Clinical Characteristics and Outcomes of Patients Screened for Transcatheter Tricuspid Valve Replacement

• Published in: JACC. Cardiovascular interventions Vol. 17; no. 4; pp. 552 - 560
• Main Authors: Hagemeyer, Daniel, Merdad, Anas, Sierra, Laura Villegas, Ruberti, Andrea, Kargoli, Faraj, Bouchat, Marine, Boiago, Mauro, Moschovitis, Aris, Deva, Djeven P., Stolz, Lukas, Ong, Geraldine, Peterson, Mark D., Piazza, Nicolo, Taramasso, Maurizio, Dumonteil, Nicolas, Modine, Thomas, Latib, Azeem, Praz, Fabien, Hausleiter, Jörg, Fam, Neil P.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 26.02.2024
• Subjects: transcatheter edge-to-edge repair; transcatheter tricuspid valve replacement; tricuspid regurgitation; RV; KCCQ; T-TEER; tricuspid regurgitation; CT; transcatheter edge-to-edge repair; TTVI; IVC; OMT; EuroSCORE; TTVR; HF; TR; transcatheter tricuspid valve replacement
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2023.12.016

Transcatheter tricuspid valve replacement (TTVR) abolishes tricuspid regurgitation (TR) and has emerged as a definitive treatment for TR. The purpose of this multicenter, observational study was to determine the clinical characteristics and short-term outcomes of patients with TR screened for TTVR. Patients underwent TTVR screening at 7 centers on a compassionate-use basis. The primary endpoints were NYHA functional class and TR grade at 30-day follow-up. Secondary endpoints included all-cause mortality, heart failure hospitalization, technical success, and reasons for TTVR screening failure. A total of 149 patients (median age 79 years [Q1-Q3: 72-84 years], 54% women) underwent TTVR screening. The TTVR screening failure rate was 74%, mainly related to large tricuspid annular diameter. Patients undergoing TTVR (n = 38) had significant functional improvements (NYHA functional class I or II from 21% to 68%; P < 0.001), with TR ≤1+ in 97% at 30-day follow-up (P < 0.001 from baseline). Technical success was achieved in 91%, with no intraprocedural mortality or conversion to surgery. At 30-day follow-up, mortality was 8%, heart failure hospitalization 5%, major bleeding 18%, and reintervention 9%. Patients who failed screening for TTVR and subsequently underwent “bailout” transcatheter edge-to-edge repair (n = 26) had favorable outcomes (NYHA functional class I or II from 27% to 58%; P < 0.001), with TR ≤1+ in 43% at 30-day follow-up (P < 0.001 from baseline). This first real-world report of TTVR screening demonstrated a high screening failure rate, mainly related to large tricuspid annular diameter. Patients undergoing TTVR had superior TR reduction and symptom alleviation compared with bailout tricuspid transcatheter edge-to-edge repair, at the cost of greater procedural complications. [Display omitted]