Sean Cai1, Nicolas Bowers1, Arjan Dhoot1, Edwin C Ho2, Geraldine Ong3, Janine Eckstein1, Jeremy Edwards3, Neil Fam3, Kim A Connelly4. 1. University of Toronto, Toronto, Ontario, Canada. 2. St. Michael's Hospital, Toronto, Ontario, Canada; Montefiore Health System, Bronx, NY, USA. 3. St. Michael's Hospital, Toronto, Ontario, Canada. 4. St. Michael's Hospital, Toronto, Ontario, Canada. Electronic address: Kim.Connelly@unityhealth.to.
Abstract
AIMS: We aimed to identify the clinical characteristics and examine outcomes in patients with significant tricuspid regurgitation (TR) who received transcatheter tricuspid valve intervention (TTVI) compared with guideline directed medical therapy (GDMT). METHODS AND RESULTS: Between 2015 and 2019, 124 patients with symptomatic severe TR were assessed at St. Michael's Hospital. Seventy-one patients were ineligible and received GDMT only while 53 patients received TTVI and GDMT. During follow-up, TTVI was associated with significant improvements in NYHA functional class and 6-min walk distance (p < .001). GDMT patients had lower survival (46.9% vs 75.1%, p = .047) and lower freedom from heart failure hospitalization (HHF) and mortality (33.2% vs 62.7%, p = .027), higher incidences per 100 person-year of gastrointestinal bleeding [15.58 (95% CI 8.90-25.31) vs 4.24 (95% CI 0.85-12.37), p = .04] and acute kidney injury [36.98 (95% CI 26.17-50.76) vs 14.12 (95% CI 6.76-25.96), p = .001] compared with TTVI patients. CONCLUSION: TTVI in addition to GDMT was effective at improving TR symptoms, functional status, and was associated with lower rates of all-cause mortality, the combined endpoint of HHF and mortality, AKI and GI bleeding. Future randomized controlled trials on TTVI are needed.
AIMS: We aimed to identify the clinical characteristics and examine outcomes in patients with significant tricuspid regurgitation (TR) who received transcatheter tricuspid valve intervention (TTVI) compared with guideline directed medical therapy (GDMT). METHODS AND RESULTS: Between 2015 and 2019, 124 patients with symptomatic severe TR were assessed at St. Michael's Hospital. Seventy-one patients were ineligible and received GDMT only while 53 patients received TTVI and GDMT. During follow-up, TTVI was associated with significant improvements in NYHA functional class and 6-min walk distance (p < .001). GDMTpatients had lower survival (46.9% vs 75.1%, p = .047) and lower freedom from heart failure hospitalization (HHF) and mortality (33.2% vs 62.7%, p = .027), higher incidences per 100 person-year of gastrointestinal bleeding [15.58 (95% CI 8.90-25.31) vs 4.24 (95% CI 0.85-12.37), p = .04] and acute kidney injury [36.98 (95% CI 26.17-50.76) vs 14.12 (95% CI 6.76-25.96), p = .001] compared with TTVIpatients. CONCLUSION:TTVI in addition to GDMT was effective at improving TR symptoms, functional status, and was associated with lower rates of all-cause mortality, the combined endpoint of HHF and mortality, AKI and GI bleeding. Future randomized controlled trials on TTVI are needed.
Authors: Anna Sannino; Federica Ilardi; Rebecca T Hahn; Patrizio Lancellotti; Philipp Lurz; Robert L Smith; Giovanni Esposito; Paul A Grayburn Journal: Front Cardiovasc Med Date: 2022-07-11
Authors: Alberto Alperi; Marcel Almendárez; Rut Álvarez; Cesar Moris; Victor Leon; Iria Silva; Daniel Hernández-Vaquero; Isaac Pascual; Pablo Avanzas Journal: Front Cardiovasc Med Date: 2022-09-14