Biphasic right ventricular reverse remodeling following tricuspid valve transcatheter edge-to-edge repair

Lukas Stolz (München)1, L. Weckbach (München)2, H. Glaser (München)1, P. Doldi (München)2, S. Schmid (München)1, T. Stocker (München)2, C. Hagl (München)3, M. Näbauer (München)2, S. Massberg (München)2, J. Hausleiter (München)2

1Ludwig-Maximilians Universität München Medizinische Klinik und Poliklinik I München, Deutschland; 2LMU Klinikum der Universität München Medizinische Klinik und Poliklinik I München, Deutschland; 3LMU Klinikum der Universität München Herzchirurgische Klinik und Poliklinik München, Deutschland


Background: Transcatheter tricuspid valve edge-to-edge repair (T-TEER) is associated with right ventricular reverse remodeling (RVRR). Detailed data on the temporal evolution of this effect are lacking until today.


Objectives: The aim of this study was to evaluate RVRR over the course of follow-up after T-TEER using sequential three-dimensional echocardiograms (3DE). 


Methods: The study included T-TEER patients with available 3DE at baseline and discharge. Further follow-ups were scheduled at 1-month, 6-months, 1 and 2 years. 3DE evaluation included right ventricular volumes (RVEDV; RVESV), right ventricular ejection fraction (RVEF), right ventricular strain of the free wall and the septum (RVLSFW; RVLSS). The analysis included 147 patients (mean age 82.1 ±7.4 years, 48% women). 


Results: We observed a biphasic pattern of RVRR following T-TEER consisting of early RV unloading (reduction in RVEDV) and later structural RVRR (reduction in RVESV). While RVEDV was significantly reduced early after the procedure (-9.5% from baseline to discharge, p<0.001), RVESV remained unchanged at one-month follow-up. Reduction in RVESV3D was observed at six-month follow-up for the first time (-8.4% from baseline to six-month follow-up, p<0.001). Reduction in both, RVEDV3D and RVESV3D peaked at one-year follow-up (-23% and -16.2%, respectively) and remained stable until two-years after T-TEER. RV function declined early after T-TEER and gradually increased over the course of follow-up (RVEF baseline 44.0 ±9.0 %, discharge 38.3 ±9.0 %, two-year follow-up 42.3 ±9.2 %). RVLSS and RVLSFW developed analogously.


Conclusions: RVRR following T-TEER occurs in two stages and involves early RV volume unloading (reduction in RVEDV) and later structural RVRR (reduction in RVESV) with an improvement in RV ejection fraction.

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