Author + information
- Received February 1, 2018
- Revision received April 23, 2018
- Accepted May 1, 2018
- Published online June 18, 2018.
- Christian Besler, MDa,∗,
- Mathias Orban, MDb,c,∗,
- Karl-Philipp Rommel, MDa,∗,
- Daniel Braun, MDb,
- Mehul Patel, MDd,
- Christian Hagl, MDe,
- Michael Borger, MD, PhDf,
- Michael Nabauer, MDb,
- Steffen Massberg, MDb,c,
- Holger Thiele, MDa,
- Jörg Hausleiter, MDb,c,† and
- Philipp Lurz, MD, PhDa,†∗ ()
- aDepartment of Cardiology, Heart Center Leipzig – University Hospital, Leipzig, Germany
- bMedizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- cMunich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
- dDepartment of Cardiology, East Carolina University, Greenville, North Carolina
- eHerzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
- fDepartment of Cardiac Surgery, Heart Center Leipzig – University Hospital, Leipzig, Germany
- ↵∗Address for correspondence:
Dr. Philipp Lurz, Department of Internal Medicine/Cardiology, University of Leipzig – Heart Center, Strümpellstraße 39, 04289 Leipzig, Germany.
Objectives This study sought to investigate predictors of procedural success and clinical outcomes in patients with tricuspid regurgitation (TR) at increased surgical risk undergoing transcatheter tricuspid valve edge-to-edge repair (TTVR).
Background Recent data suggest TTVR using the edge-to-edge repair technique in patients at high surgical risk is feasible and improves functional status at short-term follow-up.
Methods TTVR was carried out in 117 patients with symptomatic TR (median age 79.0 years [interquartile range (IQR): 75.5 to 83.0 years], EuroSCORE II 6.3% [IQR: 4.1% to 10.8%], STS mortality score 5.3% [IQR: 2.9% to 7.1%]) at 2 centers in Germany between March 2016 and November 2017. Seventy-four patients had concomitant severe mitral regurgitation and underwent transcatheter edge-to-edge repair of both valves.
Results During TTVR, 185 and 34 clips were implanted at the anteroseptal and posteroseptal commissures, respectively. Procedural success (TR reduction ≥1) was achieved in 81% of patients. Median TR effective regurgitant orifice area was reduced from 0.5 to 0.2 cm2. After a median follow-up of 184 days (IQR: 106 to 363 days), 24 patients died and 21 patients were readmitted for heart failure. TTVR procedural success independently predicted the time free of death and admission for heart failure (hazard ratio: 0.20 [95% confidence interval: 0.08 to 0.48]; p < 0.01), irrespective of concomitant mitral regurgitation. Small TR coaptation gap size and a central/anteroseptal TR jet location independently predicted procedural success on multivariate analysis.
Conclusions Successful TR reduction by TTVR serves as a predictor for reduced mortality and heart failure hospitalization. TR coaptation gap and jet location may assist in decision making whether a patient is anatomically suited for TTVR.
- edge-to-edge repair
- heart failure
- right ventricle
- transcatheter therapy
- tricuspid regurgitation
- tricuspid valve
↵∗ Drs. Besler, Orban, and Rommel contributed equally to this work and are joint first authors.
↵† Drs. Hausleiter and Lurz contributed equally to this work and are joint senior authors.
Dr. Braun has received speakers honoraria from Abbott Vascular. Dr. Hausleiter has been a consultant to and received speakers honoraria from Abbott Vascular and speakers honoraria from Edwards Lifesciences. Drs. Nabauer and Lurz have been consultants to and received speakers honoraria from Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 1, 2018.
- Revision received April 23, 2018.
- Accepted May 1, 2018.
- 2018 American College of Cardiology Foundation
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