Interventions for valvular disease and heart failure

Outcomes of transcatheter tricuspid valve intervention by right ventricular function: a multicentre propensity-matched analysis

EuroIntervention 2021;17:e343-e352. DOI: 10.4244/EIJ-D-21-00191

Florian Schlotter
Florian Schlotter1, MD; Mizuki Miura2, MD, PhD; Karl-Patrik Kresoja1, MD; Brunilda Alushi3,4, MD; Hannes Alessandrini5, MD; Adrian Attinger-Toller6, MD; Christian Besler1, MD; Luigi Biasco7, MD; Daniel Braun8, MD; Eric Brochet9, MD; Kim A. Connelly10, MD; Sabine de Bruijn11, MD; Paolo Denti12, MD; Rodrigo Estevez-Loureiro13, MD; Neil Fam10, MD; Mara Gavazzoni12, MD; Dominique Himbert9, MD; Edwin C. Ho14, MD; Jean-Michel Juliard9, MD; Daniel Kalbacher15, MD; Ryan Kaple16, MD; Felix Kreidel17, MD; Azeem Latib14, MD; Edith Lubos15, MD; Sebastian Ludwig15, MD; Michael Mehr8, MD; Vanessa Monivas18, MD; Tamim M. Nazif19, MD; Georg Nickenig20, MD; Giovanni Pedrazzini7, MD; Alberto Pozzoli2, MD; Fabien Praz21, MD; Rishi Puri22, MD, PhD; Josep Rodés-Cabau23, MD; Karl-Philipp Rommel1, MD; Ulrich Schäfer24, MD; Joachim Schofer25, MD; Horst Sievert11, MD; Gilbert H.L. Tang26, MD, MSc, MBA; Holger Thiele1, MD; Matthias Unterhuber1, MD; Alec Vahanian9, MD; Ralph Stephan von Bardeleben17, MD; Maximilian von Roeder1, MD; John G. Webb6, MD; Marcel Weber20, MD; Mirjam G. Wild21, MD; Stephan Windecker21, MD; Michel Zuber2, MD; Jörg Hausleiter8, MD; Francesco Maisano27, MD; Martin B. Leon19, MD; Rebecca T. Hahn19, MD; Alexander Lauten3,4, MD; Maurizio Taramasso2, MD, PhD; Philipp Lurz1, MD, PhD
1. Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany; 2. Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland; 3. HELIOS Klinikum Erfurt, Department of General and Interventional Cardiology & Rhythmology, Erfurt, Germany; 4. Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, and German Centre for Cardiovascular Research (DZHK), Berlin, Germany; 5. Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany; 6. Cardiology Department, St. Paul’s Hospital, Vancouver, BC, Canada; 7. Cardiology Department, Cardiocentro, Lugano, Switzerland; 8. Cardiology Department, Klinikum der Universität München, Munich, Germany; 9. Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France; 10. Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, ON, Canada; 11. Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany; 12. Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy; 13. Hospital Universitario Alvaro Cunqueiro, Vigo, Spain; 14. Cardiology Department, Montefiore Medical Center, New York, NY, USA; 15. University Heart & Vascular Center Hamburg, Hamburg, Germany; 16. Division of Cardiology, Yale University School of Medicine, New Haven, CT, USA; 17. Department of Cardiology, University Medical Center Mainz, Mainz, Germany; 18. Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; 19. Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA; 20. Cardiology Department, Universitaetsklinikum Bonn, Bonn, Germany; 21. Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; 22. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA; 23. Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada; 24. Cardiology, Angiology and Intensive Care Medicine, Catholic Marienhospital, Hamburg, Germany; 25. MVZ Department Structural Heart Disease, Asklepios Klinik St. Georg, Hamburg, Germany; 26. Cardiac Surgery Department, Mount Sinai Hospital, New York, NY, USA; 27. University of Zurich, Zurich, Switzerland

Background: Tricuspid regurgitation (TR) has a poor prognosis and limited treatment options and is frequently accompanied by right ventricular (RV) dysfunction. Transcatheter tricuspid valve interventions (TTVI) to reduce TR have been shown to be safe and feasible with encouraging early results. Patient selection for TTVI remains challenging, with the role of right ventricular (RV) function being unknown.

Aims: The aims of this study were 1) to investigate survival in a TTVI-treated patient population and a conservatively treated TR population, and 2) to evaluate the outcome of TTVI as compared to conservative treatment stratified according to the degree of RV function.

Methods: We studied 684 patients from the multicentre TriValve cohort (TTVI cohort) and compared them to 914 conservatively treated patients from two tertiary care centres. Propensity matching identified 213 pairs of patients with severe TR. As we observed a non-linear relationship of RV function and TTVI outcome, we stratified patients according to tricuspid annular plane systolic excursion (TAPSE) to preserved (TAPSE >17 mm), mid-range (TAPSE 13-17 mm) and reduced (TAPSE <13 mm) RV function. The primary outcome was one-year all-cause mortality.

Results: TTVI was associated with a survival benefit in patients with severe TR when compared to matched controls (one-year mortality rate: 13.1% vs 25.8%; p=0.031). Of the three RV subgroups, only in patients with mid-range RV function was TTVI associated with an improved survival (p log-rank 0.004). In these patients, procedural success was associated with a reduced hazard ratio for all-cause mortality (HR 0.22; 95% CI: 0.09, 0.57).

Conclusions: TTVI is associated with reduced mortality compared to conservative therapy and might exert its highest treatment effect in patients with mid-range reduced RV function.

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chronic heart failuretricuspid diseaseTTVI
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