Physiological and Clinical Changes After Tricuspid Repair

After the recent announcement by the US Food and Drug Administration (FDA) green-lighting transcatheter aortic valve replacement (TAVR) in patients across the whole spectrum, and given the advancements regarding devices already in the market (such as MitraClip) and a variety of pulmonary valves, there is only one territory left to conquer: the long forgotten tricuspid valve. Its status has resulted in many editorials literally calling it “the forgotten valve” (EuroIntervention 2017; 12: e1799-e1801).

This study analyzed the impact of chronic right ventricular volume overload and its outcomes after tricuspid regurgitation reduction on biventricular function.

Transcatheter tricuspid “edge-to-edge” repair is a new treatment option for patients with tricuspid regurgitation at high surgical risk.

A total of 29 patients with severe isolated tricuspid regurgitation received treatment using the MitraClip system. Follow-up was conducted using cardiac magnetic resonance at 1 and 6 months.

Read also: Impact of Edge to Edge Transcatheter Tricuspid Valve Repair.

Regurgitant fraction was reduced from 41% to 21% (p < 0.01) without any increase in the right ventricular afterload. The right ventricular end-diastolic volume and the right ventricular stroke volume were reduced significantly, while the effective antegrade flow increased.

This also improved the left ventricular filling with an increase in the end-diastolic volume and the stroke volume: ultimately, an augmentation of cardiac indices (2.2 ± 0.6 L/min/m² vs. 2.7 ± 0.6 L/min/m²; p < 0.01). These results at one month were still true at 6 months.

After the procedure, patient New York Heart Association functional class significantly improved, peripheral edema significantly decreased, and the 6-min walk test distance increased by 20% and 22% after 1 and 6 months, respectively.

Conclusion

Transcatheter treatment of tricuspid regurgitation using the MitraClip system reduces chronic right ventricular volume overload without increasing the right ventricular afterload, it improves left ventricular filling and, ultimately, cardiac indices. These changes translate into significant symptomatic improvement for patients.

The biventricular physiological and clinical improvement is maintained at 6 months after the procedure.

Original title:: Physiological and Clinical Consequences of Right Ventricular Volume Overload Reduction After Transcatheter Treatment for Tricuspid Regurgitation.

Reference: Karl-Philipp Rommel et al. J Am Coll Cardiol Intv 2019. Article in press.

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