1Herzzentrum der Universität zu Köln Klinik III für Innere Medizin Köln, Deutschland; 2Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland
Transcatheter direct annuloplasty (TTVA) of secondary tricuspid regurgitation (TR) with Cardioband® tricuspid valve reconstruction system (Edwards Lifesciences, Irvine, CA) has proved to be safe and efficient in acutely reducing TR in smaller and well controlled patient groups. However, data on long-term outcomes and in particular right ventricular remodeling in a larger real-world cohort still remain uncertain.
Objectives
This real-world, retrospective multicenter study sought to assess long-term efficacy as well as long-term right heart remodeling after TTVA using the Cardioband ®.
Methods
We retrospectively analyzed 156 patients who underwent TTVA due to severe, secondary TR at two German high-volume sites. The individual decision to perform TTVA was made considering anatomical features that made them unsuitable or not ideal for leaflet-based therapy. Clinical and echocardiographic outcomes were analyzed at baseline and after a median follow-up of 435 days.
Results
TR severity at baseline, discharge and long-term follow-up is presented in Figure 1. 71.2 % achieved procedural success, defined as technical success and TR reduction ≥2 grades at discharge. We ascertained significant improvements in right atrial area, right ventricular diameters and annular dimensions at long-term follow up when compared to baseline values, demonstrating positive right-heart remodeling (Table 1). In line with TR reduction and right heart remodeling, NYHA class improved (NYHA I/II 7.1% at baseline vs. NYHA I/II 67.6 % at follow-up; p < 0.001). Kaplan-Meier estimates of all-cause mortality and rehospitalization due to heart failure were 18 % and 13 %, respectively.
Conclusion
In this large, multicenter real-world cohort, TTVA is associated with a significant reduction of TR severity that is sustained for over one year. Furthermore, patients show distinct positive right atrial and right ventricular remodeling that is followed by an improvement of the patients’ functional status in long-term follow-up.