Combined Tricuspid and Mitral Versus Isolated Mitral Valve Repair for Severe MR and TR: An Analysis From the TriValve and TRAMI Registries

doi:10.1016/j.jcin.2019.10.023

JACC: Cardiovascular Interventions

Volume 13, Issue 5, 9 March 2020, Pages 543-550

https://doi.org/10.1016/j.jcin.2019.10.023 Get rights and content

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Abstract

Objectives

The aim of this study was to retrospectively compare the characteristics, procedural courses, and outcomes of patients presenting with concomitant mitral regurgitation (MR) and tricuspid regurgitation (TR) in the TriValve (Transcatheter Tricuspid Valve Therapies) and TRAMI (Transcatheter Mitral Valve Interventions) registries.

Background

Transcatheter mitral edge-to-edge valve repair (TMVR) has been shown to be successful in patients with severe MR. Lately, edge-to-edge repair has also emerged as a possible treatment for severe TR in patients at high risk for cardiac surgery. In patients with both severe MR and TR, the yield of concomitant transcatheter mitral and tricuspid valve repair (TMTVR) for patients at high surgical risk is unknown.

Methods

The characteristics, procedural data, and 1-year outcomes of all patients in the international multicenter TriValve registry and the German multicenter TRAMI registry, who presented with both severe MR and TR, were retrospectively compared. Patients in TRAMI (n = 106) underwent isolated TMVR, while those in TriValve (n = 122) additionally underwent concurrent TMTVR in compassionate and/or off-label use.

Results

All 228 patients (mean age 77 ± 8 years, 44.3% women) presented with significant dyspnea at baseline (New York Heart Association functional class III or IV in 93.9%), without any differences in the rates of pulmonary hypertension and chronic pulmonary disease. The proportion of patients with left ventricular ejection fraction <30% was higher in the TMVR group (34.9% vs. 18.0%; p < 0.001), while patients in the TMTVR group had lower glomerular filtration rates. At discharge, MR was comparably reduced in both groups. At 1 year, overall all-cause mortality was 34.0% in the TMVR group and 16.4% in the TMTVR group (p = 0.035, Cox regression). On multivariate analysis, TMTVR was associated with a 2-fold lower mortality rate (hazard ratio: 0.52; p = 0.02). The rate of patients in New York Heart Association functional class ≤II at 1 year did not differ (69.4% vs. 67.0%; p = 0.54).

Conclusions

Concurrent TMTVR was associated with a higher 1-year survival rate compared with isolated TMVR in patients with both MR and TR. Further randomized trials are needed to confirm these results.

Central Illustration

Key Words

edge-to-edge repair

heart failure

structural heart disease

tricuspid valve interventional repair

Abbreviations and Acronyms

EuroSCORE

European System for Cardiac Operative Risk Evaluation

LVEF

left ventricular ejection fraction

mitral regurgitation

NYHA

New York Heart Association

TMTVR

transcatheter mitral and tricuspid valve repair

TMVR

transcatheter edge-to-edge mitral valve repair

tricuspid regurgitation

Cited by (0)

: The statistical analysis for this manuscript was supported by an unrestricted grant from Abbott Medical. The TRAMI registry received support from Abbott Vascular. The TriValve registry was not supported by external funding. Dr. Karam has received consulting fees from Abbott Vascular. Dr. Taramasso is a consultant for Abbott Vascular, Boston Scientific, 4Tech, and CoreMedic; and has received speaking honoraria from Edwards Lifesciences. Dr. Lurz has received speaking fees from Abbott Vascular. Dr. von Bardeleben has received speaking fees from Abbott Vascular and Edwards Lifesciences. Dr. Lubos has received research support and speaking honoraria from Abbott Vascular. Dr. Schillinger has received consulting and lecture fees and travel expenses from Abbott Vascular. Dr. Maisano has served as a consultant for Abbott Vascular, Edwards Lifesciences, Cardiovalve, Valtech, and Medtronic; and is a cofounder of 4Tech. Dr. Hausleiter has received research support and speaking honoraria from Abbott Vascular and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.