Tricuspid regurgitation (TR) has been associated with worse survival and hospitalization for cardiac failure (CF). The current guidelines recommend surgery as treatment, despite its 8 – 15% 30-day mortality rate. And there is no mention of a transcatheter intervention, especially for patients with severe TR and right ventricular deterioration.
Several percutaneous intervention devices have recently been developed. Edge-to-edge devices have been the most assessed, with promising results in high risk populations presenting multiple comorbidities.
There are a few studies on transcatheter edge-to-edge repair (TEER) for TR; however, its evolution and safety, especially in patients with right ventricular function deterioration (RV), remain unclear.
This study looked at 262 patients undergoing tricuspid TEER, 44 (16.8%) presenting right ventricular function deterioration (RVFD), defined as tricuspid annular plane systolic excursion (TAPSE) <17 mm and right ventricular functional area change (RVFAC) <35%.
Patient mean age was 79, 49% were men, with EuroSCORE II 6.2%. 84% presented hypertension, 23.3% diabetes, 93% atrial fibrillation, 24% MI, 31% prior pacemaker, and 10% stroke. Creatinine clearance was 50 ml/min, NT pro BNP was 2039 and bilirubin was 0.9.
Read also: Cardioband in Tricuspid Valve Regurgitation.
Left ventricular ejection fraction was lower in patients with RVFD (56% vs 49%, p<0.001), as was TAPSE (19 vs 13, p<0.001) and RVFAC (46 vs 29, p<0.001). TR was severe in 53%, massive in 37% and torrential in 10%.
MitraClip were implanted in 36.6%, TriClip in 36.3% and Pascal in 7.1%. Procedural success was 94% and device per patient was average 1.8. Echo-Doppler 4 days after procedure revealed patients with no right ventricular function deterioration saw a decline in TAPSE and RVFAC (TAPSE, 19.0 vs 17.9 mm; P=0.001; RVFAC, 46.2% vs 40.3%; P<0.001). This was not observed in patients with deteriorated RVFAC (TAPSE, 13.2 vs 15 mm; P=0.011; RVFAC, 29.6% vs 31.6%; P=0.14).
At 30 days, there was no difference in mortality between patients with conserved RV function or RVFAC respectively, also no difference in incidence of stroke, conversion to surgery, major bleeding, kidney function deterioration, pericardial effusion or need for transfusion. 76% presented TR ≤2+.
At two years, mortality was higher in patients with deteriorated RVFAC (56.3% vs 27%, p<0.001), as was cardiovascular mortality (39% vs 14%, p<0.001) and hospitalization for cardiac failure (49.1% vs 29.1%, p=0.007). Both groups improved their functional class.
After multivariable analysis at 2 years, mortality was associated with TAPSE, RVFAC, left ventricular function and glomerular filtration.
Conclusion
Edge-to-edge repair is safe and feasible for tricuspid regurgitation in patients with right ventricular function deterioration. Right ventricular function decline was observed in patients with conserved right ventricular function but not in patients with deteriorated right ventricular function.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: Outcomes of Transcatheter Tricuspid Edge-to- Edge Repair in Patients With Right Ventricular Dysfunction.
Reference: Johanna Vogelhuber, et al. Circ Cardiovasc Interv. 2024;17:e013156. DOI: 10.1161/CIRCINTERVENTIONS.123.013156.
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