Vol 28, No 4 (2021)
Original Article
Published online: 2021-04-23

open access

Page views 1172
Article views/downloads 956
Get Citation

Connect on Social Media

Connect on Social Media

The impact of tricuspid annular geometry on outcome after percutaneous edge-to-edge repair for severe tricuspid regurgitation

Sylvia Otto1, Marija Velichkov1, Ali Hamadanchi1, P. Christian Schulze1, Sven Moebius-Winkler1
Pubmed: 33942279
Cardiol J 2021;28(4):579-588.

Abstract

Background: Percutaneous tricuspid repair using the edge-to-edge technique is a novel treatment option. More data are needed to better understand which aspects predict a favorable outcome.
Methods: Twenty high-risk patients (78.6 ± 8.3 years, EuroScore II 9.1 ± 7.7%, STS score 8.8 ± 4.3) with severe symptomatic tricuspid regurgitation (TR) were treated with the MitraClip® system. All patients underwent standardized pre-, peri-, and post-procedural evaluation. Acute success was defined as successful edge-to-edge repair with TR reduction of ≥ 1 grade and survival until hospital discharge.
Results: Fifteen (75%) patients showed acute success until discharge and 12 (60%) at 30-day followup. In 5 (25%) patients repair failed due to either unsuccessful clip implantation (n = 2), single leaflet device attachment (n = 1), TR reduction < 1 grade (n = 1), or in-hospital death (n = 1). Comparing patients with successful procedure versus those with failed repair revealed similar comorbidities but more severe right heart failure, lower left ventricular ejection fraction, worse renal function, and higher diuretic equivalent doses in the failed repair group. No differences in conventional echocardiographic parameters for TR severity but more dilated tricuspid annulus geometry (tricuspid valve annulus, coaptation depth, tenting area) in the failed repair group were observed. The success rate of non-central/non-anteroseptal jet location was only 25%.
Conclusions: Tricuspid annulus geometry assessment may be of crucial importance and seems to impact procedural outcomes in patients undergoing edge-to-edge tricuspid valve repair. Further investigations including advanced imaging are needed to better understand and treat this complex valve disease.

Article available in PDF format

View PDF Download PDF file

References

  1. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017; 38(36): 2739–2791.
  2. Chikwe J, Itagaki S, Anyanwu A, et al. Impact of concomitant tricuspid annuloplasty on tricuspid regurgitation, right ventricular function, and pulmonary artery hypertension after repair of mitral valve prolapse. J Am Coll Cardiol. 2015; 65(18): 1931–1938.
  3. Zack CJ, Fender EA, Chandrashekar P, et al. National trends and outcomes in isolated tricuspid valve surgery. J Am Coll Cardiol. 2017; 70(24): 2953–2960.
  4. Navia JL, Brozzi NA, Klein AL, et al. Moderate tricuspid regurgitation with left-sided degenerative heart valve disease: to repair or not to repair? Ann Thorac Surg. 2012; 93(1): 59–67; discussion 68.
  5. Benedetto U, Melina G, Angeloni E, et al. Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery. J Thorac Cardiovasc Surg. 2012; 143(3): 632–638.
  6. Kim JB, Yoo DG, Kim GS, et al. Mild-to-moderate functional tricuspid regurgitation in patients undergoing valve replacement for rheumatic mitral disease: the influence of tricuspid valve repair on clinical and echocardiographic outcomes. Heart. 2012; 98(1): 24–30.
  7. Taramasso M, Benfari G, van der Bijl P, et al. Transcatheter versus medical treatment of patients with symptomatic severe tricuspid regurgitation. J Am Coll Cardiol. 2019; 74(24): 2998–3008.
  8. Addetia K, Muraru D, Veronesi F, et al. 3-Dimensional echocardiographic analysis of the tricuspid annulus provides new insights into tricuspid valve geometry and dynamics. JACC Cardiovasc Imaging. 2019; 12(3): 401–412.
  9. Chang JD, Manning WJ, Ebrille E, et al. Tricuspid valve dysfunction following pacemaker or cardioverter-defibrillator implantation. J Am Coll Cardiol. 2017; 69(18): 2331–2341.
  10. Hahn RT, Zamorano JL. The need for a new tricuspid regurgitation grading scheme. Eur Heart J Cardiovasc Imaging. 2017; 18(12): 1342–1343.
  11. Badano LP, Hahn R, Rodríguez-Zanella H, et al. Morphological assessment of the tricuspid apparatus and grading regurgitation severity in patients with functional tricuspid regurgitation: thinking outside the box. JACC Cardiovasc Imaging. 2019; 12(4): 652–664.
  12. Kilic A, Saha-Chaudhuri P, Rankin JS, et al. Trends and outcomes of tricuspid valve surgery in North America: an analysis of more than 50,000 patients from the Society of Thoracic Surgeons database. Ann Thorac Surg. 2013; 96(5): 1546–52; discussion 1552.
  13. Benfari G, Antoine C, Miller WL, et al. Excess mortality associated with functional tricuspid regurgitation complicating heart failure with reduced ejection fraction. Circulation. 2019; 140(3): 196–206.
  14. Topilsky Y, Maltais S, Medina Inojosa J, et al. Burden of tricuspid regurgitation in Patients diagnosed in the community setting. JACC Cardiovasc Imaging. 2019; 12(3): 433–442.
  15. Topilsky Y, Nkomo VT, Vatury O, et al. Clinical outcome of isolated tricuspid regurgitation. JACC Cardiovasc Imaging. 2014; 7(12): 1185–1194.
  16. Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol. 2004; 43(3): 405–409.
  17. Agricola E, Marini C, Stella S, et al. Effects of functional tricuspid regurgitation on renal function and long-term prognosis in patients with heart failure. J Cardiovasc Med (Hagerstown). 2017; 18(2): 60–68.
  18. Kim JB, Jung SH, Choo SJ, et al. Surgical outcomes of severe tricuspid regurgitation: predictors of adverse clinical outcomes. Heart. 2013; 99(3): 181–187.
  19. Ratnatunga C, Edwards MB, Dore C, et al. Tricuspid valve replacement: UK heart valve registry mid-term results comparing mechanical and biological prostheses. Ann Thoracic Sur. 1998; 66(6): 1940–1947.
  20. Moraca RJ, Moon MR, Lawton JS, et al. Outcomes of tricuspid valve repair and replacement: a propensity analysis. Ann Thorac Surg. 2009; 87(1): 83–88.
  21. Chang CC, Veen KM, Hahn RT, et al. Uncertainties and challenges in surgical and transcatheter tricuspid valve therapy: a state-of-the-art expert review. Eur Heart J. 2020; 41(20): 1932–1940.
  22. Mehr M, Taramasso M, Besler C, et al. 1-Year outcomes after edge-to-edge valve repair for symptomatic tricuspid regurgitation: results from the trivalve registry. JACC Cardiovasc Interv. 2019; 12(15): 1451–1461.
  23. Alushi B, Beckhoff F, Leistner DM, et al. 5938 Mortality risk stratification in patients with severe tricuspid regurgitation - Insights from the Tricuspid Regurgitation REgistry (TRuE). Eur Heart J. 2019; 40(Suppl 1).
  24. Besler C, Orban M, Rommel KP, et al. Predictors of procedural and clinical outcomes in patients with symptomatic tricuspid regurgitation undergoing transcatheter edge-to-edge repair. JACC Cardiovasc Interv. 2018; 11(12): 1119–1128.
  25. Nickenig G, Weber M, Schueler R, et al. 6-Month outcomes of tricuspid valve reconstruction for patients with severe tricuspid regurgitation. J Am Coll Cardiol. 2019; 73(15): 1905–1915.
  26. Braun D, Nabauer M, Orban M, et al. One-year results of transcatheter treatment of severe tricuspid regurgitation using the edge-to-edge repair technique. EuroIntervention. 2018; 14(4): e413–e415.
  27. Min SY, Song JM, Kim JH, et al. Geometric changes after tricuspid annuloplasty and predictors of residual tricuspid regurgitation: a real-time three-dimensional echocardiography study. Eur Heart J. 2010; 31(23): 2871–2880.
  28. Stone GW, Lindenfeld J, Abraham WT, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med. 2018; 379(24): 2307–2318.
  29. Obadia JF, Messika-Zeitoun D, Leurent G, et al. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med. 2018; 379(24): 2297–2306.
  30. Taramasso M, Gavazzoni M, Pozzoli A, et al. Outcomes of TTVI in patients with pacemaker or defibrillator leads: data from the trivalve registry. JACC Cardiovasc Interv. 2020; 13(5): 554–564.
  31. Topilsky Y, Khanna A, Le Tourneau T, et al. Clinical context and mechanism of functional tricuspid regurgitation in patients with and without pulmonary hypertension. Circ Cardiovasc Imaging. 2012; 5(3): 314–323.
  32. Zhou X, Otsuji Y, Yoshifuku S, et al. Impact of atrial fibrillation on tricuspid and mitral annular dilatation and valvular regurgitation. Circ J. 2002; 66(10): 913–916.
  33. Mutlak D, Lessick J, Khalil S, et al. Tricuspid regurgitation in acute heart failure: is there any incremental risk? Eur Heart J Cardiovasc Imaging. 2018; 19(9): 993–1001.
  34. Neuhold S, Huelsmann M, Pernicka E, et al. Impact of tricuspid regurgitation on survival in patients with chronic heart failure: unexpected findings of a long-term observational study. Eur Heart J. 2013; 34(11): 844–852.
  35. Koelling TM, Aaronson KD, Cody RJ, et al. Prognostic significance of mitral regurgitation and tricuspid regurgitation in patients with left ventricular systolic dysfunction. Am Heart J. 2002; 144(3): 524–529.