Interventions for valvular disease and heart failure

Leaflet-to-annulus index and residual tricuspid regurgitation following tricuspid transcatheter edge-to-edge repair

EuroIntervention 2022;18:e169-e178. DOI: 10.4244/EIJ-D-21-00862

Tetsu Tanaka
Tetsu Tanaka1, MD; Atsushi Sugiura1, MD, PhD; Refik Kavsur1, MD; Johanna Vogelhuber1, MD; Can Öztürk1, MD; Marc Ulrich Becher1, MD; Sebastian Zimmer1, MD; Georg Nickenig1, MD; Marcel Weber1, MD
1. Medzinische Klinik und Poliklinik Ⅱ, Universitätsklinikum Bonn, Bonn, Germany

Background: A mismatch between tricuspid leaflet size and annular dilation is one of the morphological features tied to the development of tricuspid regurgitation (TR).

Aims: We assessed the association of the leaflet-to-annulus index (LAI) with residual TR after transcatheter edge-to-edge repair (TEER).

Methods: Consecutive patients who underwent TEER for TR were enrolled. Significant residual TR was defined as a post-procedural TR ≥3+, and patients were divided into two groups according to the amount of residual TR. The LAI was retrospectively calculated using procedural transoesophageal echocardiography and was defined as follows: (anterior leaflet length+septal leaflet length)/septolateral tricuspid annulus diameter.

Results: Of 140 patients, 43 patients had residual TR ≥3+ after TEER. The patients with residual TR ≥3+ had a lower LAI compared to those with residual TR <3+ (1.04±0.10 vs 1.13±0.09; p=0.001). In multivariable analysis, the LAI was associated with residual TR ≥3+ (odds ratio [OR] [per 0.1 increase]: 0.57; 95% confidence interval [95% CI]: 0.35–0.94; p=0.02), independent of baseline TR severity or coaptation gap size. Patients with residual TR ≥3+ had a higher incidence of the composite outcome, consisting of all-cause mortality and heart failure hospitalisation within one year after TEER (47.1% vs 26.6%, p=0.02). Residual TR ≥3+ was an independent predictor of the composite outcome within one year (hazard ratio: 2.04; 95% CI: 1.01–4.11; p=0.04).

Conclusions: The leaflet-to-annulus mismatch (i.e., LAI) is associated with residual TR ≥3+ after TEER for TR. A detailed echocardiographic analysis of the tricuspid valve will be conducive to identifing suitable subjects for TEER.

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transcatheter edge-to-edge repairtransoesophageal echocardiogramtricuspid regurgitation
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