Mizuki Miura1, Hannes Alessandrini2, Abdullah Alkhodair3, Adrian Attinger-Toller3, Luigi Biasco4, Philipp Lurz5, Daniel Braun6, Eric Brochet7, Kim A Connelly8, Sabine de Bruijn9, Paolo Denti10, Florian Deuschl11, Rodrigo Estevez-Loureiro12, Neil Fam8, Christian Frerker13, Mara Gavazzoni1, Jörg Hausleiter6, Dominique Himbert7, Edwin Ho14, Jean-Michel Juliard7, Ryan Kaple15, Christian Besler5, Susheel Kodali16, Felix Kreidel17, Karl-Heinz Kuck2, Azeem Latib18, Alexander Lauten19, Vanessa Monivas20, Michael Mehr6, Guillem Muntané-Carol21, Tamin Nazif16, Georg Nickenig22, Giovanni Pedrazzini4, François Philippon21, Alberto Pozzoli1, Fabien Praz23, Rishi Puri21, Josep Rodés-Cabau21, Ulrich Schäfer11, Joachim Schofer24, Horst Sievert9, Gilbert H L Tang25, Holger Thiele5, Karl-Philipp Rommel5, Alec Vahanian26, Ralph Stephan Von Bardeleben17, John G Webb3, Marcel Weber22, Stephan Windecker23, Mirjam Winkel23, Michel Zuber1, Martin B Leon16, Francesco Maisano1, Rebecca T Hahn16, Maurizio Taramasso27. 1. Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland. 2. Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany. 3. Cardiology Department, St. Paul Hospital, Vancouver, British Columbia, Canada. 4. Cardiology Department, Cardiocentro, Lugano, Switzerland. 5. Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany. 6. Cardiology Department, Klinikum der Universität München, Munich, Germany. 7. Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France. 8. Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Ontario, Canada. 9. Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany. 10. Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy. 11. Cardiology Department, University Heart Center Hamburg, Hamburg, Germany. 12. Cardiology Department, University Hospital Alvaro Cunqueiro, Vigo, Spain. 13. Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany; Cardiology Department, University Hospital of Köln, Köln, Germany. 14. Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Ontario, Canada; Cardiology Department, Montefiore Medical Center, New York, New York. 15. Cardiology Department, Westchester Medical Center, Valhalla, New York. 16. Cardiology Department, NewYork-Presbyterian/Columbia University Medical Center, New York, New York. 17. Cardiology Department, University Medical Center Mainz, Mainz, Germany. 18. Cardiology Department, Montefiore Medical Center, New York, New York. 19. Cardiology Department, Charité University Hospital, Berlin, Germany. 20. Cardiology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain. 21. Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. 22. Cardiology Department, Universitatsklinikum Bonn, Bonn, Germany. 23. Cardiology Department, Inselspital, Bern University Hospital, Bern, Switzerland. 24. Cardiology Department, Albertinen Heart Center, Hamburg, Germany. 25. Cardiac Surgery Department, Mount Sinai Hospital, New York, New York. 26. Cardiology Department, Universite de Paris, Paris, France. 27. Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland. Electronic address: maurizio.taramasso@usz.ch.
Abstract
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).
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).
Authors: Varius Dannenberg; Matthias Koschutnik; Carolina Donà; Christian Nitsche; Katharina Mascherbauer; Gregor Heitzinger; Kseniya Halavina; Andreas A Kammerlander; Georg Spinka; Max-Paul Winter; Martin Andreas; Markus Mach; Matthias Schneider; Anna Bartunek; Philipp E Bartko; Christian Hengstenberg; Julia Mascherbauer; Georg Goliasch Journal: Front Cardiovasc Med Date: 2022-06-02