Transcatheter Edge-to-Edge Tricuspid Repair for Severe Tricuspid Regurgitation Reduces Hospitalizations for Heart Failure

Orban, Mathias; Rommel, Karl-Philipp; Ho, Edwin C.; Unterhuber, Matthias; Pozzoli, Alberto; Connelly, Kim A.; Deseive, Simon; Besler, Christian; Ong, Geraldine; Braun, Daniel; Edwards, Jeremy; Miura, Mizuki; Guelmez, Goekhan; Stolz, Lukas; Gavazzoni, Mara; Zuber, Michel; Orban, Martin; Nabauer, Michael; Maisano, Francesco; Thiele, Holger; Massberg, Steffen; Taramasso, Maurizio; Fam, Neil P.; Lurz, Philipp und Hausleiter, Jörg (2020): Transcatheter Edge-to-Edge Tricuspid Repair for Severe Tricuspid Regurgitation Reduces Hospitalizations for Heart Failure. In: Jacc-Heart Failure, Bd. 8, Nr. 4: S. 265-276

Abstract

OBJECTIVES The goal of this study was to evaluate the effect of transcatheter edge-to-edge tricuspid valve repair (TTVR) for severe tricuspid regurgitation (TR) on hospitalization for heart failure (HHF) and HF-related endpoints. Background: Patients with severe TR need effective therapies beyond conservative treatment. The impact of TTVR on HHF and HF-related endpoints is unknown. METHODS Isolated TTVR was performed in 119 patients. Assessments were conducted of New York Heart Association functional class, 6-min walk distance, Minnesota Living with Heart Failure Questionnaire scores, N-terminal pro-B-type natriuretic peptide level, and medication. HHFs were analyzed in the preceding 12 months before and until the longest available follow-up after TTVR. Results were compared with those of 114 patients who underwent combined mitral and tricuspid valve repair. RESULTS Procedural success with a reduction to moderate or less TR and no in-hospital death was achieved in 82% of patients. With a median follow-up of 360 days (interquartile range: 187 to 408 days), a durable TR reduction to moderate or less was achieved in 72% of patients (p < 0.001). TTVR reduced the annual rate of HHF by 22% (1.21 to 0.95 HHF/patient-year;p = 0.02), with concomitant clinical improvement in New York Heart Association functional class (patients in class II or lower: 9% to 67%;p < 0.001), 6-min walk distance (+39 m;p = 0.001), and Minnesota Living with Heart Failure Questionnaire score (-6 points;p = 0.02). N-terminal pro-B-type natriuretic peptide level decreased numerically by 783 pg/ml. Diuretic dose before TTVR was increased, but HF medication did not change after TTVR. Procedural success was associated with improved 1-year survival (79% vs. 60%;p = 0.04) and event-free-survival (death thorn first HHF: 67% vs. 40%;p = 0.001). Transcatheter mitral and tricuspid valve repair-treated patients had comparable outcomes. CONCLUSIONS TTVR for severe TR is associated with a reduction of HHF and improved clinical outcomes. (c) 2020 by the American College of Cardiology Foundation.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 2213-1779
• Sprache: Englisch