1Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; 2Northwestern University Feinberg School of Medicine Chicago, USA; 3Herzzentrum der Universität zu Köln Klinik III für Innere Medizin Köln, Deutschland; 4Herz- und Diabeteszentrum NRW Klinik für Kardiologie Bad Oeynhausen, Deutschland
Aims
Transcatheter tricuspid valve repair (TTVr) have significantly expanded treatment options for tricuspid regurgitation (TR). However, a sizeable proportion of patients is still declined for TTVr. The TriSelect study has reported that the majority of patients with TTVr screen failure were excluded because of overt tricuspid valve and right ventricular enlargement. However, little is known about the outcome of these patients. Thus, the aim of this study was to compare the one-year outcomes of patients accepted or rejected for TTVr in terms of mortality.
Methods and Results
547 patients were evaluated for TTVr between 01/2016-12/2021 from 3 centers in the US and Germany. Median age was 80 (74-83) years and 60% were female. Over half (58.1%) were accepted for TTVr (including edge-to-edge repair and direct annuloplasty). Of those who were deemed unsuitable for TTVI (n=229, 41.9%), the most common reasons patients were excluded for TTVI were for anatomical criteria (n=130, 56.8%). Other reasons for rejection included clinical futility (n=41, 17.9%), low symptom burden (n=29, 12.7%), and technical limitations (n=29, 12.7%).
One-year follow up data revealed that mortality was higher in patients who were declined for TTVr (12.7% vs 30.2%; log-rank p=0.002). Importantly, patients who screen-failed because of anatomical criteria also showed a higher mortality rate (33.3%; log-rank p=0.001. Mortality was also higher in patients with unsatisfactory results after TTVr (postprocedural TR greater than moderate) compared to patients with acceptable results (19.3% vs. 8.6%; log-rank p=0.008). Conversely, there was no significant difference in mortality between TTVr patients with TR reduction equal or greater than 2 grades compared to less effective TR reduction (10.7% vs. 4.3%; log-rank p=0.36). Notably, the comparison of one-year mortality rates between patients with unsatisfactory TTVr results and those excluded from TTVr did not yield a significant difference (19.3% vs. 30.2%; log-rank p=0.72).
Conclusion
TTVr screen failure patients present a high mortality at 1-year follow up. However, patients who exhibit suboptimal procedural results in TTVr, might manifest comparably substantial mortality rates. Therefore, careful considerations of patient and device factors appears to be essential, as the potential benefits of TTVr might be realized only when optimal reduction of tricuspid regurgitation is achieved.