Early and mid-term outcomes of transcatheter tricuspid valve repair: systematic review and meta-analysis of observational studies

Alperi, Alberto; Avanzas, Pablo; Almendárez, Marcel; León, Víctor; Hernández-Vaquero, Daniel; Silva, Iria; Valle, David Fernández del; Fernández, Félix; Díaz, Rocío; Rodes-Cabau, Josep; Morı́s, César; Pascual, Isaac

doi:10.1016/j.rec.2022.06.004

Cited by 4 publications

(4 citation statements)

References 30 publications

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“…Furthermore, the annuloplasty group had a higher incidence of major bleeding than the coaptation group (6.9% versus 5.2% perioperatively, and 12.5% versus 6.0% during the short-term follow-up, Supplementary Figures 4 and 5 ). This tendency was consistent with a recent meta-analysis that reported that bleeding complications were higher in the annuloplasty group than in the TEER group (13.3% versus 2.8%) 38 ; however, when the bleeding occurred was not mentioned in this analysis. According to a real-world study including the first 60 patients treated with the Cardioband annuloplasty system, major bleeding was one of the most common postprocedural adverse events, accounting for 11.7% of patients.…”

Section: Discussionsupporting

confidence: 93%

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: Discussionsupporting

confidence: 93%

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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“…More specifically, most tested devices so far showed a good safety profile, with high rates of implantation, acute postprocedural and periprocedural success, and low rates of device-related adverse events or mortality. In addition, most devices show a significant improvement in TR severity, with most patients having a reduction of at least 1 grade in echocardiographic evaluation of TR severity and a large percent of 2 grades, with valve implantation showing the best results in terms of residual TR [ 73 ]. Finally, considering that most trials are not randomized and do not have a large follow-up period, the need for a large randomized trial in the near future comparing transcatheter interventions with optimal medical therapy and surgery, as well as transcatheter valve repair and replacement, should be highlighted.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Tricuspid Valve Interventions: A Triumph for Transcatheter Procedures?

Dimitriadis

Pyrpyris

Aznaouridis

et al. 2023

Life

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Tricuspid regurgitation (TR) is a common valvular pathology, estimated to affect 1.6 million people in the United States alone. Even though guidelines recommend either medical therapy or surgical treatment for TR, the misconception of TR as a benign disease along with the high mortality rates of surgical intervention led to undertreating this disease and commonly describing it as a “forgotten” valve. Recently, the development of transcatheter interventions for TR show promising potential for use in the clinical setting. There are currently few approved and numerous tested percutaneously delivered devices, which can be categorized, based on their mechanism of action, to either valve repair or valve replacement procedures. Both procedures were tested in clinical trials and show an echocardiographic reduction in TR sustained for at least 1 year after the procedure, as well as symptom relief and functional improvement of the patients. Device selection should be personalized, taking into consideration the anatomy of each valve and the available options at each heart center. Moreover, appropriate patient selection and timing of the procedure are also crucial for the success of the procedure. In this review, we analyze the clinical trials available for all devices currently approved or tested, aiming to provide a comprehensive summary of the most recent evidence in the field of transcatheter TR interventions.

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“…The tool-box for the percutaneous treatment of tricuspid valve disease is rapidly expanding ( Figure 4 ), and a trend toward a tailored device selection taking into consideration anatomical features, clinical status and patients' risk profile is expected in the near future. A recent meta-analysis focusing on observational and single-arm trials for transcatheter tricuspid valve repair systems has demonstrated extremely low rates for major cardiovascular complications, especially for the edge-to-edge technique, whereas the main caveat for percutaneous tricuspid repair interventions seems to be the relatively high rates of residual significant TR ( 58 ). Therefore, current data suggest the superiority of TTV replacement vs. repair regarding valve performance and the presence of residual TR.…”

Section: Clinical Perspectivesmentioning

confidence: 99%

Transcatheter tricuspid valve interventions: Current status and future perspectives

Alperi

Almendárez

Álvarez

et al. 2022

Front. Cardiovasc. Med.

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The development of transcatheter therapies to treat valvular heart diseases has changed the rules of the game, particularly in the case of aortic stenosis and mitral regurgitation. In the last years, the tricuspid valve has also been the focus of these percutaneous techniques for several reasons: (1) tricuspid regurgitation is a frequent disease associated with poor clinical outcomes in spite of medical treatment, leading to end-stage right ventricular heart failure, (2) surgical tricuspid valve repair or replacement has been the treatment of choice for patients with tricuspid valve disease, but high mortality rates for isolated surgical tricuspid valve intervention have been reported in the literature, and (3) most patients with tricuspid pathology are ultimately denied cardiac surgery because of their comorbidity burden. Thus, in this context the development of less invasive catheter-based therapies would be of high clinical relevance. The present review provides an overview regarding the framework of chronic tricuspid regurgitation transcatheter therapeutic options, summarizes the transcatheter systems under clinical use or clinical evaluation with their technical features, and describes the updated current evidence in this challenging and evolving field.

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Early and mid-term outcomes of transcatheter tricuspid valve repair: systematic review and meta-analysis of observational studies

Cited by 4 publications

References 30 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

Transcatheter Tricuspid Valve Interventions: A Triumph for Transcatheter Procedures?

Transcatheter tricuspid valve interventions: Current status and future perspectives

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