More Evidence for the “Forgotten Valve.” Results from the TriValve Registry

Transcatheter tricuspid valve replacement is feasible with different devices, with a reasonable procedural success rate, and is associated with low peri-procedural mortality and significant clinical improvement. Mid-term survival was favorable in this high-risk population.

Greater leaflet coaptation depth was associated with reduced procedural success, which, unsurprisingly, turned out to be an independent predictor of mortality.

The TriValve international registry was developed to assess the clinical usefulness of the initial application of transcatheter tricuspid valve replacement with different devices in patients with severe and symptomatic tricuspid regurgitation and high surgical risk.

Read also: New Light on the ‘Forsaken Valve’.

This registry included 312 high-risk patients (76.4 ± 8.5 years of age; 57% female; EuroSCORE II 9 ± 8%) at 18 centers. Interventions included repair at the leaflet level (MitraClip or PASCAL), annulus repair (Cardioband, TriCinch, and Trialign), or coaptation (FORMA) and replacement (caval implants, NaviGate, etc.).

More than one third of patients had prior intervention on a valve (whether surgical or transcatheter). Regurgitation etiology was functional in 93% of patients and mean annular diameter was 46.9 ± 9 mm; additionally, in most patients, the regurgitant jet was central (vena contracta 1.1 ± 0.5; effective regurgitant orifice area 0.78 ± 0.6 cm2). Pre-procedural systolic pulmonary artery pressure was high, with mean systolic pulmonary pressure 41 ± 14.8 mmHg.

The device most frequently used was MitraClip, with 210 cases, followed by all other devices with an average of 15-20 devices each.

Read also: TCT 2017 | The TRI-REPAIR and the FORMA Trials: New Devices for the “Forgotten Valve”.

Procedural success (defined as residual regurgitation ≤2+) was achieved in 72.8% of cases. Greater coaptation depth was an independent predictor of procedural failure (p = 0.002).

Thirty-day overall mortality was 3.6%; however, there was a significant difference between patients with and without procedural success (1.9% vs. 6.9%; p = 0.04).

Original title: Outcomes After Current Transcatheter Tricuspid Valve Intervention. Mid-Term Results from the International TriValve Registry.

Reference: Maurizio Taramasso et al. J Am Coll Cardiol Intv 2019. Article in press.

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome