One-year echocardiographic outcome of transcatheter tricuspid valve repair: Comparison of edge-to-edge repair versus annuloplasty

Johanna Vogelhuber (Bonn)1, A. Sugiura (Bonn)1, T. Tanaka (Bonn)1, M. U. Becher (Solingen)2, V. Tiyerili (Waldbröl)3, S. Zimmer (Bonn)1, G. Nickenig (Bonn)1, C. Öztürk (Bonn)1, M. Weber (Bonn)1

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.

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