Hemodynamic Effects of Transcatheter Tricuspid Valve Annuloplasty With Cardioband and Their Associations With Clinical Outcomes.

BACKGROUND

Transcatheter tricuspid valve annuloplasty (TTVA) with the Cardioband system is a safe and effective option for high-risk patients with symptomatic severe tricuspid regurgitation (TR). Hemodynamics play a crucial role in these patients. However, it remains unclear if hemodynamic changes after TTVA are linked to clinical outcomes.

METHODS

Consecutive patients with severe functional TR who underwent TTVA between 2019 and 2022 were retrospectively analyzed. Right heart catheterization was performed before and after cinching to assess hemodynamic parameters, including XV height (difference between the V-wave and the nadir of right atrial pressure). The primary end point was 2-year survival.

RESULTS

Fifty-eight patients with complete hemodynamic assessment were included. All patients presented with torrential (40%), severe (38%), or massive (22%) TR. TR was reduced by ≥2 grades in 83% and by ≥1 grade in 97%. Hemodynamics following TTVA showed significant increases in median cardiac index (2.4-2.8 L/[min·m²]), pulmonary artery pulsatility index (1.73-2.13), and right ventricle cardiac power index (0.15-0.21 W/m²). Right atrial pressure (mean/V-wave) decreased significantly, with the most notable change in XV height (12.5 to 7 mm Hg; P<0.001). Lower postprocedural XV height independently predicted 2-year survival (P=0.002) and was significantly associated with lower TR grade at follow-up (P=0.002) and right ventricle reverse remodeling (P<0.001). Immediate right ventricle remodeling was also associated with 2-year survival (P=0.024).

CONCLUSIONS

Postprocedural XV height was independently associated with 2-year survival and linked to TR reduction and right ventricle remodeling. TTVA improves hemodynamics even in advanced TR, and hemodynamic markers may support risk stratification.