Aims
This study aimed to identify predictors of procedural success in patients undergoing direct annuloplasty (TTVA).
Methods
We retrospectively collected clinical and echocardiographic imaging data before, during and after TTVA at four tertiary centers in Europe. The primary endpoint was residual tricuspid regurgitation (TR) of moderate or less; the secondary endpoint was a composite of freedom from all-cause mortality and rehospitalization for heart failure, and New-York Heart Association (NYHA) class ≤ II at one-year follow-up. A two-step regularized regression approach including clinical and echocardiographic parameters was used to identify predictors of the primary endpoint.
Results
This study includes data from 225 patients treated at four European centers. The median age was 79 years (IQR: 74-82), with 72.0% being female. TR grade was massive or worse in 65.3%; 40.4% were classified as atrial functional TR. The primary endpoint was achieved in 72.9% of all patients, the secondary endpoint in 48.7%. In the final multivariable logistic regression model, four variables were significantly associated with the primary endpoint: TR vena contracta, bi-commissural tricuspid annulus diameter, tricuspid valve (TV) coaptation gap, and the presence of atrial TR. Among these, the presence of atrial TR yielded the strongest association (OR 2.75, 95% CI: 1.03-7.95, P = 0.049). Sub-analyses revealed higher rates of achieving the primary and secondary endpoints in patients with atrial TR when compared to non-atrial TR.
Conclusion
Our study confirms previous findings that atrial functional tricuspid regurgitation appears to be optimally suited for TTVA, yielding high procedural safety and efficacy in this group.
