Impact of tricuspid valve regurgitation in surgical high-risk patients undergoing MitraClip implantation: results from the TRAMI registry

TY - JOUR

T1 - Impact of tricuspid valve regurgitation in surgical high-risk patients undergoing MitraClip implantation: results from the TRAMI registry

AU - Kalbacher, Daniel

AU - Schäfer, Ulrich

AU - von Bardeleben, R Stephan

AU - Zuern, Christine S

AU - Bekeredjian, Raffi

AU - Ouarrak, Taoufik

AU - Sievert, Horst

AU - Nickenig, Georg

AU - Boekstegers, Peter

AU - Senges, Jochen

AU - Schillinger, Wolfgang

AU - Lubos, Edith

PY - 2017/2/3

Y1 - 2017/2/3

N2 - AIMS: We sought to assess the impact of tricuspid regurgitation (TR) severity on patient outcome in a collective with relevant mitral regurgitation undergoing MitraClip implantation..METHODS AND RESULTS: From August 2010 to July 2013, 766 patients (age 75.3±8.5 years, 61% male, median EuroSCORE 24.3%±18.4) were prospectively enrolled in the TRAMI registry and stratified by echocardiography into no/mild, moderate and severe TR. Overall, the mean number of implanted MitraClips was higher in patients with severe TR but increasing TR severity was not associated with procedural success. In-hospital and one-year mortality as well as MACE and MACCE (death, myocardial infarction±stroke) rates were higher with increasing TR severity. Kaplan-Meier curves indicated a significant difference for mortality (p<0.0001), but not for rehospitalisation for heart failure. After multivariate Cox regression, severe TR proved to be a predictor for one-year mortality (HR 2.01, 95% CI: 1.25-3.26, p=0.004). Higher rates of severe bleeding were more frequent with increasing TR grades.CONCLUSIONS: In patients with MitraClip implantation, increasing TR severity is associated with adverse outcome, higher bleeding rates and decreased survival rates.

AB - AIMS: We sought to assess the impact of tricuspid regurgitation (TR) severity on patient outcome in a collective with relevant mitral regurgitation undergoing MitraClip implantation..METHODS AND RESULTS: From August 2010 to July 2013, 766 patients (age 75.3±8.5 years, 61% male, median EuroSCORE 24.3%±18.4) were prospectively enrolled in the TRAMI registry and stratified by echocardiography into no/mild, moderate and severe TR. Overall, the mean number of implanted MitraClips was higher in patients with severe TR but increasing TR severity was not associated with procedural success. In-hospital and one-year mortality as well as MACE and MACCE (death, myocardial infarction±stroke) rates were higher with increasing TR severity. Kaplan-Meier curves indicated a significant difference for mortality (p<0.0001), but not for rehospitalisation for heart failure. After multivariate Cox regression, severe TR proved to be a predictor for one-year mortality (HR 2.01, 95% CI: 1.25-3.26, p=0.004). Higher rates of severe bleeding were more frequent with increasing TR grades.CONCLUSIONS: In patients with MitraClip implantation, increasing TR severity is associated with adverse outcome, higher bleeding rates and decreased survival rates.

KW - Aged

KW - Aged, 80 and over

KW - Cardiac Catheterization/methods

KW - Female

KW - Heart Valve Prosthesis

KW - Heart Valve Prosthesis Implantation/methods

KW - Humans

KW - Male

KW - Middle Aged

KW - Mitral Valve Insufficiency/surgery

KW - Prospective Studies

KW - Registries

KW - Risk

KW - Severity of Illness Index

KW - Treatment Outcome

KW - Tricuspid Valve Insufficiency/surgery

U2 - 10.4244/EIJ-D-16-00850

DO - 10.4244/EIJ-D-16-00850

M3 - SCORING: Journal article

C2 - 28089952

VL - 12

SP - 1809

EP - 1816

JO - EUROINTERVENTION

JF - EUROINTERVENTION

SN - 1774-024X

IS - 15

ER -