The impact of tricuspid annular geometry on outcome after percutaneous edge-to-edge repair for severe tricuspid regurgitation

Abstract

Background: Percutaneous tricuspid repair using the edge-to-edge technique is a novel treatment option. More data are needed to better understand which aspects predict a favorable outcome Methods: Twenty high-risk patients (78.6 ± 8.3 years, EUROScore II 9.1 ± 7.7%, STS score 8.8 ± 4.3) with severe symptomatic tricuspid regurgitation (TR) were treated with the MitraClip ® system. All patients underwent standardized pre-, peri-, and post-procedural evaluation. Acute success was defined as successful edge-to-edge repair with TR reduction of ≥ 1 grade and survival until hospital discharge.Results: Fifteen (75%) patients showed acute success until discharge and 12 (60%) at 30-day follow-up. In 5 (25%) patients repair failed due to either unsuccessful clip implantation (n = 2), single leaflet device attachment (n = 1), TR reduction < 1 grade (n = 1), or in-hospital death (n = 1). Comparing patients with successful procedure versus those with failed repair revealed similar comorbidities but more severe right heart failure, lower left ventricular ejection fraction, worse renal function, and higher diuretic equivalent doses in the failed repair group. No differences in conventional echocardiographic parameters for TR severity but more dilated tricuspid annulus geometry (tricuspid valve [TV] annulus, coaptation depth, tenting area) in the failed repair group were observed. The success rate of non-central/nonanteroseptal jet location was only 25%. Conclusions:Tricuspid annulus geometry assessment may be of crucial importance and seems to impact procedural outcomes in patients undergoing edge-to-edge TV repair. Further investigations including advanced imaging are needed to better understand and treat this complex valve disease.

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

“…A total of 17 studies 12 , 13 , 18 , 22 – 26 , 28 – 36 were included in the analysis of procedural outcomes ( Table 2 and Supplementary Table 6 ). The pooled technical and procedural success rates were 93.9% (95% confidence interval (CI): 90.7%–96.4%) and 82.1% (95% CI: 74.0%–89.0%), respectively.…”

“…A total of 16 studies 12 , 13 , 18 , 22 – 26 , 28 – 33 , 35 , 36 were included for analyzing short-term outcomes ( Supplementary Table 7 ). The short-term all-cause mortality rate was 3.3% (95% CI: 2.0%–4.8%) ( I 2 = 0.0) ( Table 2 and Figure 2 ).…”

“…According to a study including 20 patients with severe symptomatic TR treated with MitraClip, the rate of SLDA was 15%, and the median time to SLDA was 37 days. 33 In addition, larger coaptation gaps (>7.2 mm) and noncentral/nonanteroseptal location of the TR jet have both been identified as risk factors for procedural success in patients undergoing TEER. 40 Therefore, the use of devices with larger clip arms (MitraClip XTR system or the PASCAL system), annuloplasty devices, or transcatheter valve replacement may be a better alternative for patients with large tricuspid annuli, wide leaflet coaptation gaps and tethered leaflets.…”

Risk stratification by systemic manifestations secondary to hemodynamic disorders of patients with severe tricuspid regurgitation

“…Patients in the TriValve Registry examining the applications of transcatheter tricuspid valve intervention showed similar high-risk profile, with the prevalence of previous admission for right ventricular failure of 69%, an incidence of chronic pulmonary disease of 78%, a mean eGFR of 42.6 ± 18.5 ml/min and a median AST/ALT of 29/20 UI/L. In such a morbid patient population, dedicated risk factors or risk score models were developed to predict the outcome of tricuspid valve intervention while mainly concentrated on anatomical, morphological or functional assessments of the heart [ 20 – 22 ]. In recent years, a research has raised the TRI-SCORE model, namely 6 out of 8 parameters rely on assessments of symptoms, signs, usage of medications and laboratory tests for renal and liver function [ 23 ].…”