Efficacy and Safety of Direct Annuloplasty in CIED Patients with Tricuspid Regurgitation: real-world insights

Jan Wrobel (Köln)1, T. Gietzen (Köln)1, J. L. Althoff (Köln)1, C. Hasse (Köln)1, J. von Stein (Köln)1, P. von Stein (Köln)1, C. Iliadis (Köln)1, S. Baldus (Köln)1, R. Pfister (Köln)1, M. I. Körber (Köln)1

1Herzzentrum der Universität zu Köln Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin Köln, Deutschland

 

Background: Cardiac implantable electronic devices (CIEDs) present a challenge in managing patients with tricuspid regurgitation (TR). Direct transcatheter tricuspid valve annuloplasty (TTVA) with the Cardioband® has emerged as a promising therapeutic approach to address TR in this specific patient population, yet evidence on the efficacy and safety of TTVA in CIED patients is lacking.
Objectives: This study aimed to evaluate the safety and efficacy of TTVA in CIED patients with secondary TR in terms of reducing TR severity, improving functional status and to investigate the impact of TTVA on the integrity and functionality of CIEDs.
Methods: A retrospective, single-center analysis was conducted to compare patients with CIEDs to non-CIED patients who underwent TTVA using the Edwards Cardioband®. Data were collected from the electronic health records of the University Hospital Cologne from October 2018 to September 2023.
Results: Out of a total of 104 TR patients treated with TTVA, 29 (27,9%) were identified as CIED carriers. There were no significant intergroup differences in baseline (BL) patient characteristics, TR severity and New York Heart Association functional (NYHA) class. Both cohorts exhibited considerable TR reduction, with comparable procedural success, minimal device-related and periprocedural complications. NTproBNP levels were higher at baseline and follow-up in the CIED cohort. The integrity and functionality of CIEDs remained unaffected, considering pre- and postprocedural CIED interrogation (n=18). Echocardiographic follow-up at 30 days (d) yielded similar TR reduction in CIED and non-CIED patients, translating into comparable symptomatic improvements according to the NYHA class and NTproBNP reduction in both groups. One-year survival was nonsignificantly different between cohorts. (Table 1)
Conclusions: TTVA using the Edwards Cardioband® proved equally effective and safe in CIED patients and holds promise as a viable strategy for managing TR in this high-risk group, without impairing post-interventional CIED performance.

Table 1:

Efficacy and Safety

TTVA + CIED
(n = 29)

TTVA only
(n = 75)

p-value

TR severity (BL)

4,13 (±0,86)

4(±0,88)

0,512

-EROA cm2

0,81(±0,41)

0,81(±0,78)

0,542

-TR VC mm

14,74(±5,05)

13,33(±4,28)

0,156

TR severity (discharge)

2,62(±0,94)

2,28(±1,01)

0,091

TR severity (30 d)

2,54(±1,1)

2,34(±1,0)

0,441

-EROA cm2

0,36(±0,24)

0,36(±0,49)

0,26

-TR VC mm

7,48(±3,96)

7,12(±4,04)

0,425

NYHA class (BL)

3,07(±0,45)

2,95(±0,49)

0,228

NYHA class (30 d)

2,33(±0,76)

2,15(±0,62)

0,229

NYHA class (BL vs. 30 d)

-1(±1,09)

-1,2(±1,09)

0,357

NTproBNP (BL) (pg/ml)

5082(±5033)

2384(±1994)

< 0,0001

NTproBNP (30 days) (pg/ml)

3371(±2345)

1806(±1166)

0,001

NTproBNP

(BL vs. 30 d) (pg/ml)

-63,35(±1653)

-77,81(±1231)

0,981

1-year survival (%)

78,23

85,28

0,3269

RCA perforation/penetration

8/28

9/75

0,07

RCA Stent implantation

0/29

4/75

0,574

Emergency cardiac surgery

0/29

1/75

>0,999

New arrhythmias

4/29

5/75

0,261

Device detachment

1/29

2/75

>0,999

Femoral bleeding

8/29

13/75

0,28

Stroke

1/29

1/75

0,482

CIED Interrogation

Pre TTVA
(n = 18)

Post TTVA
(n = 18)

p-value

Battery life (months)

67,29(±45,07)

58,09(±38,14)

0,199

RA and RV sensing (%)

11,05(±9,71)

10,51(±9,4)

0,534

RV capture threshold (V)

0,92(±0,2)

0,91(±0,25)

0,696

RV impedance (Ohm)

477,4(±124,5)

495,8(±129,6)

0,371

RV output (V)

1,97(±0,36)

1,97(±0,49)

0,758

RA impedance (Ohm)

480,2(±128,8)

406(±90,2)

0,048

RV stimulation (%)

76,06(±35,52)

74,84(±39,18)

0,695

 

 

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