Impact of Massive or Torrential Tricuspid Regurgitation in Patients Undergoing Transcatheter Tricuspid Valve Intervention.
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Miura Mizuki, Alessandrini Hannes, Alkhodair Abdullah, Attinger-Toller Adrian, Biasco Luigi, Lurz Philipp, Braun Daniel, Brochet Eric, Connelly Kim A, de Bruijn Sabine, Denti Paolo, Deuschl Florian, Estevez-Loureiro Rodrigo, Fam Neil, Frerker Christian, Gavazzoni Mara, Hausleiter Jörg, Himbert Dominique, Ho Edwin, Juliard Jean-Michel, Kaple Ryan, Besler Christian, Kodali Susheel, Kreidel Felix, Kuck Karl-Heinz, Latib Azeem, Lauten Alexander, Monivas Vanessa, Mehr Michael, Muntané-Carol Guillem, Nazif Tamin, Nickenig Georg, Pedrazzini Giovanni, Philippon François, Pozzoli Alberto, Praz Fabien, Puri Rishi, Rodés-Cabau Josep, Schäfer Ulrich, Schofer Joachim, Sievert Horst, Tang Gilbert H L, Thiele Holger, Rommel Karl-Philipp, Vahanian Alec, Von Bardeleben Ralph Stephan, Webb John G, Weber Marcel, Windecker Stephan, Winkel Mirjam, Zuber Michel, Leon Martin B, Maisano Francesco, Hahn Rebecca T, Taramasso Maurizio, TriValve Investigators
Аннотация
BACKGROUND: The use of TTVI to treat symptomatic severe TR has been increasing rapidly, but little is known regarding the impact of massive or torrential TR beyond severe TR.
METHODS: The study population comprised 333 patients with significant symptomatic TR from the TriValve Registry who underwent TTVI. Mid-term outcomes after TTVI were assessed according to the presence of massive or torrential TR, defined as vena contracta width ≥14 mm. Procedural success was defined as patient survival after successful device implantation and delivery system retrieval, with residual TR ≤2+. The primary endpoint comprised survival rate and freedom from rehospitalization for heart failure, survival rate, and rehospitalization at 1 year.
RESULTS: Baseline massive or torrential TR and severe TR were observed in 154 patients (46.2%) and 179 patients (53.8%), respectively. Patients with massive or torrential TR had a higher prevalence of ascites than those with severe TR (27.3% vs. 20.4%, respectively; p = 0.15) and demonstrated a similar procedural success rate (83.2% vs. 77.3%, respectively; p = 0.21). The incidence of peri-procedural adverse events was low, with no significant between-group differences. Freedom from the composite endpoint was significantly lower in patients with massive or torrential TR than in those with severe TR, which was significantly associated with an increased risk for 1-year death of any cause or rehospitalization for heart failure (adjusted hazard ratio: 1.91; 95% confidence interval: 1.10 to 3.34; p = 0.022). Freedom from the composite endpoint was significantly higher in patients with massive or torrential TR when procedural success was achieved (69.9% vs. 54.2%, p = 0.048).
CONCLUSIONS: Baseline massive or torrential TR is associated with an increased risk for all-cause mortality and rehospitalization for heart failure 1 year after TTVI. Procedural success is related to better outcomes, even in the presence of baseline massive or torrential TR. (International Multisite Transcatheter Tricuspid Valve Therapies Registry [TriValve]; NCT03416166).