Clinical ResearchTranscatheter Tricuspid Valve Intervention in Patients With Previous Left Valve Surgery
Section snippets
Methods
The design of the TriValve registry has been published elsewhere.12 A total of 25 centers from Europe and North America participated in this registry. The study included patients with TR considered at increased surgical risk and referred for TTVI by each center. Grading of the severity of TR was assessed using a semiquantitative and quantitative assessment, as described previously.12 The transcatheter devices for TTVI included in the registry were: MitraClip (Abbott Vascular, Santa Clara, CA),
Results
A total of 462 patients that underwent TTVI from July 2014 to August 2019, 82 (18%) of them with PLVS, were included in the study. The main baseline and procedural characteristics along with the in-hospital outcomes are presented in Table 1. Patients with PLVS were younger (72 ± 10 years vs 78 ± 9 years, respectively; P < 0.01), more frequently female (67.1% vs 53.2%; P = 0.02), and less frequently presented previous myocardial infarction (3.7% vs 16.9%; P < 0.01). Patients with PLVS less
Discussion
The present study described, for the first time, the baseline characteristics and clinical outcomes of patients with PLVS undergoing TTVI. The main findings can be summarised as follows: 1) PLVS was present in one-fifth of patients undergoing TTVI; 2) patients with PLVS exhibited periprocedural (high procedural success, low in-hospital/30-day mortality) and late (mortality, rehospitalisation) outcomes similar to those without PLVS; 3) in PVLS patients, a poorer right ventricular function (as
Conclusion
In patients with PLVS, TTVI was associated with high rates of procedural success, low early mortality, and improved functional status, with no differences compared with no-PLVS patients. However, about one-third of patients required rehospitalisation or died after a median follow-up of 6 months, with poorer right ventricular function and previous heart failure hospitalisation determining an increased risk. These results would support TTVI as a reasonable alternative to redo surgery in patients
Funding Sources
Dr Rodés-Cabau holds the Research Chair “Fondation Famille Jacques Larivière” for the Development of Structural Heart Disease Interventions. Dr Muntané-Carol was supported by a grant from the Fundación Alfonso Martín Escudero (Madrid, Spain).
Disclosures
Dr Taramasso has served as a consultant for Abbott Vascular, Boston Scientific, 4Tech, and CoreMedic and received speaker honoraria from Edwards Lifesciences. Dr Gavazzoni has served as a consultant for Biotronik. Dr Latib has served on the advisory board for Medtronic and Abbott Vascular, on the Speakers Bureau for Abbott Vascular, on the scientific advisory board for Millipede, and as a consultant for 4Tech, Mitralign, and Millipede. Dr Braun has received speaker honoraria and travel support
References (27)
- et al.
Transcatheter tricuspid valve interventions: landscape, challenges, and future directions
J Am Coll Cardiol
(2018) - et al.
The growing clinical importance of secondary tricuspid regurgitation
J Am Coll Cardiol
(2012) - et al.
Impact of tricuspid regurgitation on long-term survival
J Am Coll Cardiol
(2004) - et al.
National trends and outcomes in isolated tricuspid valve surgery
J Am Coll Cardiol
(2017) - et al.
Outcome and determinants of prognosis in patients undergoing isolated tricuspid valve surgery: retrospective single center analysis
Int J Cardiol
(2014) - et al.
Development of a risk prediction model and clinical risk score for isolated tricuspid valve surgery
Ann Thorac Surg
(2018) - et al.
The international multicenter TriValve registry: which patients are undergoing transcatheter tricuspid repair?
JACC Cardiovasc Interv
(2017) - et al.
Predictors of residual tricuspid regurgitation after mitral valve surgery
Ann Thorac Surg
(2003) - et al.
Outcomes of isolated tricuspid valve surgery have improved in the modern era
Ann Thorac Surg
(2019) - et al.
Transcatheter edge-to-edge repair for reduction of tricuspid regurgitation: 6-month outcomes of the TRILUMINATE single-arm study
Lancet
(2019)
Tricuspid reoperation after left-sided rheumatic valve operations
Ann Thorac Surg
Surgical treatment of tricuspid regurgitation after mitral valve surgery: a retrospective study in China
J Cardiothorac Surg
Surgical risk and outcome of repair versus replacement for late tricuspid regurgitation in redo operation
Ann Thorac Surg
Cited by (4)
Tricuspid valve replacement: The old and the new
2022, Progress in Cardiovascular DiseasesCitation Excerpt :The most used approach for TTVI is transcatheter repair, with many devices under different phases of investigation, and with 3 of them being recently approved for commercial use in Europe (Triclip, Pascal and Cardioband). Although different studies from real world registries in high-risk population showed feasibility and promising initial results in different clinical settings,44,83–88 there are many patients who do not qualify for repair strategy and who could benefit from a catheter based TVR. Different replacement devices are under clinical and preclinical investigation (Figs. 1 and 2).
Right Ventricular Adaptation, Tricuspid Regurgitation, and Clinical Outcomes: A Close Bond
2022, JACC: Case ReportsPotential Candidates for Transcatheter Tricuspid Valve Intervention After Transcatheter Aortic Valve Replacement: Predictors and Prognosis
2021, JACC: Cardiovascular InterventionsCitation Excerpt :In that study, the TriClip system offered a sustained reduction in TR severity up to 1 year, which translated to clinical improvement in terms of functional status and favorable mortality at 6 months and at 1 year (19,28). These results suggest the potential benefit of TTVI in patients exhibiting symptomatic moderate or greater TR after TAVR, although current evidence is limited in this specific population (29). First, more than 20% of patients were excluded because of inadequate echocardiographic images for the assessment of TR, which may have resulted in some degree of selection bias.
Tricuspid Regurgitation After Previous Left Heart Surgery: Are Transcatheter Approaches a Viable Solution?
2021, Canadian Journal of Cardiology
See editorial by Levi et al., pages 949–952 of this issue.
Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03416166.
See page 1100 for disclosure information.