The natural history of tricuspid regurgitation is associated to hospitalization for cardiac failure and mortality. This is why the AHA/ACC guidelines recommend surgery when the tricuspid fails during left valve surgical repair, because its slow progression is associated with high mortality (35%).
Many of these patients are high risk and percutaneous intervention has surged as an interesting alternative, even though at present its inhospital complication rates range from 5% to 9%, depending on the series.
The study analyzed the CLASP TR at one year, which included 65 patients with tricuspid regurgitation. The PASCAL and PASCAL ACE were used.
Patient mean age was 77, more than half were women, 15% presented diabetes, 30% heart disease, 6% MI, 10% stroke, 28% ascites, 9% cirrhosis, and 7% intestinal bleeding.
43% had kidney function deterioration and eGFR was 53 ml/min.
30% presented myocardial revascularization surgery (CABG), 16% aortic valve surgery or intervention, and 20% mitral valve surgery or intervention. Also, 14% had a pacemaker.
All patients were in functional class (FC) III-IV and mortality STS score was 5%.
97% presented severe tricuspid regurgitation, massive or torrential.
Implantation success rate was 90.8%, and most patients received between one and two devices.
At 30 days, mortality resulted 3.1%, stroke 1.5% and there were no differences in need for reintervention.
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Between 30 days and one year, 3 patients presented cardiovascular death, 2 stroke, and one reintervention.
At one year, survival was 87.9% and freedom from hospitalization for cardiac failure was 78%. 92% were in functional class I-II, 86% had mild to moderate tricuspid regurgitation with significant improvement in quality of like, and 6-minute walk test. ECG showed significant reduction of tricuspid annulus diameter, regurgitation jet, right ventricular end-diastolic diameter, right atrial diameter and volume and vena cava diameter.
The annualized reduction by hospitalization for cardiac failure pre and post implantation was 56%.
Conclusion
The PASCAL system showed low complications and high survival rates with sustained improvement in tricuspid regurgitation, functional capacity and quality of life at one year.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: 1-Year Outcomes of Transcatheter Tricuspid Valve Repair.
Reference: Kodali, et al. J Am Coll Cardiol 2023;81:1766–1776.
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