Author + information
- Received January 2, 2020
- Revision received February 10, 2020
- Accepted February 19, 2020
- Published online May 18, 2020.
- Nicole Karam, MD, PhDa,b,∗,
- Michael Mehr, MDa,∗,
- Maurizio Taramasso, MDc,∗,
- Christian Besler, MDd,
- Tobias Ruf, MDe,
- Kim A. Connelly, MDf,
- Marcel Weber, MDg,
- Ermela Yzeiraj, MDh,
- Davide Schiavi, MDi,
- Antonio Mangieri, MDi,
- Laura Vaskelyte, MDj,
- Hannes Alessandrini, MDk,
- Florian Deuschl, MDl,
- Nicolas Brugger, MDm,
- Hasan Ahmad, MDn,
- Edwin Ho, MDf,
- Luigi Biasco, MDo,
- Mathias Orban, MDa,
- Simon Deseive, MDa,
- Daniel Braun, MDa,
- Mara Gavazzoni, MDc,
- Karl-Philipp Rommel, MDd,
- Alberto Pozzoli, MDc,
- Christian Frerker, MDk,
- Michael Näbauer, MDa,
- Steffen Massberg, MDa,
- Giovanni Pedrazzini, MDo,
- Gilbert H.L. Tang, MD, MSc, MBAp,
- Stephan Windecker, MDm,
- Ulrich Schäfer, MDl,
- Karl-Heinz Kuck, MDk,
- Horst Sievert, MDj,
- Paolo Denti, MDq,
- Azeem Latib, MDi,r,
- Joachim Schofer, MDh,
- Georg Nickenig, MDg,
- Neil Fam, MDf,
- Stephan von Bardeleben, MDe,
- Philipp Lurz, MDd,
- Francesco Maisano, MDc,† and
- Jörg Hausleiter, MDa,s,†∗ ()
- aMedizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
- bEuropean Hospital Georges Pompidou, Cardiology Department, Université de Paris, PARCC, INSERM, Paris, France
- cDepartment of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
- dLeipzig Heart Center, University of Leipzig, Leipzig, Germany
- eMainz University Hospital, University of Mainz, Mainz, Germany
- fDivision of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- gBonn University Hospital, University of Bonn, Bonn, Germany
- hAlbertinen Heart Center, Hamburg, Germany
- iGVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
- jCardioVascular Center, Frankfurt, Germany
- kAsklepios Klinik St. Georg, Hamburg, Germany
- lUniversity Heart Center Hamburg, University of Hamburg, Hamburg, Germany
- mInselspital, University of Bern, Bern, Switzerland
- nWestchester Medical Center, Valhalla, New York
- oCardioCentro Ticino, Lugano, Switzerland
- pMount Sinai Medical Center, New York, New York
- qSan Raffaele University Hospital, Milan, Italy
- rDepartment of Cardiology, Montefiore Medical Center, Bronx, New York
- sMunich Heart Alliance, Partner Site German Center for Cardiovascular Disease, Munich, Germany
- ↵∗Address for correspondence:
Dr. Jorg Hausleiter, Medizinische Klinik I, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377 Munich, Germany.
Objectives The aim of this study was to assess the value of echocardiographic right ventricular (RV) and systolic pulmonary artery pressure (sPAP) assessment in predicting transcatheter tricuspid edge-to-edge valve repair (TTVR) outcome.
Background RV dysfunction and pulmonary hypertension are associated with poor prognosis and are systematically sought during tricuspid regurgitation evaluation. The value of echocardiographic assessment in predicting TTVR outcome is unknown.
Methods Data were taken from the TriValve (Transcatheter Tricuspid Valve Therapies) registry, which includes patients undergoing TTVR at 14 European and North American centers. The primary outcome was 1-year survival free from hospitalization for heart failure, and secondary outcomes were 1-year survival and absence of hospital admission for heart failure at 1 year.
Results Overall, 249 patients underwent TTVR between June 2015 and 2018 (mean tricuspid annular plane systolic excursion [TAPSE] 15.8 ± 15.3 mm, mean sPAP 43.6 ± 16.0 mm Hg). Tricuspid regurgitation grade ≥3+ was found in 96.8% of patients at baseline and 29.4% at final follow-up; 95.6% were in New York Heart Association functional class III or IV initially, compared with 34.3% at follow-up (p < 0.05). Final New York Heart Association functional class did not differ among TAPSE and sPAP quartiles, even when both low TAPSE and high sPAP were present. Rates of 1-year survival and survival free from hospitalization for heart failure were 83.9% and 78.7%, respectively, without significant differences according to baseline echocardiographic RV characteristics (TAPSE, fractional area change, and end-diastolic area) and sPAP (p > 0.05 for all).
Conclusions TTVR provides clinical improvement, with 1-year survival free from hospital readmission >75% in patients with severe tricuspid regurgitation. Conventional echocardiographic parameters used to assess RV function and sPAP did not predict clinical outcome after TTVR.
- edge-to-edge repair
- pulmonary artery pressure
- right ventricular function
- tricuspid regurgitation
↵∗ Drs. Karam, Mehr, and Taramasso share first authorship.
↵† Drs. Maisano and Hausleiter share last authorship.
Dr. Karam has received consulting fees from Abbott Vascular. Dr. Mehr has received travel grants from Bristol-Myers Squibb. Dr. Connelly has received honoraria from Abbott; and is supported by a new investigator award from Canadian Institutes of Health Research and an early researcher award from the Ministry of Health. Dr. Braun has received speaking honoraria from Abbott Vascular. Dr. Nabauer has received speaking honoraria from Abbott Vascular. Dr. Tang is a consultant for Abbott Structural Heart. Dr. Windecker has received research contracts to the institution from Abbott, Amgen, Bayer, Boston Scientific, Biotronik, Medtronic, Edwards Lifesciences, St. Jude Medical, and Terumo. Dr. Schäfer has received consulting, grant support, travel, and speaking honoraria from Abbott. Dr. Latib has received consulting fees from Medtronic, Abbott, and Edwards Lifesciences. Dr. Hausleiter has received research support and speaking honoraria from Abbott Vascular and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received January 2, 2020.
- Revision received February 10, 2020.
- Accepted February 19, 2020.
- 2020 American College of Cardiology Foundation
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