Leaflet Morphology and its Implications for Direct Transcatheter Annuloplasty of Tricuspid Regurgitation

TY - JOUR

T1 - Leaflet Morphology and its Implications for Direct Transcatheter Annuloplasty of Tricuspid Regurgitation

AU - Körber, Maria Isabel

AU - Roder, Fabian

AU - Gerçek, Muhammed

AU - Koell, Benedikt

AU - Kalbacher, Daniel

AU - Iliadis, Christos

AU - Brüwer, Monique

AU - Friedrichs, Kai Peter

AU - Rudolph, Volker

AU - Baldus, Stephan

AU - Pfister, Roman

N1 - Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PY - 2023/3/27

Y1 - 2023/3/27

N2 - BACKGROUND: Leaflet morphology has been associated with treatment success in edge-to-edge repair of tricuspid regurgitation (TR), but the impact on annuloplasty is unclear.OBJECTIVES: The authors sought to examine the association of leaflet morphology with efficacy and safety of direct annuloplasty in TR.METHODS: The authors analyzed patients who underwent catheter-based direct annuloplasty with the Cardioband at 3 centers. Leaflet morphology was assessed according to number and location of leaflets by echocardiography. Patients with simple morphology (2 or 3 leaflets) were compared with complex morphology (>3 leaflets).RESULTS: The study included 120 patients (median age 80 years) with ≥severe TR. A total of 48.3% of patients had a 3-leaflet morphology, 5% a 2-leaflet morphology, and 46.7% had >3 tricuspid leaflets. Baseline characteristics did not differ relevantly between groups except for a higher incidence of torrential TR grade (50 vs 26.6%) in complex morphologies. Postprocedural improvement of 1 (90.6% vs 92.9%) and 2 (71.9% vs 67.9%) TR grades was not significantly different between groups, but patients with complex morphology had more often residual TR ≥3 at discharge (48.2 vs 26.6%; P = 0.014). This difference did not remain significant (P = 0.112) after adjusting for baseline TR severity, coaptation gap, and nonanterior jet localization. Safety endpoints including complications of the right coronary artery, and technical success did not show significant differences.CONCLUSIONS: Efficacy and safety of transcatheter direct annuloplasty using Cardioband are not affected by leaflet morphology. Assessment of leaflet morphology should be part of procedural planning in patients with TR and might help to individually tailor repair techniques to patient anatomy.

AB - BACKGROUND: Leaflet morphology has been associated with treatment success in edge-to-edge repair of tricuspid regurgitation (TR), but the impact on annuloplasty is unclear.OBJECTIVES: The authors sought to examine the association of leaflet morphology with efficacy and safety of direct annuloplasty in TR.METHODS: The authors analyzed patients who underwent catheter-based direct annuloplasty with the Cardioband at 3 centers. Leaflet morphology was assessed according to number and location of leaflets by echocardiography. Patients with simple morphology (2 or 3 leaflets) were compared with complex morphology (>3 leaflets).RESULTS: The study included 120 patients (median age 80 years) with ≥severe TR. A total of 48.3% of patients had a 3-leaflet morphology, 5% a 2-leaflet morphology, and 46.7% had >3 tricuspid leaflets. Baseline characteristics did not differ relevantly between groups except for a higher incidence of torrential TR grade (50 vs 26.6%) in complex morphologies. Postprocedural improvement of 1 (90.6% vs 92.9%) and 2 (71.9% vs 67.9%) TR grades was not significantly different between groups, but patients with complex morphology had more often residual TR ≥3 at discharge (48.2 vs 26.6%; P = 0.014). This difference did not remain significant (P = 0.112) after adjusting for baseline TR severity, coaptation gap, and nonanterior jet localization. Safety endpoints including complications of the right coronary artery, and technical success did not show significant differences.CONCLUSIONS: Efficacy and safety of transcatheter direct annuloplasty using Cardioband are not affected by leaflet morphology. Assessment of leaflet morphology should be part of procedural planning in patients with TR and might help to individually tailor repair techniques to patient anatomy.

KW - Humans

KW - Aged, 80 and over

KW - Tricuspid Valve Insufficiency/diagnostic imaging

KW - Treatment Outcome

KW - Tricuspid Valve/diagnostic imaging

KW - Mitral Valve/surgery

KW - Echocardiography/adverse effects

U2 - 10.1016/j.jcin.2023.01.364

DO - 10.1016/j.jcin.2023.01.364

M3 - SCORING: Journal article

C2 - 36990560

VL - 16

SP - 693

EP - 702

JO - JACC-CARDIOVASC INTE

JF - JACC-CARDIOVASC INTE

SN - 1936-8798

IS - 6

ER -