Philipp Lurz1, Mathias Orban2,3, Christian Besler1, Daniel Braun2, Florian Schlotter1, Thilo Noack4, Steffen Desch1, Nicole Karam2,5, Karl-Patrik Kresoja1, Christian Hagl6, Michael Borger4, Michael Nabauer2, Steffen Massberg2,3, Holger Thiele1, Jörg Hausleiter2,3, Karl-Philipp Rommel1. 1. Department of Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany. 2. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistrasse 15, 81377 Munich, Germany. 3. Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Biedersteiner Strasse 29, Munich, Germany. 4. Department of Cardiac Surgery, Heart Center at University of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany. 5. Department of Cardiology, European Hospital Georges Pompidou and Paris Cardiovascular Research Center (INSERMU970), 20 rue Leblanc, 75015 Paris, France. 6. Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Marchioninistrasse 15, 81377 Munich, Germany.
Abstract
AIMS: Patients with pulmonary hypertension (PHT) are often excluded from surgical therapies for tricuspid regurgitation (TR). Transcatheter tricuspid valve repair (TTVR) with the MitraClip™ technique is a novel treatment option for these patients. We aimed to assess the role of PHT in severe TR and its implications for TTVR. METHODS AND RESULTS: A total of 243 patients underwent TTVR at two centres. One hundred twenty-one patients were grouped as iPHT+ [invasive systolic pulmonary artery pressures (PAPs) ≥50 mmHg]. Patients were similarly stratified according to echocardiographic PAPs (ePHT). The occurrence of the combined clinical endpoint (death, heart failure hospitalization, and reintervention) was investigated during a follow-up of 330 (interquartile range 175-402) days. iPHT+ patients were at higher preoperative risk (P < 0.01), had more severe symptoms (P = 0.01), higher N-terminal pro-B-type natriuretic peptide levels (P < 0.01), more impaired right ventricular (RV) function (P < 0.01), and afterload corrected RV function (P < 0.01). Procedural TTVR success was similar in iPHT+ and iPHT- patients (84 vs. 84%, P = 0.99). The echocardiographic diagnostic accuracy to detect iPHT was only 55%. During follow-up, 35% of patients reached the combined clinical endpoint. The discordant diagnosis of iPHT+/ePHT- carried the highest risk for the combined clinical endpoint [HR 3.76 (CI 2.25-6.37), P < 0.01], while iPHT+/ePHT+ patients had a similar survival-free time from the combined endpoint compared to iPHT- patients (P = 0.48). In patients with isolated tricuspid procedure (n = 131) a discordant iPHT+/ePHT- diagnosis and an impaired afterload corrected RV function (P < 0.01 for both) were independent predictors for the occurrence of the combined endpoint. CONCLUSION: The discordant echocardiographic and invasive diagnosis of PHT in severe TR predicts outcomes after TTVR. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Patients with pulmonary hypertension (PHT) are often excluded from surgical therapies for tricuspid regurgitation (TR). Transcatheter tricuspid valve repair (TTVR) with the MitraClip™ technique is a novel treatment option for these patients. We aimed to assess the role of PHT in severe TR and its implications for TTVR. METHODS AND RESULTS: A total of 243 patients underwent TTVR at two centres. One hundred twenty-one patients were grouped as iPHT+ [invasive systolic pulmonary artery pressures (PAPs) ≥50 mmHg]. Patients were similarly stratified according to echocardiographic PAPs (ePHT). The occurrence of the combined clinical endpoint (death, heart failure hospitalization, and reintervention) was investigated during a follow-up of 330 (interquartile range 175-402) days. iPHT+ patients were at higher preoperative risk (P < 0.01), had more severe symptoms (P = 0.01), higher N-terminal pro-B-type natriuretic peptide levels (P < 0.01), more impaired right ventricular (RV) function (P < 0.01), and afterload corrected RV function (P < 0.01). Procedural TTVR success was similar in iPHT+ and iPHT- patients (84 vs. 84%, P = 0.99). The echocardiographic diagnostic accuracy to detect iPHT was only 55%. During follow-up, 35% of patients reached the combined clinical endpoint. The discordant diagnosis of iPHT+/ePHT- carried the highest risk for the combined clinical endpoint [HR 3.76 (CI 2.25-6.37), P < 0.01], while iPHT+/ePHT+ patients had a similar survival-free time from the combined endpoint compared to iPHT- patients (P = 0.48). In patients with isolated tricuspid procedure (n = 131) a discordant iPHT+/ePHT- diagnosis and an impaired afterload corrected RV function (P < 0.01 for both) were independent predictors for the occurrence of the combined endpoint. CONCLUSION: The discordant echocardiographic and invasive diagnosis of PHT in severe TR predicts outcomes after TTVR. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Mark Lachmann; Elena Rippen; Tibor Schuster; Erion Xhepa; Moritz von Scheidt; Teresa Trenkwalder; Costanza Pellegrini; Tobias Rheude; Amelie Hesse; Anja Stundl; Gerhard Harmsen; Shinsuke Yuasa; Heribert Schunkert; Adnan Kastrati; Karl-Ludwig Laugwitz; Michael Joner; Christian Kupatt Journal: Open Heart Date: 2022-10
Authors: Alina Zubarevich; Marcin Szczechowicz; Andreas Brcic; Anja Osswald; Konstantinos Tsagakis; Daniel Wendt; Bastian Schmack; Michel Pompeu B O Sá; Jef Van den Eynde; Arjang Ruhparwar; Konstantin Zhigalov Journal: J Cardiothorac Surg Date: 2020-11-16 Impact factor: 1.637