JACC. Cardiovascular interventions · 2025
Transcatheter Tricuspid Valve Replacement and CLEFT After Tricuspid TEER.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Saxon John T, Rajagopal Dhiren, Tyler Scott, Nickolite Katie, Wingerter Kelly, Chidester Jeffrey, Thourani Vinod, Stewart James, Jabri Ahmad, O'Neill Brian, Villablanca Pedro, Yadav Pradeep
Аннотация
BACKGROUND: Severe tricuspid regurgitation (TR) is associated with excess mortality and symptoms of heart failure. Tricuspid transcatheter edge-to-edge repair (T-TEER) alleviates symptoms, but not all T-TEER achieve optimal results. Transcatheter tricuspid valve replacement (TTVR) after T-TEER is possible, but short-term outcomes are not well known, and some patients require advanced electrosurgical techniques to facilitate TTVR.
OBJECTIVES: The aim of this paper is to describe techniques and outcomes among patients who underwent TTVR after T-TEER.
METHODS: The authors describe initial experience and lessons learned for TTVR after T-TEER, including CLEFT (clip liberalization to facilitate TTVR), and an algorithm to guide TTVR procedural planning. The authors also report the outcomes of a series of TTVR procedures after T-TEER, with or without CLEFT. The primary outcome was procedural technical success. Secondary outcomes included 30-day mortality, TR severity, and NYHA functional class.
RESULTS: A total of 16 patients with severe, symptomatic TR after T-TEER were treated with TTVR using the EVOQUE valve. The median age was 75 years (Q1-Q3: 67-85 years), and 68.8% patients (11 of 16) were women. Median Society of Thoracic Surgeons Predicted Risk of Mortality was 8.3% (Q1-Q3: 6.9%-12.4%). Thirteen patients (81.3%) were in NYHA functional class III or IV. Eight patients underwent leaflet modification immediately prior to TTVR. The procedural technical success rate was 93.7% (15 of 16; 95% CI: 69.8%-99.8%). Survival to 30 days was 93.7% (15 of 16). The proportion of patients in NYHA functional class I or II improved to 86.7% (13 of 16; P < 0.001 compared with baseline), and TR severity was reduced (93.3% with no or mild TR; P < 0.001) at 30 days.
CONCLUSIONS: The authors present the largest series of TTVR after T-TEER with electrosurgical leaflet modification in a subset of patients. At 30 days, TR severity was markedly reduced, and substantial symptom alleviation occurred.
OBJECTIVES: The aim of this paper is to describe techniques and outcomes among patients who underwent TTVR after T-TEER.
METHODS: The authors describe initial experience and lessons learned for TTVR after T-TEER, including CLEFT (clip liberalization to facilitate TTVR), and an algorithm to guide TTVR procedural planning. The authors also report the outcomes of a series of TTVR procedures after T-TEER, with or without CLEFT. The primary outcome was procedural technical success. Secondary outcomes included 30-day mortality, TR severity, and NYHA functional class.
RESULTS: A total of 16 patients with severe, symptomatic TR after T-TEER were treated with TTVR using the EVOQUE valve. The median age was 75 years (Q1-Q3: 67-85 years), and 68.8% patients (11 of 16) were women. Median Society of Thoracic Surgeons Predicted Risk of Mortality was 8.3% (Q1-Q3: 6.9%-12.4%). Thirteen patients (81.3%) were in NYHA functional class III or IV. Eight patients underwent leaflet modification immediately prior to TTVR. The procedural technical success rate was 93.7% (15 of 16; 95% CI: 69.8%-99.8%). Survival to 30 days was 93.7% (15 of 16). The proportion of patients in NYHA functional class I or II improved to 86.7% (13 of 16; P < 0.001 compared with baseline), and TR severity was reduced (93.3% with no or mild TR; P < 0.001) at 30 days.
CONCLUSIONS: The authors present the largest series of TTVR after T-TEER with electrosurgical leaflet modification in a subset of patients. At 30 days, TR severity was markedly reduced, and substantial symptom alleviation occurred.