The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Clinical impact of elevated tricuspid valve inflow gradients after transcatheter edge-to-edge tricuspid valve repair

DOI: 10.4244/EIJ-D-19-00237

1. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany, Germany
2. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
3. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
4. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
5. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
6. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
7. Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany; Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
8. European Hospital Georges Pompidou (Cardiology Department) and Paris Cardiovascular Research Center (INSERMU970), Paris, France
9. Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany; Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
10. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
11. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
12. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
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Aims: The aim of this study was to compare outcome of patients with a post-procedural tricuspid valve gradient (TVG) of >3 mmHg vs. ≤3 mmHg after transcatheter edge-to-edge tricuspid valve repair (TTVR). 

Methods and results: Between March 2016 and October 2018 we treated 145 patients with severe tricuspid regurgitation (TR) with TTVR by placing 2.2±0.7 clips per patient. Device success (TR reduction ≥1° to at least moderate) was achieved in 125 patients (86.2%). TTVR resulted in an elevated TVG >3 mmHg in 25 (17.2%) patients. Device success (84% vs. 86.7%, p=0.9), number of clips implanted (2.3±0.7 vs. 2.2±0.7, p=0.33), clinical improvement including NYHA class (III/IV 24% vs. 28%, p=0.92) and increase in 6 minute walking test at 1 month (67 m [IQR 5-103 m] vs. 56 m [IQR 8-97 m], p=0.93), mortality (HR 1.07; 95% CI [0.43-2.65], plogrank=0.88) and the combined endpoint mortality and hospitalization for heart failure at one year (HR 1.07; 95% CI [0.46-2.48], plogrank=0.88) was similar between patients with a TVG >3 mmHg vs. patients with a TVG ≤3mmHg. 

Conclusions: A small cohort of patients demonstrated with an elevated TVG higher than 3 mmHg at discharge. This elevation had no impact on clinical improvement, on mortality and hospitalization for heart failure.

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