https://doi.org/10.1007/s00392-025-02625-4
1Herzzentrum der Universität zu Köln Klinik III für Innere Medizin Köln, Deutschland; 2Universitätsklinikum Köln Klinik III für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin Köln, Deutschland; 3Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; 4Herzzentrum der Universität zu Köln Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin Köln, Deutschland; 5Universitätsklinikum Köln Herzzentrum - Kardiologie Köln, Deutschland; 6Herz- und Diabeteszentrum NRW Klinik für Kardiologie Bad Oeynhausen, Deutschland
Patients screened for transcatheter tricuspid annuloplasty (TTVA) for severe tricuspid regurgitation (TR) often represent a higher risk collective with more advanced disease stages compared to T-TEER. The recent endpoint definitions according to the tricuspid valve academic research consortium (TVARC) require a postinterventional reduction of tricuspid regurgitation (TR) to grade ≤ moderate for intraprocedural success. Previously, procedural success was frequently defined as reduction in TR ≥ 2 grades in the past years.
Aims
This study was performed to determine intraprocedural success following TTVA according to TVARC criteria and to determine if patients who did not meet these criteria (due to residual TR > moderate) still benefited from the procedure.
Methods
We retrospectively examined patients undergoing TTVA between 2018 and 2023 in two German centers. The primary endpoint was intraprocedural success and clinical success according to TVARC. Furthermore, we examined right ventricular remodeling in transthoracic echocardiography (TTE) und symptomatic improvement.
Results
Among 204 consecutive patients undergoing TTVA, intraprocedural success was achieved in 71.6% (n=146). Clinical success at 30 days follow-up was observed in 65.8% (n=131/199) in TTVA. A TR reduction of ≥ 2 grades (not considered in TVARC) was achieved in 78.4% of patients.
Overall, 38.7 % (n=79) of patients presented with baseline torrential TR and echocardiography showed a significant reduction in median TR-severity after 30 days (4 vs. 2). Patients who reached a TR reduction of ≥ 2 grades but did not meet the endpoint clinical success according to TVARC (n=28, 13.7%) presented more frequently with torrential TR at baseline (85.7% vs. 22.7%; p<0.01) and showed higher median right ventricular (RV) basal diameter (median 51.0 mm vs. 45.0 mm; p=0.01) and right atrial (RA) area (37.0 vs. 32.17; p=0.19) at baseline. Nevertheless, these patients showed an equally successful improvement of at least one grade in NYHA functional class (73.0% vs. 73.3%, p=0.89). Additionally, both groups showed a comparable reduction of median RV basal diameter (- 5.00 mm vs. - 5.50 mm) and RA area (- 5.89 cm² vs. - 5.51 cm²) at 30 days follow-up.
Conclusion
In this large collective of patients following TTVA, intraprocedural and clinical success according to TVARC were achieved in about two-thirds of patients. Patients who did not meet the necessary endpoint of TR reduction to <= moderate presented with more severe baseline disease but still benefited from the procedure with regard to remodeling and NYHA status