Tricuspid valve: Is Percutaneous Intervention Feasible in Patients with Definite Pacemaker?

Courtesy of Dr. Carlos Fava.

As we know, with higher life expectancy comes a significant increase in the use of definite pacemakers, defibrillators and resynchronization devices. Along these lines, the presence of catheters is associated to tricuspid regurgitation, which over time might become severe, leading to cardiac regurgitation and potentially heart failure. 

This group is now being treated with transcatheter tricuspid valve intervention (TTVI), but little is known about its efficacy.

The study looked at 470 tricuspid regurgitation patients form the TriValve registry undergoing TTVI between January 2015 and December 2018. 121 (25.7%) of these patients presented pacemakers or defibrillators (Cardiac Implantable Electronic Device – CIED) and its evolution was compared against 349 patients with no CIED.

The groups were similar, mean age was 76, they were mostly women, with 36% atrial fibrillation, and EuroScore 10. Patients receiving CIED presented a higher number of hospitalizations, more functional class III-IV, ascites, peripheral edema, COPD, need for diuretics and higher NT pro-BNP. The most frequent cause was functional.

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In addition, CIED patients presented lower ejection fraction, larger left ventricular diameter and area and higher pulmonary artery systolic pressure. However, effective regurgitant orifice area was smaller. 

In both groups, the device most used was the MitraClip, with 80% procedural success.

In-hospital mortality was 2.9% for the no-CIED and 3.7% for the CIED (p=0.7). 

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At 30 days, there were no significant differences neither in residual tricuspid regurgitation ≤2+ (70.8 vs. 73.7%) nor in improvement to functional class I-II (66% vs. 65% p=0.3).

Survival at one year was similar (80.7% vs. 73.6% p=0.3).

Conclusion

Transcatheter tricuspid valve intervention in patients with definite pacemaker or defibrillators is feasible and has good hospital outcomes which in the short term are comparable to those of patients with no pacemakers or defibrillators. 

Courtesy of Dr. Carlos Fava.

Original Title: Outcomes of TTVI in Patients With Pacemaker or Defibrillator Leads Data From the TriValve Registry.

Reference: Maurizio Taramasso, et al. J Am coll Cardiol Intv 2020;13:554-64.

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