Systemic inflammatory response syndrome after transcatheter tricuspid valve replacement with the EVOQUE system: incidence, predictors and clinical impact

F. M. Haug (München)¹, N. Piber (München)², H. A. Alvarez-Covarrubias (München)¹, H. Ruge (München)², J. Pflug (München)¹, S. Voss (München)², T. Trenkwalder (München)¹, E. Xhepa (München)¹, M. Joner (München)¹, M. Krane (München)², T. Rheude (München)^1
1TUM Klinikum Deutsches Herzzentrum Herz- und Kreislauferkrankungen München, Deutschland; ²TUM Klinikum Deutsches Herzzentrum Herz-und Gefäßchirurgie München, Deutschland

Background: Transcatheter tricuspid valve replacement (TTVR) using the EVOQUE system is an emerging treatment option for severe tricuspid regurgitation (TR). Although systemic inflammatory response syndrome (SIRS) is frequently observed following percutaneous cardiovascular interventions, data on SIRS following transcatheter tricuspid valve interventions are lacking.

Objectives: We sought to investigate the incidence and clinical impact of SIRS following TTVR using the EVOQUE system.

Methods: This retrospective, single-center study included consecutive patients undergoing TTVR using the EVOQUE system for severe TR. SIRS was defined as fulfilling at least two of the following criteria within 48 hours after the procedure: 1. Leucocyte count (≥12 x10⁹/l or ≤4 x10⁹/l); 2. Hypo- or hyperthermia (≥38.0°C or ≤36.0°C); 3. Heart rate ≥90 bpm; 4. Respiratory rate ≥20/min or paCO2 ≤ 33mmHg. Peri-procedural complications were adjudicated according to TVARC criteria. The outcomes of interest were heart failure hospitalization and all-cause mortality.

Results: A total of 58 patients were included. Median age was 80.5 years and 75.9% were female. SIRS occurred in 69% (40/58), while severe SIRS was observed in 35% (20/58). The most common SIRS were: tachypnea or hypocapnia 100%, tachycardia 70%, leucocyte count abnormalities 42.5% and fever 42.5%. Minor and major vascular complications (52.5% vs 22.2%; p=0.033) and in-hospital bleeding events (Type 3 - 5) (32.5% vs 5.6%; p=0.028) were significantly more frequent among patients with SIRS than in those without SIRS. During a mean follow-up of 322 days, no significant differences were observed between patients with and without SIRS in all-cause mortality (7.5% vs. 11.1%; log-rank p = 0.439) or heart failure hospitalization (25.0% vs. 46.2%; p = 0.101).

Conclusion: SIRS is a frequent phenomenon following TTVR with the EVOQUE system. Patients with SIRS experienced significantly higher rates of periprocedural vascular complications and in-hospital bleeding; however, SIRS was not associated with an increased risk of all-cause mortality or heart failure hospitalization during short-term follow-up.