Prognostic Implications of Residual Tricuspid Regurgitation Grading After Transcatheter Tricuspid Valve Repair.
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Dreyfus Julien, Taramasso Maurizio, Kresoja Karl-Patrik, Omran Hazem, Iliadis Christos, Russo Giulio, Weber Marcel, Nombela-Franco Luis, Estevez Loureiro Rodrigo, Hausleiter Jörg, Latib Azeem, Stolz Lukas, Praz Fabien, Windecker Stephan, Zamorano Jose Luis, von Bardeleben Ralph Stephan, Tang Gilbert H L, Hahn Rebecca, Lubos Edith, Webb John, Schofer Joachim, Fam Neil, Lauten Alexander, Pedrazzini Giovanni, Rodés-Cabau Josep, Nejjari Mohammed, Badano Luigi, Alessandrini Hannes, Himbert Dominique, Sievert Horst, Piayda Kerstin, Donal Erwan, Modine Thomas, Nickenig Georg, Pfister Roman, Rudolph Volker, Bernick Jordan, Wells George A, Bax Jeroen, Lurz Philipp, Enriquez-Sarano Maurice, Maisano Francesco, Messika-Zeitoun David, TRIGISTRY Investigators
Аннотация
OBJECTIVES: The authors sought to assess the impact of residual TR severity post-TTV repair on survival.
METHODS: We evaluated the survival rate at 2 years of 613 patients with severe isolated functional TR who underwent TTV repair in TRIGISTRY according to the severity of residual TR at discharge using a 3-grade (mild, moderate, and severe) or 4-grade scheme (mild, mild to moderate, moderate to severe, and severe).
RESULTS: Residual TR was none/mild in 33%, moderate in 52%, and severe in 15%. The 2-year adjusted survival rates significantly differed between the 3 groups (85%, 70%, and 44%, respectively; restricted mean survival time [RMST]: P = 0.0001). When the 319 patients with moderate residual TR were subdivided into mild to moderate (n = 201, 33%) and moderate to severe (n = 118, 19%), the adjusted survival rate was also significantly different between groups (85%, 80%, 55%, and 44%, respectively; RMST: P = 0.001). Survival was significantly lower in patients with moderate to severe residual TR compared to patients with mild to moderate residual TR (P = 0.006). No difference in survival rates was observed between patients with no/mild and mild to moderate residual TR (P = 0.67) or between patients with moderate to severe and severe residual TR (P = 0.96).
CONCLUSIONS: The moderate residual TR group was heterogeneous and encompassed patients with markedly different clinical outcomes. Refining TR grade classification with a more granular 4-grade scheme improved outcome prediction. Our results highlight the importance of achieving a mild to moderate or lower residual TR grade during TTV repair, which could define a successful intervention.