Predictors and prognostic relevance of tricuspid alterations in patients undergoing transcatheter edge-to-edge mitral valve repair

Kavsur, Refik; Iliadis, Christos; Spieker, Maximilian; Brachtendorf, Birthe M; Tiyerili, Vedat; Horn, Patrick; Baldus, Stephan; Kelm, Malte; Nickenig, Georg; Pfister, Roman; Westenfeld, Ralf; Becher, Marc Ulrich

doi:10.4244/eij-d-20-01094

Cited by 22 publications

(21 citation statements)

References 21 publications

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“…Similarly, recent large cohort studies on adults with acquired heart disease have reported such an association when MR was greater than moderate. 30 , 31 The progression of TV annular dilatation and subsequent functional TR are caused by further worsening of pulmonary hypertension, atrial arrhythmias, and right and left ventricle interdependence. 32 Although the mechanism of TR recurrence was not systematically available in our study, we hypothesize that the mechanism by which preoperative MR contributes to TR recurrence in our cohort of patients with congenital heart disease is similar.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and risk analysis after tricuspid valve surgery for non-Ebstein 2-ventricle congenital tricuspid valve diseases

et al. 2022

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Section: Discussionmentioning

confidence: 99%

Outcomes and risk analysis after tricuspid valve surgery for non-Ebstein 2-ventricle congenital tricuspid valve diseases

et al. 2022

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“…This study was designed as a retrospective analysis of data from the Heart Failure Network Rhineland registry, which is a multicentre, prospective, observational registry of symptomatic patients with MR who underwent TMVR at three high‐volume heart centres in Germany (University Hospitals of Bonn, Cologne, and Düsseldorf). 15 , 16 We identified consecutive patients who underwent their first edge‐to‐edge TMVR with the MitraClip system from October 2011 to September 2018. Only patients with available pre‐procedural and post‐procedural [2 months ± 1 month after TMVR (henceforth referred to as ‘2 months’)] NT‐proBNP results were included in the analysis (Supporting Information, Figure S1 ).…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Periprocedural changes in natriuretic peptide levels and clinical outcome after transcatheter mitral valve repair

et al. 2021

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Aims This multicentre study investigated the association of periprocedural changes in the levels of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) with clinical outcomes after transcatheter edge‐to‐edge mitral valve repair (TMVR). Methods and results Patients were retrospectively analysed who underwent TMVR with the MitraClip system (Abbott Vascular, Santa Clara, CA, USA) and had available sequential NT‐proBNP testing at baseline and 2 months after TMVR. Periprocedural changes in NT‐proBNP following TMVR were assessed as the percent change in NT‐proBNP between baseline and the 2 month follow‐up, and the significant reduction in NT‐proBNP was defined as a decrease of >30% in the follow‐up NT‐proBNP compared with the pre‐procedural NT‐proBNP level. Primary outcome was defined as a composite outcome consisting of all‐cause mortality and hospitalization due to heart failure from 2 months to 2 years after TMVR. Additionally, we identified the cut‐off value of pre‐procedural NT‐proBNP to predict the composite outcome using a receiver operating characteristic analysis (cut‐off: 2485 pg/mL). Of 485 patients undergoing TMVR (age: 76.2 ± 9.2 years, female: 42.1%, secondary mitral regurgitation: 67.2%), 150 patients (30.9%) had the significant reduction in NT‐proBNP (>30%) following the procedure. Patients with the NT‐proBNP reduction had a lower incidence of the composite outcome, compared with those without the reduction in NT‐proBNP (31.4% vs. 40.2%; log‐rank P = 0.03). The significant reduction in NT‐proBNP was also associated with a lower risk of the composite outcome [adjusted hazard ratio (HR): 0.67; 95% confidence interval (CI): 0.45–0.97; P = 0.04], independently of pre‐procedural NT‐proBNP levels and other clinical parameters. The percent change in NT‐proBNP was associated with a linear trend of the incidence of the composite outcome (adjusted HR per 10% decrease: 0.96; 95% CI: 0.94–0.98; P < 0.001). A stratified analysis revealed that the prognostic impact of the significant reduction in NT‐proBNP was consistent among clinical subgroups, including aetiology of mitral regurgitation (P for interaction = 0.99). Higher pre‐procedural NT‐proBNP level (>2485 pg/mL) was associated with the increased risk of the composite outcome (adjusted HR: 1.50; 95% CI: 1.03–2.17; P = 0.03); however, patients with a higher pre‐procedural NT‐proBNP who achieved the significant reduction in NT‐proBNP had a similar risk of the composite outcome to those with a lower pre‐procedural NT‐proBNP. Conclusions Changes in sequential NT‐proBNP measurements were associated with clinical outcomes within 2 years after TMVR. The assessment of NT‐proBNP dynamics may be valuable to assess the residual risk for patients undergoing TMVR and could assist with post‐procedural management after TMVR.

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“…Recent studies focused on the change in TR severity after M-TEER by hemodynamic pulmonary circulatory relief after MR reduction. Successful M-TEER was associated with modest reduction in TR severity as early as 1 month after procedure ( 46 , 47 ). Nevertheless, in a significant proportion of patients, TR remains stable or even worsens.…”

Section: The Role Of Tricuspid Regurgitation In Mitral Valve Transcat...mentioning

confidence: 99%

“…Several retrospective observational studies sought to identify predictors for worsening TR after M-TEER. Identified predictors were atrial fibrillation, the degree of residual postprocedural MR, TAD and less procedural sPAP reduction ( 47 , 48 ). Consequently, effective reduction of MR, as well as preserved RV dimensions seem to be important prerequisites for reduction of concomitant TR.…”

Section: The Role Of Tricuspid Regurgitation In Mitral Valve Transcat...mentioning

confidence: 99%

Right ventricular function in transcatheter mitral and tricuspid valve edge-to-edge repair

Stolz

Doldi

Weckbach

et al. 2022

Front. Cardiovasc. Med.

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Since transcatheter edge-to-edge repair (TEER) has become a valuable therapy in the treatment of both, mitral (MR) and tricuspid regurgitation (TR), the question of optimized patient selection has gained growing importance. After years of attributing rather little attention to the right ventricle (RV) and its function in the setting of valvular heart failure, this neglect has recently changed. The present review sought to summarize anatomy and function of the RV in a clinical context and aimed at presenting the current knowledge on how the RV influences outcomes after TEER for atrioventricular regurgitation. The anatomy of the RV is determined by its unique shape, which necessitates to use three-dimensional imaging methods for detailed and comprehensive characterization. Complex parameters such as RV to pulmonary artery coupling (RVPAc) have been developed to combine information of RV function and afterload which is primary determined by the pulmonary vasculature and LV filling pressure. Beyond that, TR, which is closely related to RV function also plays an important role in the setting of TEER. While mitral valve transcatheter edge-to-edge repair (M-TEER) leads to reduction of concomitant TR in some patients, the prognostic value of TR in the setting of M-TEER remains unclear. Overall, this review summarizes the current state of knowledge of the outstanding role of RV function and associated TR in the setting of TEER and outlines the unsolved questions associated with right-sided heart failure.

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Predictors and prognostic relevance of tricuspid alterations in patients undergoing transcatheter edge-to-edge mitral valve repair

Cited by 22 publications

References 21 publications

Outcomes and risk analysis after tricuspid valve surgery for non-Ebstein 2-ventricle congenital tricuspid valve diseases

Outcomes and risk analysis after tricuspid valve surgery for non-Ebstein 2-ventricle congenital tricuspid valve diseases

Periprocedural changes in natriuretic peptide levels and clinical outcome after transcatheter mitral valve repair

Right ventricular function in transcatheter mitral and tricuspid valve edge-to-edge repair

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