Aetiology‐based clinical scenarios predict outcomes of transcatheter edge‐to‐edge tricuspid valve repair of functional tricuspid regurgitation

Abstract

Aims Transcatheter tricuspid valve repair (TTVR) is an emerging technique to treat tricuspid regurgitation (TR). Predictors of adverse outcomes are scarce, and stratification by TR aetiologies is lacking. Methods and results We report the bi‐centre procedural outcomes of 164 patients undergoing TTVR for TR stratified into four aetiology‐based clinical scenarios (CSs). By stepwise categorization, patients were categorized into Dialysis‐CS if they were on chronic haemodialysis; patients not undergoing dialysis with MR grade ≥ 3 into MR‐CS; patients not meeting the inclusion into Dialysis‐CS or MR‐CS with an invasively‐determined systolic pulmonary artery pressure ≥ 50 mmHg into PAPs‐CS; and the remaining patients into Afib‐CS in case a history of atrial fibrillation/flutter existed. Clinical characteristics and procedural outcomes were evaluated. Procedural success was > 80% in all CSs and decreased mortality (P = 0.03). Within the group of patients with procedural success, PAPs‐CS had the highest rates of the primary endpoint of death, heart failure hospitalization or reintervention (P = 0.01). Mortality was significantly higher in PAPs‐CS when compared to the other CSs (P = 0.03) and Dialysis‐CS had the highest mortality rate (33.3%). In all CSs, the majority of patients experienced New York Heart Association functional class improvement at follow‐up. Conclusions Stratification of TTVR into aetiology‐based CSs may open new paths to stratify for clinical risk and procedural benefit and may aid in the design of clinical trials in the heterogeneous TTVR patient population. Despite the observed CS outcome differences, TTVR appears feasible and safe, and confers functional improvements in patients with TR and heart failure.

Transcatheter edge‐to‐edge tricuspid valve repair for functional tricuspid regurgitation: does aetiology matter?

“…Of 159 patients who underwent TTVr, 11 (6.9%) were categorized into Dialysis‐CS, 74 (46.5%) into MR‐CS, 30 (18.9%) into PAPs‐CS, and 44 (27.7%) into Afib‐CS. Procedural success (defined as TR reduction ≥ 1 grade) rate was 88.7%, and was similar between the CSs ( P = 0.38) . Procedural success was associated with decreased rates of the primary endpoint ( P < 0.001) and mortality ( P = 0.03).…”

“…In this issue of the Journal, Schlotter et al . report the procedural outcomes of 159 patients who underwent TTVr for severe functional TR stratified by four aetiology‐based clinical scenarios (CS).…”

“…left‐sided valve disease), (iii) PAPs‐CS for patients not on haemodialysis and not meeting inclusion criteria for MR‐CS, with invasively‐determined pulmonary artery systolic pressure ≥ 50 mmHg (i.e. PAH), and (iv) Afib‐CS for patients with history of atrial fibrillation/flutter . The primary endpoint was a composite of death, heart failure hospitalization, and reintervention.…”

September 2019 at a glance: focus on devices

“…Among patients with procedural success, PAPs‐CS had the highest rate of the primary endpoint (death, HF hospitalization or reintervention) while mortality rates were comparable in PAPs‐CS and Dialysis‐CS, and higher compared to the other two CSs. Improvements in functional status were observed in the majority of patients regardless of their CS …”

“…However, it is still unclear which patients would have a prognostic benefit. Schlotter et al . reported procedural and clinical outcomes of 164 patients undergoing TTVR for TR stratified into four aetiology‐based clinical scenarios (CSs): Dialysis‐CS, mitral regurgitation ≥3 CS, pulmonary artery systolic pressure ≥50 mmHg (PAPs‐CS), and atrial fibrillation CS.…”