Clinical Outcomes Following Isolated Transcatheter Tricuspid Valve Repair

Bocchino, Pier Paolo; Angelini, Filippo; Vairo, Alessandro; Andreis, Alessandro; Fortuni, Federico; Franchin, Luca; Frea, Simone; Raineri, Claudia; Pidello, Stefano; Conrotto, Federico; Montefusco, Antonio; Alunni, Gianluca; Ferrari, Gaetano Maria De

doi:10.1016/j.jcin.2021.08.050

Cited by 26 publications

(13 citation statements)

References 39 publications

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“…Notwithstanding, according to previous studies, the improvements in functional status and activity capacity were consistent with the correction of TR severity regardless of the use of coaptation devices or annuloplasty devices. 10 The reduction to moderate or less TR was associated with a 3-fold reduction in mortality and unplanned HHF at 1 year compared with those with severe TR or greater postprocedure (8.8% versus 24.5%; HR: 0.31; p = 0.041). 27 In addition, patients whose TR was corrected to moderate or less severity were free of death or HHF within 6-month follow-up postprocedure.…”

Section: Discussionmentioning

confidence: 85%

“… 9 Another meta-analysis with a total of 771 patients undergoing ITTVR for moderate or greater TR, indicated the all-cause mortality rate to be 11% at a weighted mean of 212 days of follow-up. 10 However, the perioperative and short-term outcomes were not available in these meta-analyses. In our study, the pooled perioperative and short-term (within 30 days) all-cause mortality rates for patients undergoing TTVR were low at 1.0% and 3.3%, which were significantly reduced compared with those of patients undergoing tricuspid valve surgery.…”

Section: Discussionmentioning

confidence: 99%

“… 7 , 8 Previous systematic reviews concluded that TTVR was feasible and effective in the reduction of TR severity and improvement of symptoms and exercise capacity in patients with severe TR. 9 , 10 However, these studies mainly focused on functional and echocardiographic improvements, and major adverse events were rarely reported in their analyses. Therefore, we conducted this systematic review and meta-analysis to assess the periprocedural, short-term, and long-term effectiveness and safety outcomes of TTVR in patients with significant TR.…”

Section: Introductionmentioning

confidence: 99%

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Periprocedural, short-term, and long-term outcomes following transcatheter tricuspid valve repair: a systemic review and meta-analysis

Zhu

Kaisaier

et al. 2023

Therapeutic Advances in Chronic Disease

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Background: There has been an increasing use of transcatheter tricuspid valve repair (TTVR) recently. However, the periprocedural, short-term, and long-term outcomes of TTVR remain unclear. Objectives: To determine the clinical outcomes in patients with significant tricuspid regurgitation undergoing TTVR. Design: Systematic review and meta-analysis. Data Source and Methods: The systematic review and meta-analysis is reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and EMBASE were searched for clinical trials and observational studies until March 2022. Studies reporting the incidence of clinical outcomes after TTVR were included. The clinical outcomes included periprocedural, short-term (in-hospital or within 30 days), and long-term (>6-month follow-up) outcomes. The primary outcome was all-cause mortality whereas the secondary outcomes included technical success, procedural success, cardiovascular mortality, rehospitalization for heart failure (HHF), major bleeding, and single leaflet device attachment. The incidence of these outcomes across studies was pooled by a random-effects model. Results: A total of 21 studies with 896 patients were included. A total of 729 (81.4%) patients underwent isolated TTVR while only 167 (18.6%) patients underwent combined mitral and tricuspid valve repair. Over 80% of the patients used coaptation devices while approximately 20% used annuloplasty devices. The median follow-up duration was 365 days. Technical and procedural success was high at 93.9% and 82.1%, respectively. The pooled perioperative, short-term, and long-term all-cause mortality for patients undergoing TTVR was 1.0%, 3.3%, and 14.1%, respectively. The long-term cardiovascular mortality rate was 5.3% while the HHF rate was 21.5%. Major bleeding and single leaflet device attachment were two major complications, accounting for 14.3% and 6.4%, respectively, during long-term follow-up. Conclusion: TTVR is associated with high procedural success and low procedural and short-term mortality. However, all-cause mortality, cardiovascular mortality, and HHF rates remain high during long-term follow-up. Registration: PROSPERO (CRD42022310020).

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Periprocedural, short-term, and long-term outcomes following transcatheter tricuspid valve repair: a systemic review and meta-analysis

Zhu

Kaisaier

et al. 2023

Therapeutic Advances in Chronic Disease

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“…Long-term chronic right and left ventricular adaptations after surgery may lead to improved postoperative exercise capacity of TR patients (19). Previous studies have also confirmed that different TTVI devices could significantly improve the clinical symptoms of TR patients, which was demonstrated by the NYHA class, 6MWD, and KCCQ score (20). Additionally, right ventricular remodeling during follow-up, including the function.…”

Section: Discussionmentioning

confidence: 90%

Hemodynamics of transcatheter tricuspid valve replacement with Lux-Valve

Wang

Ning

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveTranscatheter tricuspid valve intervention (TTVI) has emerged as an alternative treatment option for high-risk and inoperable patients with symptomatic tricuspid regurgitation (TR). However, scarce data in hemodynamic profiles were available on TTVI. In this paper, we attempt to report the hemodynamic profiles of LuX-Valve.Methods30 patients from July 2020 to July 2021 were enrolled in this study. The patient was diagnosed with severe symptomatic TR. The clinical, invasive hemodynamic, and echocardiographic data were collected.ResultsThe surgical success rate was 100%. The cardiac index and stroke volume increased sharply from 2.42(2.27, 2.85) and 47.8(43.6, 62.0) to 3.04 ± 0.63 and 57.2 ± 14.7, respectively. With the elimination of TR and the increase of forward blood flow of the tricuspid valve, the extravascular lung water [798.0 (673.0, 1147.0) vs. 850.3 ± 376.1, P < 0.01] increased subsequently. The peak right atrium pressure decreased after Lux-Valve implantation (21.0 ± 6.4 vs. 19.4 ± 6.5, P < 0.05). On the contrary, the nadir right atrium pressure increased [10.0(8.0, 15.0) vs. 12.0(10.0, 17.0), P < 0.01]. Notably, the right atrium pressure difference dropped sharply from 9.0(5.0, 13.0) to 5.0(4.0, 8.0) after Lux-Valve implantation. There was no significant change in the pulmonary artery pressure. The right atrium volume decreased from 128(83, 188) to 91(67, 167) mL at 1 month and 107(66,157) mL at 6 months. With the remolding of the right heart chamber, the tricuspid annulus diameter shrank significantly from 42.5 ± 5.6 to 36.6 ± 6.3 mm at 1 month and 36.0 (33.0, 38.0) at 6 months.ConclusionInvasive right atrium pressure may act as a potential candidate for TR evaluation and procedural guidance. Elimination of TR by LuX-Valve implantation improves the cardiac output and right atrium pressure and has no significant effect on the pulmonary artery pressure even with the increment of forward blood flow, suggesting the hemodynamic superiority of transcatheter tricuspid valve replacement but needs further study.

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“…Compared with left-sided valvular heart disease, TR is often overlooked, and research focusing on the prognostic factors of tricuspid regurgitation is very limited. As symptoms and prognosis may improve with TR correction, it is vital to explore readily available prognostic factors to aid routine surveillance and clinical decisions for TR ( 11 ). The prognostic value of blood pressure (BP) and resting heart rate (RHR) has been confirmed in various diseases ( 12 – 14 ).…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of blood pressure and resting heart rate in patients with tricuspid regurgitation

Guo

Zhang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe prognostic value of blood pressure (BP) and resting heart rate (RHR) in tricuspid regurgitation (TR) patients is unknown.AimsThis study aimed to investigate the associations of BP and RHR with all-cause mortality in patients with TR.MethodsA total of 2,013 patients with moderate or severe TR underwent echocardiography and BP measurement. The associations of routinely measured BP and RHR with 2-year all-cause mortality were analyzed.ResultsThe cohort had 45.9% male patients and a mean age of 62.5 ± 15.9 years. At the 2-year follow-up, 165 patient deaths had occurred. The risk of death decreased rapidly, negatively correlating with systolic blood pressure (SBP) up to 120 mmHg and diastolic blood pressure (DBP) up to 70 mmHg. For RHR, the risk increased in direct proportion, starting at 80 beats per min. After adjusting for age, sex, body mass index (BMI), diabetes, coronary heart disease, pulmonary hypertension, estimated glomerular filtration rate (eGFR), and NYHA class, SBP [hazard ratio (HR):0.89; 95% CI:0.823–0.957 per 10 mmHg increase; P =0.002], DBP (HR:0.8; 95% CI:0.714–0.908 per 10 mmHg increase; P < 0.001), and RHR (HR: 1.1; 95% CI: 1.022–1.175 per 10 beats per min increase; P = 0.011) were independently associated with all-cause mortality. These associations persisted after further adjustments for echocardiographic indices, medications, serological tests, and etiologies.ConclusionIn this cohort of patients with TR, routinely measured BP and RHR were associated with all-cause mortality independently. However, further large-scale, high-quality studies are required to validate our findings.

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Clinical Outcomes Following Isolated Transcatheter Tricuspid Valve Repair

Cited by 26 publications

References 39 publications

Periprocedural, short-term, and long-term outcomes following transcatheter tricuspid valve repair: a systemic review and meta-analysis

Periprocedural, short-term, and long-term outcomes following transcatheter tricuspid valve repair: a systemic review and meta-analysis

Hemodynamics of transcatheter tricuspid valve replacement with Lux-Valve

Prognostic value of blood pressure and resting heart rate in patients with tricuspid regurgitation

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