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JACC Cardiovasc Interv. 2019 Jan 28;12(2):155-165. doi: 10.1016/j.jcin.2018.10.022. Epub 2018 Dec 26.

Outcomes After Current Transcatheter Tricuspid Valve Intervention: Mid-Term Results From the International TriValve Registry.

Author information

1
University Hospital of Zurich, University of Zurich, Zurich, Switzerland. Electronic address: Maurizio.Taramasso@usz.ch.
2
Asklepios Klinik St. Georg, Hamburg, Germany.
3
San Raffaele University Hospital, Milan, Italy.
4
InselSpital Bern, Bern, Switzerland.
5
St. Paul's Hospital, Vancouver, British Columbia, Canada.
6
Cardiocentro Ticino, Lugano, Switzerland.
7
LMU Klinikum, Munich, Germany.
8
Bichat Hospital, Paris, France.
9
St. Michaels Hospital, Toronto, Canada.
10
UKE Hamburg, Hamburg, Germany.
11
University Hospital of Zurich, University of Zurich, Zurich, Switzerland; St. Michaels Hospital, Toronto, Canada.
12
Westchester Medical Center, Valhalla, New York.
13
Charité University Hospital, Berlin, Germany.
14
Herzzentrum Leipzig, Leipzig, Germany.
15
New York-Presbyterian/Columbia University Medical Center, New York, New York.
16
University Hospital of Bonn, Bonn, Germany.
17
University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
18
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
19
Albertinen Hospital, Hamburg, Germany.
20
CardioVascular Center, Frankfurt, Germany.
21
Mount Sinai Hospital, New York, New York.

Abstract

OBJECTIVES:

A large, prospective international registry was developed to evaluate the initial clinical applications of transcatheter tricuspid valve intervention (TTVI) with different devices.

BACKGROUND:

TTVI for native tricuspid valve dysfunction has been emerging during the last few years as an alternative therapeutic option to serve a large high-risk population of patients with severe symptomatic tricuspid regurgitation (TR).

METHODS:

The TriValve Registry included 312 high-risk patients with severe TR (76.4 ± 8.5 years of age; 57% female; EuroSCORE II 9 ± 8%) at 18 centers. Interventions included repair at the level of the leaflets (MitraClip, Abbott Vascular, Santa Clara, California; PASCAL Edwards Lifesciences, Irvine, California), annulus (Cardioband, Edwards Lifesciences; TriCinch, 4tech, Galway, Ireland; Trialign, Mitraling, Tewksbury, Massachusetts), or coaptation (FORMA, Edwards Lifesciences) and replacement (Caval Implants, NaviGate, NaviGate Cardiac Structures, Lake Forest, California). Clinical outcomes were prospectively determined during mid-term follow-up.

RESULTS:

A total of 108 patients (34.6%) had prior left heart valve intervention (84 surgical and 24 transcatheter, respectively). TR etiology was functional in 93%, and mean annular diameter was 46.9 ± 9 mm. In 75% of patients the regurgitant jet was central (vena contracta 1.1 ± 0.5; effective regurgitant orifice area 0.78 ± 0.6 cm2). Pre-procedural systolic pulmonary artery pressure was 41 ± 14.8 mm Hg. Implanted devices included: MitraClip in 210 cases, Trialign in 18 cases, TriCinch first generation in 14 cases, caval valve implantation in 30 cases, FORMA in 24 cases, Cardioband in 13 cases, NaviGate in 6 cases, and PASCAL in 1. In 64% of the cases, TTVI was performed as a stand-alone procedure. Procedural success (defined as the device successfully implanted and residual TR ≤2+) was 72.8%. Greater coaptation depth (odds ratio: 24.1; p = 0.002) was an independent predictor of reduced device success. Thirty-day mortality was 3.6% and was significantly lower among patients with procedural success (1.9% vs. 6.9%; p = 0.04); Actuarial survival at 1.5 years was 82.8 ± 4% and was significantly higher among patients who had procedural success achieved.

CONCLUSIONS:

TTVI is feasible with different technologies, has a reasonable overall procedural success rate, and is associated with low mortality and significant clinical improvement. Mid-term survival is favorable in this high-risk population. Greater coaptation depth is associated with reduced procedural success, which is an independent predictor of mortality.

KEYWORDS:

transcatheter tricuspid valve intervention; tricuspid regurgitation; tricuspid valve

PMID:
30594510
DOI:
10.1016/j.jcin.2018.10.022

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