadows16, Jeffrey W Delaney17, Mayra E Guerrero18, Stefano Salizzoni19, Howaida El-Said20, Ariel Finkelstein21, Isaac George22, Marc Gewillig23, Maria Alvarez-Fuente24, Luke Lamers25, Asim N Cheema26, Jacqueline N Kreutzer27, Tanja Rudolph28, David Hildick-Smith29, Allison K Cabalka30. 1. Stanford University, Palo Alto, California. Electronic address: doff@stanford.edu. 2. UCLA, Los Angeles, California. 3. University of Washington, Seattle, Washington. 4. Intermountain Heart Institute, Salt Lake City, Utah. 5. Stanford University, Palo Alto, California. 6. German Heart Centre Munich, Munich, Germany. 7. Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy. 8. Mitera Children's Hospital, Athens, Greece. 9. University of Virginia, Charlottesville, Virginia. 10. Primary Children's Hospital. Salt Lake City, Utah. 11. Rabin Medical Center, Petah-Tiqva, Israel. 12. German Heart Center Berlin, Berlin, Germany. 13. San Raffaele Hospital, Milan, Italy. 14. Leeds General Infirmary, Leeds, United Kingdom. 15. Morgan Stanley Children's Hospital of New York, New York, New York. 16. University of California-San Francisco, San Francisco, California. 17. Children's Hospital and Medical Center, Omaha, Nebraska. 18. Henry Ford Hospital, Detroit, Michigan. 19. Citta della Salute e della Scienza, Molinette, Torino, Italy. 20. University of California San Diego and Rady Childrens Hospital, San Diego, California. 21. Tel Aviv Medical Center, Tel Aviv, Israel. 22. Columbia University, New York, New York. 23. UZ Leuven, Leuven, Belgium. 24. Hospital Ramón y Cajal, Madrid, Spain. 25. University of Wisconsin, Madison, Wisconsin. 26. St. Michael's Hospital, Toronto, Ontario, Canada. 27. Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania. 28. Heart Center at University of Cologne, Cologne, Germany. 29. Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom. 30. Mayo Clinic, Rochester, Minnesota.
Abstract
BACKGROUND: Transcatheter aortic and pulmonary valves have been used to treat stenosis or regurgitation after prior surgical tricuspid valve (TV) replacement or repair. Little is known about intermediate-term valve-related outcomes after transcatheter tricuspid valve replacement (TTVR), including valve function, thrombus, and endocarditis. OBJECTIVES: The authors sought to evaluate mid-term outcomes in a large cohort of patients who underwent TTVR after surgical TV repair or replacement, with a focus on valve-related outcomes. METHODS: Patients who underwent TTVR after prior surgical TV replacement or repair were collected through an international registry. Time-related outcomes were modeled and risk factors assessed. RESULTS: Data were collected for 306 patients who underwent TTVR from 2008 through 2017 at 80 centers; 52 patients (17%) had a prior history of endocarditis. Patients were followed for a median of 15.9 months after implantation (0.1 to 90 months), with 64% of patients estimated to be alive without TV reintervention or a valve-related event at 3 years. The cumulative 3-year incidence of death, reintervention, and valve-related adverse outcomes (endocarditis, thrombosis, or significant dysfunction) were 17%, 12%, and 8%, respectively. Endocarditis was diagnosed in 8 patients 2 to 29 months after TTVR, for an annualized incidence rate of 1.5% per patient-year (95% confidence interval: 0.45% to 2.5%). An additional 8 patients were diagnosed with clinically relevant valve thrombosis, 3 in the short term, 2 within 2 months, and 3 beyond 6 months. Only 2 of these 8 patients received anticoagulant therapy before thrombus detection (p = 0.13 vs. patients without thrombus). Prior endocarditis was not a risk factor for reintervention, endocarditis, or valve thrombosis, and there was no difference in valve-related outcomes according to TTVR valve type. CONCLUSIONS: TV dysfunction, endocarditis, and leaflet thrombosis were uncommon after TTVR. Patients with prior endocarditis were not at higher risk for endocarditis or other adverse outcomes after TTVR, and endocarditis occurred with similar frequency in different valve types. Though rare, leaflet thrombosis is an important adverse outcome, and further study is necessary to determine the appropriate level of prophylactic therapy after TTVR.
BACKGROUND: Transcatheter aortic and pulmonary valves have been used to treat stenosis or regurgitation after prior surgical tricuspid valve (TV) replacement or repair. Little is known about intermediate-term valve-related outcomes after transcatheter tricuspid valve replacement (TTVR), including valve function, thrombus, and endocarditis. OBJECTIVES: The authors sought to evaluate mid-term outcomes in a large cohort of patients who underwent TTVR after surgical TV repair or replacement, with a focus on valve-related outcomes. METHODS:Patients who underwent TTVR after prior surgical TV replacement or repair were collected through an international registry. Time-related outcomes were modeled and risk factors assessed. RESULTS: Data were collected for 306 patients who underwent TTVR from 2008 through 2017 at 80 centers; 52 patients (17%) had a prior history of endocarditis. Patients were followed for a median of 15.9 months after implantation (0.1 to 90 months), with 64% of patients estimated to be alive without TV reintervention or a valve-related event at 3 years. The cumulative 3-year incidence of death, reintervention, and valve-related adverse outcomes (endocarditis, thrombosis, or significant dysfunction) were 17%, 12%, and 8%, respectively. Endocarditis was diagnosed in 8 patients 2 to 29 months after TTVR, for an annualized incidence rate of 1.5% per patient-year (95% confidence interval: 0.45% to 2.5%). An additional 8 patients were diagnosed with clinically relevant valve thrombosis, 3 in the short term, 2 within 2 months, and 3 beyond 6 months. Only 2 of these 8 patients received anticoagulant therapy before thrombus detection (p = 0.13 vs. patients without thrombus). Prior endocarditis was not a risk factor for reintervention, endocarditis, or valve thrombosis, and there was no difference in valve-related outcomes according to TTVR valve type. CONCLUSIONS:TV dysfunction, endocarditis, and leaflet thrombosis were uncommon after TTVR. Patients with prior endocarditis were not at higher risk for endocarditis or other adverse outcomes after TTVR, and endocarditis occurred with similar frequency in different valve types. Though rare, leaflet thrombosis is an important adverse outcome, and further study is necessary to determine the appropriate level of prophylactic therapy after TTVR.
Authors: Philipp Lake; Elmar W Kuhn; Victor Mauri; Sascha Macherey; Julia Kaliba; Stephan Baldus; Christian Frerker; Tobias Schmidt Journal: Clin Res Cardiol Date: 2021-04-28 Impact factor: 5.460
Authors: Varius Dannenberg; Carolina Donà; Matthias Koschutnik; Max-Paul Winter; Christian Nitsche; Andreas A Kammerlander; Philipp E Bartko; Christian Hengstenberg; Julia Mascherbauer; Georg Goliasch Journal: Wien Klin Wochenschr Date: 2021-03-31 Impact factor: 1.704