1Universitätsklinikum Bonn Medizinische Klinik und Poliklinik II Bonn, Deutschland; 2Städt. Klinikum Solingen gGmbH Klinik für Kardiologie und internistische Intensivmedizin Solingen, Deutschland; 3Kreiskrankenhaus Waldbröl GmbH Klinik für Innere Medizin, Kardiologie Waldbröl, Deutschland
Objectives: We sought to compare currently available CE-certified transcatheter tricuspid valve repair (TTVr) therapy options in consideration of efficacy, safety and echocardiographical outcomes.
Methods: After propensity matching we retrospectively included 55 patients with symptomatic high-grade tricuspid regurgitation (TR) who underwent either a MitraClip/PASCAL or a Cardioband procedure. Comprehensive clinical and echocardiographic evaluation, including comprehensive strain analysis, were performed before and one year after the procedure.
Results: 41 patients (74.5%) underwent transcatheter edge-to-edge repair (A), and 14 patients (25.5%) were treated by interventional direct annuloplasty (B) of TR (94.5 % functional). At one-year follow-up, we found a significant and sustained reduction of TR in both groups (A: 54.7% vs B: 49.3%, p=0.7). Tricuspid diameter was significantly significantly reduced by group A (6.9%) and by group B (10.7%, both p<0.01) and led to a significant decrease in right atrial dimensions (A: 9.4%; B: 10.7%, p<0.05) and pressure (A: 26.6%; B: 28.6%, p<0.05) without statistical significance in comparison of both groups (p>0.05). In group A, right ventricular (RV) function was found to be increased in strain analysis (RV-GLS: -17.90±8.35% to -21.14±7.02%, p= 0.01) with decreased RV systolic pressure (38.92±16.56 mmHg to 32.98±10.99 mmHg, p= 0.02), whereas no relevant changes in group B. We documented improved NYHA class (A: 26.5% vs B: 18.53%, p=0.3) and 6MWT (A: 18.2% vs. B: 23.2%, p=0.6) at one-year FU in both groups. One-year mortality and heart failure rehospitalisations were comparable between the groups. Of note, a moderate amelioration of renal dysfunction was documented at one-year-FU (p=0.01).
Conclusion: Both TTVr modalities were efficacious to reduce TR, followed by sustained improved functional capacity. Right atrial volumes und pressure decreased postinterventionally as a sign of reduced volume overload of the right heart.