Mathias Orban1, Karl-Philipp Rommel2, Edwin C Ho3, Matthias Unterhuber2, Alberto Pozzoli4, Kim A Connelly5, Simon Deseive1, Christian Besler2, Geraldine Ong5, Daniel Braun6, Jeremy Edwards5, Mizuki Miura4, Gökhan Gülmez4, Lukas Stolz6, Mara Gavazzoni4, Michel Zuber7, Martin Orban1, Michael Nabauer6, Francesco Maisano4, Holger Thiele2, Steffen Massberg1, Maurizio Taramasso4, Neil P Fam5, Philipp Lurz2, Jörg Hausleiter8. 1. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany. 2. Heart Center Leipzig at University Leipzig, Leipzig, Germany. 3. Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Division of Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland. 4. Division of Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland. 5. Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. 6. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany. 7. Division of Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland; Division of Cardiology, University Hospital of Zurich, Zurich, Switzerland. 8. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany. Electronic address: joerg.hausleiter@med.uni-muenchen.de.
Abstract
OBJECTIVES: The goal of this study was to evaluate the effect of transcatheter edge-to-edge tricuspid valve repair (TTVR) for severe tricuspid regurgitation (TR) on hospitalization for heart failure (HHF) and HF-related endpoints. BACKGROUND: Patients with severe TR need effective therapies beyond conservative treatment. The impact of TTVR on HHF and HF-related endpoints is unknown. METHODS: Isolated TTVR was performed in 119 patients. Assessments were conducted of New York Heart Association functional class, 6-min walk distance, Minnesota Living with Heart Failure Questionnaire scores, N-terminal pro-B-type natriuretic peptide level, and medication. HHFs were analyzed in the preceding 12 months before and until the longest available follow-up after TTVR. Results were compared with those of 114 patients who underwent combined mitral and tricuspid valve repair. RESULTS: Procedural success with a reduction to moderate or less TR and no in-hospital death was achieved in 82% of patients. With a median follow-up of 360 days (interquartile range: 187 to 408 days), a durable TR reduction to moderate or less was achieved in 72% of patients (p < 0.001). TTVR reduced the annual rate of HHF by 22% (1.21 to 0.95 HHF/patient-year; p = 0.02), with concomitant clinical improvement in New York Heart Association functional class (patients in class II or lower: 9% to 67%; p < 0.001), 6-min walk distance (+39 m; p = 0.001), and Minnesota Living with Heart Failure Questionnaire score (-6 points; p = 0.02). N-terminal pro-B-type natriuretic peptide level decreased numerically by 783 pg/ml. Diuretic dose before TTVR was increased, but HF medication did not change after TTVR. Procedural success was associated with improved 1-year survival (79% vs. 60%; p = 0.04) and event-free-survival (death + first HHF: 67% vs. 40%; p = 0.001). Transcatheter mitral and tricuspid valve repair-treated patients had comparable outcomes. CONCLUSIONS: TTVR for severe TR is associated with a reduction of HHF and improved clinical outcomes.
OBJECTIVES: The goal of this study was to evaluate the effect of transcatheter edge-to-edge tricuspid valve repair (TTVR) for severe tricuspid regurgitation (TR) on hospitalization for heart failure (HHF) and HF-related endpoints. BACKGROUND:Patients with severe TR need effective therapies beyond conservative treatment. The impact of TTVR on HHF and HF-related endpoints is unknown. METHODS: Isolated TTVR was performed in 119 patients. Assessments were conducted of New York Heart Association functional class, 6-min walk distance, Minnesota Living with Heart Failure Questionnaire scores, N-terminal pro-B-type natriuretic peptide level, and medication. HHFs were analyzed in the preceding 12 months before and until the longest available follow-up after TTVR. Results were compared with those of 114 patients who underwent combined mitral and tricuspid valve repair. RESULTS: Procedural success with a reduction to moderate or less TR and no in-hospital death was achieved in 82% of patients. With a median follow-up of 360 days (interquartile range: 187 to 408 days), a durable TR reduction to moderate or less was achieved in 72% of patients (p < 0.001). TTVR reduced the annual rate of HHF by 22% (1.21 to 0.95 HHF/patient-year; p = 0.02), with concomitant clinical improvement in New York Heart Association functional class (patients in class II or lower: 9% to 67%; p < 0.001), 6-min walk distance (+39 m; p = 0.001), and Minnesota Living with Heart Failure Questionnaire score (-6 points; p = 0.02). N-terminal pro-B-type natriuretic peptide level decreased numerically by 783 pg/ml. Diuretic dose before TTVR was increased, but HF medication did not change after TTVR. Procedural success was associated with improved 1-year survival (79% vs. 60%; p = 0.04) and event-free-survival (death + first HHF: 67% vs. 40%; p = 0.001). Transcatheter mitral and tricuspid valve repair-treated patients had comparable outcomes. CONCLUSIONS: TTVR for severe TR is associated with a reduction of HHF and improved clinical outcomes.
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