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Canadian Journal of Cardiology

Transcatheter Tricuspid Valve Repair in Prohibitive Risk Patients: Impact on Quality of Life and Major Organ Systems

Published:September 09, 2022DOI:https://doi.org/10.1016/j.cjca.2022.09.006

      Abstract

      BACKGROUND

      Percutaneous repair for severe tricuspid regurgitation (TR) is emerging as a viable option, but patient selection is challenging and predetermined by comorbidities. This study evaluated mid-term outcomes of transcatheter tricuspid valve repair (TTVR) in very sick inoperable patients, and explored the concept of risk-based therapeutic futility.

      METHODS

      TTVR patients treated in our center were prospectively assigned to prohibitive (PR) and high-risk (HR) subgroups, based on Society of Thoracic Surgeons (STS) Score, frailty indices, and major organ system compromise. Efficacy and safety outcomes were compared at baseline, 30 days and 6 months.

      RESULTS

      Thirty-three patients (mean-age 81.9±5.1) completed follow-up between May 2021 and March 2022, 18 PR (mean STS-Score 15.5±7%) and 15 HR (mean STS-Score 6.4±1.7%). The primary efficacy endpoint of at least one-grade TR reduction by 30 days was recorded in 93.9% of all patients, with no device related adverse events. Improvement in initial New York Heart Association class III/IV occurred in 74% of PR and 93% of HR patients. Six-minute walk test increased by 81±43.6meters (p<0.001) and 85.8±47.9meters (p<0.001), respectively. Renal function tests improved by 15% (p=0.048) vs 7% (p=0.050), while liver enzymes decreased by 18% (p=0.020) vs 28% (p=0.052). Right ventricular systolic function likewise increased in both subgroups by at least 24% (p<0.001). Six-month mortality was 12.1%, with 6 hospitalizations for acute heart failure.

      CONCLUSIONS

      TR reduction significantly impacted quality of life, functional capacity, cardiac remodeling and multiorgan involvement, similarly in PR and HR patients. TTVR is feasible in very sick symptomatic patients, irrespective of predicted risk.

      Graphical abstract

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