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Kodali S, Hahn RT, George I, Davidson CJ, Narang A, Zahr F, Chadderdon S, Smith R, Grayburn PA, O'Neill WW, Wang DD, Herrmann H, Silvestry F, Elmariah S, Inglessis I, Passeri J, Lim DS, Salerno M, Makar M, Mack MJ, Leon MB, Makkar R. Transfemoral Tricuspid Valve Replacement in Patients With Tricuspid Regurgitation: TRISCEND Study 30-Day Results. JACC Cardiovasc Interv 2022; 15:471-480. [PMID: 35272771 DOI: 10.1016/j.jcin.2022.01.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The TRISCEND study (Edwards EVOQUE Tricuspid Valve Replacement: Investigation of Safety and Clinical Efficacy after Replacement of Tricuspid Valve with Transcatheter Device) is evaluating the safety and performance of transfemoral transcatheter tricuspid valve replacement in patients with clinically significant tricuspid regurgitation (TR) and elevated surgical risk. BACKGROUND Transcatheter valve replacement could lead to a paradigm shift in treating TR and improving patient quality of life. METHODS In the prospective, single-arm, multicenter TRISCEND study, patients with symptomatic moderate or greater TR, despite medical therapy, underwent percutaneous transcatheter tricuspid valve replacement with the EVOQUE system. A composite rate of major adverse events, echocardiographic parameters, and clinical, functional, and quality-of-life measures were assessed at 30 days. RESULTS Fifty-six patients (mean age of 79.3 years, 76.8% female, 91.1% TR severe or greater, 91.1% atrial fibrillation, and 87.5% New York Heart Association functional class III or IV) were treated. At 30 days, TR was reduced to mild or less in 98%. The composite major adverse events rate was 26.8% at 30 days caused by 1 cardiovascular death in a patient with a failed procedure, 2 reinterventions after device embolization, 1 major access site or vascular complication, and 15 severe bleeds, of which none were life-threatening or fatal. No myocardial infarction, stroke, renal failure, major cardiac structural complications, or device-related pulmonary embolism were observed. New York Heart Association significantly improved to functional class I or II (78.8%; P < 0.001), 6-minute walk distance improved 49.8 m (P < 0.001), and Kansas City Cardiomyopathy Questionnaire score improved 19 points (P < 0.001). CONCLUSIONS Early experience with the transfemoral EVOQUE system in patients with clinically significant TR demonstrated technical feasibility, acceptable safety, TR reduction, and symptomatic improvement at 30 days. The TRISCEND II randomized trial (NCT04482062) is underway.
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Affiliation(s)
- Susheel Kodali
- Columbia University Irving Medical Center, New York, New York, USA.
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Isaac George
- Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - Firas Zahr
- Oregon Health and Science University, Portland, Oregon, USA
| | | | - Robert Smith
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | - Paul A Grayburn
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | | | | | - Howard Herrmann
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frank Silvestry
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sammy Elmariah
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - D Scott Lim
- University of Virginia, Charlottesville, VA, USA
| | | | - Moody Makar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael J Mack
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York, USA
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
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Tohme-Shaya F, Pradhan AM. Innovation in valve repair devices. Lancet 2019; 394:1968-1970. [PMID: 31708189 DOI: 10.1016/s0140-6736(19)32535-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Fadia Tohme-Shaya
- Center on Drugs and Public Policy and Institute for Clinical and Translational Research, School of Pharmacy, University of Maryland Baltimore, Baltimore, MD 21201, USA; Hariri School of Nursing, American University of Beirut, Beirut, Lebanon.
| | - Apoorva M Pradhan
- Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA
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