Outcomes of transcatheter tricuspid valve intervention by right ventricular function: a multicentre propensity-matched analysis

TY - JOUR

T1 - Outcomes of transcatheter tricuspid valve intervention by right ventricular function: a multicentre propensity-matched analysis

AU - Schlotter, Florian

AU - Miura, Mizuki

AU - Kresoja, Karl-Patrik

AU - Alushi, Brunilda

AU - Alessandrini, Hannes

AU - Attinger-Toller, Adrian

AU - Besler, Christian

AU - Biasco, Luigi

AU - Braun, Daniel

AU - Brochet, Eric

AU - Connelly, Kim A

AU - de Bruijn, Sabine

AU - Denti, Paolo

AU - Estevez-Loureiro, Rodrigo

AU - Fam, Neil

AU - Gavazzoni, Mara

AU - Himbert, Dominique

AU - Ho, Edwin C

AU - Juliard, Jean-Michel

AU - Kalbacher, Daniel

AU - Kaple, Ryan

AU - Kreidel, Felix

AU - Latib, Azeem

AU - Lubos, Edith

AU - Ludwig, Sebastian

AU - Mehr, Michael

AU - Monivas, Vanessa

AU - Nazif, Tamim M

AU - Nickenig, Georg

AU - Pedrazzini, Giovanni

AU - Pozzoli, Alberto

AU - Praz, Fabien

AU - Puri, Rishi

AU - Rodés-Cabau, Josep

AU - Rommel, Karl-Philipp

AU - Schäfer, Ulrich

AU - Schofer, Joachim

AU - Sievert, Horst

AU - Tang, Gilbert H L

AU - Thiele, Holger

AU - Unterhuber, Matthias

AU - Vahanian, Alec

AU - von Bardeleben, Ralph Stephan

AU - von Roeder, Maximilian

AU - Webb, John G

AU - Weber, Marcel

AU - Wild, Mirjam G

AU - Windecker, Stephan

AU - Zuber, Michel

AU - Hausleiter, Jörg

AU - Maisano, Francesco

AU - Leon, Martin B

AU - Hahn, Rebecca T

AU - Lauten, Alexander

AU - Taramasso, Maurizio

AU - Lurz, Philipp

AU - TriValve Registry

PY - 2021/7/20

Y1 - 2021/7/20

N2 - BACKGROUND: Tricuspid regurgitation (TR) has a poor prognosis and limited treatment options and is frequently accompanied by right ventricular (RV) dysfunction. Transcatheter tricuspid valve interventions (TTVI) to reduce TR have been shown to be safe and feasible with encouraging early results. Patient selection for TTVI remains challenging, with the role of right ventricular (RV) function being unknown.AIMS: The aims of this study were 1) to investigate survival in a TTVI-treated patient population and a conservatively treated TR population, and 2) to evaluate the outcome of TTVI as compared to conservative treatment stratified according to the degree of RV function.METHODS: We studied 684 patients from the multicentre TriValve cohort (TTVI cohort) and compared them to 914 conservatively treated patients from two tertiary care centres. Propensity matching identified 213 pairs of patients with severe TR. As we observed a non-linear relationship of RV function and TTVI outcome, we stratified patients according to tricuspid annular plane systolic excursion (TAPSE) to preserved (TAPSE >17 mm), mid-range (TAPSE 13-17 mm) and reduced (TAPSE <13 mm) RV function. The primary outcome was one-year all-cause mortality.RESULTS: TTVI was associated with a survival benefit in patients with severe TR when compared to matched controls (one-year mortality rate: 13.1% vs 25.8%; p=0.031). Of the three RV subgroups, only in patients with mid-range RV function was TTVI associated with an improved survival (p log-rank 0.004). In these patients, procedural success was associated with a reduced hazard ratio for all-cause mortality (HR 0.22; 95% CI: 0.09, 0.57).CONCLUSIONS: TTVI is associated with reduced mortality compared to conservative therapy and might exert its highest treatment effect in patients with mid-range reduced RV function.

AB - BACKGROUND: Tricuspid regurgitation (TR) has a poor prognosis and limited treatment options and is frequently accompanied by right ventricular (RV) dysfunction. Transcatheter tricuspid valve interventions (TTVI) to reduce TR have been shown to be safe and feasible with encouraging early results. Patient selection for TTVI remains challenging, with the role of right ventricular (RV) function being unknown.AIMS: The aims of this study were 1) to investigate survival in a TTVI-treated patient population and a conservatively treated TR population, and 2) to evaluate the outcome of TTVI as compared to conservative treatment stratified according to the degree of RV function.METHODS: We studied 684 patients from the multicentre TriValve cohort (TTVI cohort) and compared them to 914 conservatively treated patients from two tertiary care centres. Propensity matching identified 213 pairs of patients with severe TR. As we observed a non-linear relationship of RV function and TTVI outcome, we stratified patients according to tricuspid annular plane systolic excursion (TAPSE) to preserved (TAPSE >17 mm), mid-range (TAPSE 13-17 mm) and reduced (TAPSE <13 mm) RV function. The primary outcome was one-year all-cause mortality.RESULTS: TTVI was associated with a survival benefit in patients with severe TR when compared to matched controls (one-year mortality rate: 13.1% vs 25.8%; p=0.031). Of the three RV subgroups, only in patients with mid-range RV function was TTVI associated with an improved survival (p log-rank 0.004). In these patients, procedural success was associated with a reduced hazard ratio for all-cause mortality (HR 0.22; 95% CI: 0.09, 0.57).CONCLUSIONS: TTVI is associated with reduced mortality compared to conservative therapy and might exert its highest treatment effect in patients with mid-range reduced RV function.

U2 - 10.4244/EIJ-D-21-00191

DO - 10.4244/EIJ-D-21-00191

M3 - SCORING: Journal article

C2 - 33956637

VL - 17

SP - e343-e352

JO - EUROINTERVENTION

JF - EUROINTERVENTION

SN - 1774-024X

IS - 4

ER -