Six‐month outcome after transcatheter edge‐to‐edge repair of severe tricuspid regurgitation in patients with heart failure

Orban, Mathias; Besler, Christian; Braun, Daniel; Näbauer, Michael; Zimmer, Marion; Orban, Martin; Noack, Thilo; Mehilli, Julinda; Hagl, Christian; Seeburger, Joerg; Borger, Michael A.; Linke, Axel; Thiele, Holger; Maßberg, Steffen; Ender, Joerg; Lurz, Philipp; Hausleiter, Jörg

doi:10.1002/ejhf.1147

Cited by 83 publications

(48 citation statements)

References 33 publications

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“…Patients at elevated surgical risk, who are traditionally excluded from valve surgery, are subject to progressive right heart failure, conferring a high morbidity and mortality. Minimally invasive transcatheter strategies have emerged as potential treatment options for these patients and preliminary evidence suggests that transcatheter tricuspid valve repair (TTVR) is feasible and has a low‐risk profile . While substantial improvements in symptoms and functional capacity after TTVR device therapy have been reported, randomized controlled outcome trials are lacking thus far.…”

Section: Introductionmentioning

confidence: 99%

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

Schlotter

Orban

Rommel

et al. 2019

European J of Heart Fail

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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.

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Section: Introductionmentioning

confidence: 99%

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

Schlotter

Orban

Rommel

et al. 2019

European J of Heart Fail

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“…The right femoral vein was used as site for the introduction of the 24 F Mitraclip XTR steerable guide. The insertion of the clip delivery system was performed 90° counter‐clockwise from its usual locking position, as recently proposed . We decided to use the Mitraclip XTR device to facilitate leaflet grasping.…”

Section: Case Reportmentioning

confidence: 99%

Transcatheter edge‐to‐edge tricuspid repair for recurrence of valvular regurgitation after left ventricular assist device and tricuspid ring implantation

et al. 2020

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Tricuspid regurgitation in patients with left ventricular assist device (LVAD) has a significant impact on prognosis and quality of life, and its effects on liver and renal function could negatively impact planned heart transplantation. The aim of the present case is to report the feasibility and the clinical impact of tricuspid transcatheter edge-to-edge repair in LVAD patients as adjunctive bridge to transplantation strategy. A 59-year-old female patient previously treated with LVAD implantation (HeartMate III) and tricuspid valve repair with 32 mm rigid ring (Medtronic Contour 3D) as bridge to transplantation developed recurrence of significant tricuspid regurgitation with right ventricular decompensation needing inotropic support. Preoperative echo showed torrential tricuspid valve regurgitation Effective regurgitant orifice area(EROA 1.4 cm 2 ) with suspicious of partial detachment of the prosthetic ring. The patient was successfully treated with transcatheter edge-to-edge repair with the MitraClip XTR device. Tricuspid regurgitation was reduced by 50% (postoperative EROA 0.7 cm 2 ). She remained stable under continuous inotropic support with no other episodes of right ventricular decompensation and was successfully transplanted 30 days after the clipping procedure. Transcatheter treatment of tricuspid regurgitation in a patient with LVAD was an effective strategy to gain time and bridge the patient to heart transplantation.

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“…Right ventricular dysfunction and tricuspid regurgitation (TR) are major independent determinants of outcomes in patients with HF and valve disease . Transcatheter tricuspid valve repair (TTVR) by MitraClip is an emerging tool to treat patients with significant TR at high surgical risk . However, it is still unclear which patients would have a prognostic benefit.…”

Section: Devicesmentioning

confidence: 99%

September 2019 at a glance: focus on devices

Adamo

Lombardi

Metra

2019

European J of Heart Fail

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Six‐month outcome after transcatheter edge‐to‐edge repair of severe tricuspid regurgitation in patients with heart failure

Abstract: Transcatheter edge-to-edge TV repair for severe TR is safe and effective in reducing TR. It appears to be associated with improved clinical outcome in the majority of patients.

Cited by 83 publications

References 33 publications

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

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

Transcatheter edge‐to‐edge tricuspid repair for recurrence of valvular regurgitation after left ventricular assist device and tricuspid ring implantation

September 2019 at a glance: focus on devices

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