Transcatheter Tricuspid Valve Intervention in Patients With Right Ventricular Dysfunction or Pulmonary Hypertension
Authors: Muntané-Carol Guillem , Taramasso Maurizio , Miura Mizuki , Gavazzoni Mara , Pozzoli Alberto , Alessandrini Hannes , Latib Azeem , Attinger-Toller Adrian , Biasco Luigi , Braun Daniel , Brochet Eric , Connelly Kim A. , de Bruijn Sabine , Denti Paolo , Deuschl Florian , Lubos Edith , Ludwig Sebastian , Kalbacher Daniel , Estevez-Loureiro Rodrigo , Fam Neil , Frerker Christian , Ho Edwin , Juliard Jean-Michel , Kaple Ryan , Kodali Susheel , Kreidel Felix , Harr Claudia , Lauten Alexander , Lurz Julia , Monivas Vanessa , Mehr Michael , Nazif Tamin , Nickening Georg , Pedrazzini Giovanni , Philippon François , Praz Fabien , Puri Rishi , Schäfer Ulrich , Schofer Joachim , Sievert Horst , Tang Gilbert H.L. , Khattab Ahmed A. , Andreas Martin , Russo Marco , Thiele Holger , Unterhuber Matthias , Himbert Dominique , Urena Marina , von Bardeleben Ralph Stephan , Webb John G. , Weber Marcel , Windecker Stephan , Winkel Mirjam , Zuber Michel , Hausleiter Jörg , Lurz Philipp , Maisano Francesco , Leon Martin B. , Hahn Rebecca T. , Rodés-Cabau Josep 
Published: February 2021

Background:
Scarce data exist on patients with right ventricular dysfunction (RVD) or pulmonary hypertension (PH) undergoing transcatheter tricuspid valve intervention. This study aimed to determine the early and midterm outcomes and the factors associated with mortality in this group of patients.

Methods:
This subanalysis of the multicenter TriValve (Transcatheter Tricuspid Valve Therapies) registry included 300 patients with severe tricuspid regurgitation with RVD (n=244), PH (n=127), or both (n=71) undergoing transcatheter tricuspid valve intervention. RVD was defined as a tricuspid annular plane systolic excursion <17 mm, and PH as an estimated pulmonary artery systolic pressure ≥50 mm Hg.

Results:

Mean age of the patients was 77±9 years (54% women). Procedural success was 80.7%, and 9 patients (3%) died during the hospitalization. At a median follow-up of 6 (interquartile range, 2–12) months, 54 patients (18%) died, and the independent associated factors were higher gamma-glutamyl transferase values at baseline (hazard ratio, 1.02 for each increase of 10 u/L [95% CI, 1.002–1.04]), poorer renal function defined as an estimated glomerular filtration rate <45 mL/min (hazard ratio, 2.3 [95% CI, 1.22–4.33]), and the lack of procedural success (hazard ratio, 2.11 [95% CI, 1.17–3.81]). The grade of RVD and the amount of PH at baseline were not found to be predictors of mortality. Most patients alive at follow-up improved their functional class (New York Heart Association I–II in 66% versus 7% at baseline,
P
<0.001).

Conclusions:
In patients with severe tricuspid regurgitation and RVD/PH, transcatheter tricuspid valve intervention was associated with high procedural success and a relatively low in-hospital mortality, along with significant improvements in functional status. However, about 1 out of 5 patients died after a median follow-up of 6 months, with hepatic congestion, renal dysfunction, and the lack of procedural success determining an increased risk. These results may improve the clinical evaluation of transcatheter tricuspid valve intervention candidates and would suggest a closer follow-up in those at increased risk.

Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT03416166.