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Schlotter F, Miura M, Kresoja KP, Alushi B, Alessandrini H, Attinger-Toller A, Besler C, Biasco L, Braun D, Brochet E, Connelly K, de Bruijn S, Denti P, Estévez-Loureiro R, Fam NP, Gavazzoni M, Himbert D, Ho E, Juliard JM, Kalbacher D, Kaple R, Kreidel F, Latib A, Lubos E, Ludwig S, Mehr M, Monivas V, Nazif T, Nickenig G, Pedrazzini G, Pozzoli A, Praz F, Puri R, Rodés-Cabau J, Rommel KP, Schäfer U, Schofer J, Sievert H, Tang G, Thiele H, Unterhuber M, Vahanian A, von Bardeleben R, von Roeder M, Webb J, Weber M, Wild MG, Windecker S, Zuber M, Hausleiter J, Maisano F, Leon MB, Hahn RT, Lauten A, Taramasso M, Lurz P. Outcomes of transcatheter tricuspid valve intervention by right ventricular function: a multicentre propensity-matched analysis. EUROINTERVENTION 2021; 17:e343-e352. [PMID: 33956637 PMCID: PMC9724849 DOI: 10.4244/eij-d-21-00191] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Tricuspid regurgitation (TR) has a poor prognosis and limited treatment options and is frequently accompanied by right ventricular (RV) dysfunction. Transcatheter tricuspid valve interventions (TTVI) to reduce TR have been shown to be safe and feasible with encouraging early results. Patient selection for TTVI remains challenging, with the role of right ventricular (RV) function being unknown. AIMS The aims of this study were 1) to investigate survival in a TTVI-treated patient population and a conservatively treated TR population, and 2) to evaluate the outcome of TTVI as compared to conservative treatment stratified according to the degree of RV function. METHODS We studied 684 patients from the multicentre TriValve cohort (TTVI cohort) and compared them to 914 conservatively treated patients from two tertiary care centres. Propensity matching identified 213 pairs of patients with severe TR. As we observed a non-linear relationship of RV function and TTVI outcome, we stratified patients according to tricuspid annular plane systolic excursion (TAPSE) to preserved (TAPSE >17 mm), mid-range (TAPSE 13-17 mm) and reduced (TAPSE <13 mm) RV function. The primary outcome was one-year all-cause mortality. RESULTS TTVI was associated with a survival benefit in patients with severe TR when compared to matched controls (one-year mortality rate: 13.1% vs 25.8%; p=0.031). Of the three RV subgroups, only in patients with mid-range RV function was TTVI associated with an improved survival (p log-rank 0.004). In these patients, procedural success was associated with a reduced hazard ratio for all-cause mortality (HR 0.22; 95% CI: 0.09, 0.57). CONCLUSIONS TTVI is associated with reduced mortality compared to conservative therapy and might exert its highest treatment effect in patients with mid-range reduced RV function.
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Affiliation(s)
- Florian Schlotter
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Mizuki Miura
- Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Karl-Patrik Kresoja
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Brunilda Alushi
- HELIOS Klinikum Erfurt, Department of General and Interventional Cardiology & Rhythmology, Erfurt, Germany,Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, and German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | | | | | - Christian Besler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Luigi Biasco
- Cardiology Department, Cardiocentro, Lugano, Switzerland
| | - Daniel Braun
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Eric Brochet
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | - Kim Connelly
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, ON, Canada
| | - Sabine de Bruijn
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | | | - Neil P. Fam
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, ON, Canada
| | - Mara Gavazzoni
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Dominique Himbert
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | - Edwin Ho
- Cardiology Department, Montefiore Medical Center, New York, NY, USA
| | | | | | - Ryan Kaple
- Division of Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Felix Kreidel
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Azeem Latib
- Cardiology Department, Montefiore Medical Center, New York, NY, USA
| | - Edith Lubos
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | | | - Michael Mehr
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Vanessa Monivas
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Tamim Nazif
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Georg Nickenig
- Cardiology Department, Universitaetsklinikum Bonn, Bonn, Germany
| | | | - Alberto Pozzoli
- Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabien Praz
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Josep Rodés-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Ulrich Schäfer
- Cardiology, Angiology and Intensive Care Medicine, Catholic Marienhospital, Hamburg, Germany
| | - Joachim Schofer
- MVZ Department Structural Heart Disease, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Horst Sievert
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Gilbert Tang
- Cardiac Surgery Department, Mount Sinai Hospital, New York, NY, USA
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Matthias Unterhuber
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Alec Vahanian
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | | | - Maximilian von Roeder
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - John Webb
- Cardiology Department, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Marcel Weber
- Cardiology Department, Universitaetsklinikum Bonn, Bonn, Germany
| | - Mirjam G. Wild
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michel Zuber
- Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jörg Hausleiter
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | | | - Martin B. Leon
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Rebecca T. Hahn
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Alexander Lauten
- HELIOS Klinikum Erfurt, Department of General and Interventional Cardiology & Rhythmology, Erfurt, Germany,Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, and German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Maurizio Taramasso
- Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Struempellstr. 39, 04289 Leipzig, Germany
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Muntané-Carol G, Taramasso M, Miura M, Gavazzoni M, Pozzoli A, Alessandrini H, Latib A, Attinger-Toller A, Biasco L, Braun D, Brochet E, Connelly KA, de Bruijn S, Denti P, Deuschl F, Lubos E, Ludwig S, Kalbacher D, Estevez-Loureiro R, Fam N, Frerker C, Ho E, Juliard JM, Kaple R, Kodali S, Kreidel F, Harr C, Lauten A, Lurz J, Monivas V, Mehr M, Nazif T, Nickening G, Pedrazzini G, Philippon F, Praz F, Puri R, Schäfer U, Schofer J, Sievert H, Tang GHL, Khattab AA, Andreas M, Russo M, Thiele H, Unterhuber M, Himbert D, Urena M, von Bardeleben RS, Webb JG, Weber M, Windecker S, Winkel M, Zuber M, Hausleiter J, Lurz P, Maisano F, Leon MB, Hahn RT, Rodés-Cabau J. Transcatheter Tricuspid Valve Intervention in Patients With Right Ventricular Dysfunction or Pulmonary Hypertension: Insights From the TriValve Registry. Circ Cardiovasc Interv 2021; 14:e009685. [PMID: 33541097 DOI: 10.1161/circinterventions.120.009685] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Scarce data exist on patients with right ventricular dysfunction (RVD) or pulmonary hypertension (PH) undergoing transcatheter tricuspid valve intervention. This study aimed to determine the early and midterm outcomes and the factors associated with mortality in this group of patients. METHODS This subanalysis of the multicenter TriValve (Transcatheter Tricuspid Valve Therapies) registry included 300 patients with severe tricuspid regurgitation with RVD (n=244), PH (n=127), or both (n=71) undergoing transcatheter tricuspid valve intervention. RVD was defined as a tricuspid annular plane systolic excursion <17 mm, and PH as an estimated pulmonary artery systolic pressure ≥50 mm Hg. RESULTS Mean age of the patients was 77±9 years (54% women). Procedural success was 80.7%, and 9 patients (3%) died during the hospitalization. At a median follow-up of 6 (interquartile range, 2-12) months, 54 patients (18%) died, and the independent associated factors were higher gamma-glutamyl transferase values at baseline (hazard ratio, 1.02 for each increase of 10 u/L [95% CI, 1.002-1.04]), poorer renal function defined as an estimated glomerular filtration rate <45 mL/min (hazard ratio, 2.3 [95% CI, 1.22-4.33]), and the lack of procedural success (hazard ratio, 2.11 [95% CI, 1.17-3.81]). The grade of RVD and the amount of PH at baseline were not found to be predictors of mortality. Most patients alive at follow-up improved their functional class (New York Heart Association I-II in 66% versus 7% at baseline, P<0.001). CONCLUSIONS In patients with severe tricuspid regurgitation and RVD/PH, transcatheter tricuspid valve intervention was associated with high procedural success and a relatively low in-hospital mortality, along with significant improvements in functional status. However, about 1 out of 5 patients died after a median follow-up of 6 months, with hepatic congestion, renal dysfunction, and the lack of procedural success determining an increased risk. These results may improve the clinical evaluation of transcatheter tricuspid valve intervention candidates and would suggest a closer follow-up in those at increased risk. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03416166.
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Affiliation(s)
- Guillem Muntané-Carol
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (G.M.-C., F. Philippon, R.P., J.R.-C.)
| | - Maurizio Taramasso
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Mizuki Miura
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Mara Gavazzoni
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Alberto Pozzoli
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Hannes Alessandrini
- Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany (H.A., C.F., C.H.)
| | - Azeem Latib
- Cardiology Department, Montefiore Medical Center, New York, NY (A. Latib, E.H.)
| | | | - Luigi Biasco
- Cardiology Department, Cardiocentro, Lugano, Switzerland (L.B., G.P.)
| | - Daniel Braun
- Cardiology Department, Klinikum der Universität München, Germany (D.B., M. Mehr, J.H.)
| | - Eric Brochet
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France (E.B., J.-M.J., D.H., M.U.)
| | - Kim A Connelly
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Canada (K.A.C., N.F., E.H.)
| | - Sabine de Bruijn
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany (S.d.B., H.S.)
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy (P.D.)
| | - Florian Deuschl
- Cardiology Department, University Heart and Vascular Center Hamburg, Germany (F.D., E.L., S.L., D.K., U.S.)
| | - Edith Lubos
- Cardiology Department, University Heart and Vascular Center Hamburg, Germany (F.D., E.L., S.L., D.K., U.S.)
| | - Sebastian Ludwig
- Cardiology Department, University Heart and Vascular Center Hamburg, Germany (F.D., E.L., S.L., D.K., U.S.)
| | - Daniel Kalbacher
- Cardiology Department, University Heart and Vascular Center Hamburg, Germany (F.D., E.L., S.L., D.K., U.S.)
| | - Rodrigo Estevez-Loureiro
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain (R.E.-L., V.M.)
| | - Neil Fam
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Canada (K.A.C., N.F., E.H.)
| | - Christian Frerker
- Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany (H.A., C.F., C.H.)
| | - Edwin Ho
- Cardiology Department, Montefiore Medical Center, New York, NY (A. Latib, E.H.).,Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Canada (K.A.C., N.F., E.H.)
| | - Jean-Michel Juliard
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France (E.B., J.-M.J., D.H., M.U.)
| | - Ryan Kaple
- Cardiology Department, Westchester Medical Center, Valhalla, NY (R.K.)
| | - Susheel Kodali
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY (S.K., T.N., M.B.N., R.T.H.)
| | - Felix Kreidel
- Cardiology Department, Department of Cardiology, University Medical Center Mainz, Germany (F.K., R.S.V.B.)
| | - Claudia Harr
- Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany (H.A., C.F., C.H.)
| | - Alexander Lauten
- Cardiology Department, Charité University Hospital, Berlin, Germany (A. Lauten)
| | - Julia Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Germany (J.L., H.T., M.U., P.L.)
| | - Vanessa Monivas
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain (R.E.-L., V.M.)
| | - Michael Mehr
- Cardiology Department, Klinikum der Universität München, Germany (D.B., M. Mehr, J.H.)
| | - Tamin Nazif
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY (S.K., T.N., M.B.N., R.T.H.)
| | - Georg Nickening
- Cardiology Department, Universitatsklinikum Bonn, Germany (G.N., M. Weber)
| | | | - François Philippon
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (G.M.-C., F. Philippon, R.P., J.R.-C.)
| | - Fabien Praz
- Cardiology Department, Inselspital, Bern University Hospital (F. Praz, S.W., M. Winkel), University of Bern, Switzerland
| | - Rishi Puri
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (G.M.-C., F. Philippon, R.P., J.R.-C.)
| | - Ulrich Schäfer
- Cardiology Department, University Heart and Vascular Center Hamburg, Germany (F.D., E.L., S.L., D.K., U.S.)
| | - Joachim Schofer
- Cardiology Department, Albertinen Heart Center, Hamburg, Germany (J.S.)
| | - Horst Sievert
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany (S.d.B., H.S.)
| | - Gilbert H L Tang
- Cardiac Surgery Department, Mount Sinai Hospital, New York, NY (G.H.L.T.)
| | - Ahmed A Khattab
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.).,Cardiology Department (A.A.K.), University of Bern, Switzerland.,Cardiology Department, Cardiance Clinic, Pfäffikon, Switzerland (A.A.K.)
| | - Martin Andreas
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna (M.A., M.R.)
| | - Marco Russo
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna (M.A., M.R.)
| | - Holger Thiele
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Germany (J.L., H.T., M.U., P.L.)
| | - Matthias Unterhuber
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Germany (J.L., H.T., M.U., P.L.)
| | - Dominique Himbert
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France (E.B., J.-M.J., D.H., M.U.)
| | - Marina Urena
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France (E.B., J.-M.J., D.H., M.U.)
| | | | - John G Webb
- Cardiology Department, St. Paul Hospital, Vancouver, Canada (A.A.-T., J.G.W.)
| | - Marcel Weber
- Cardiology Department, Universitatsklinikum Bonn, Germany (G.N., M. Weber)
| | - Stephan Windecker
- Cardiology Department, Inselspital, Bern University Hospital (F. Praz, S.W., M. Winkel), University of Bern, Switzerland
| | - Mirjam Winkel
- Cardiology Department, Inselspital, Bern University Hospital (F. Praz, S.W., M. Winkel), University of Bern, Switzerland
| | - Michel Zuber
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Jörg Hausleiter
- Cardiology Department, Klinikum der Universität München, Germany (D.B., M. Mehr, J.H.)
| | - Philipp Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Germany (J.L., H.T., M.U., P.L.)
| | - Francesco Maisano
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Martin B Leon
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY (S.K., T.N., M.B.N., R.T.H.)
| | - Rebecca T Hahn
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY (S.K., T.N., M.B.N., R.T.H.)
| | - Josep Rodés-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (G.M.-C., F. Philippon, R.P., J.R.-C.)
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Miura M, Alessandrini H, Alkhodair A, Attinger-Toller A, Biasco L, Lurz P, Braun D, Brochet E, Connelly KA, de Bruijn S, Denti P, Deuschl F, Estevez-Loureiro R, Fam N, Frerker C, Gavazzoni M, Hausleiter J, Himbert D, Ho E, Juliard JM, Kaple R, Besler C, Kodali S, Kreidel F, Kuck KH, Latib A, Lauten A, Monivas V, Mehr M, Muntané-Carol G, Nazif T, Nickenig G, Pedrazzini G, Philippon F, Pozzoli A, Praz F, Puri R, Rodés-Cabau J, Schäfer U, Schofer J, Sievert H, Tang GH, Thiele H, Rommel KP, Vahanian A, Von Bardeleben RS, Webb JG, Weber M, Windecker S, Winkel M, Zuber M, Leon MB, Maisano F, Hahn RT, Taramasso M. Impact of Massive or Torrential Tricuspid Regurgitation in Patients Undergoing Transcatheter Tricuspid Valve Intervention. JACC Cardiovasc Interv 2020; 13:1999-2009. [DOI: 10.1016/j.jcin.2020.05.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/17/2020] [Accepted: 05/07/2020] [Indexed: 12/11/2022]
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Taramasso M, Gavazzoni M, Pozzoli A, Alessandrini H, Latib A, Attinger-Toller A, Biasco L, Braun D, Brochet E, Connelly KA, de Bruijn S, Denti P, Deuschl F, Estevez-Louriero R, Fam N, Frerker C, Ho E, Juliard JM, Kaple R, Kodali S, Kreidel F, Kuck KH, Lauten A, Lurz J, Monivas V, Mehr M, Nazif T, Nickening G, Pedrazzini G, Praz F, Puri R, Rodés-Cabau J, Schäfer U, Schofer J, Sievert H, Tang GHL, Khattab AA, Thiele H, Unterhuber M, Vahanian A, Von Bardeleben RS, Webb JG, Weber M, Windecker S, Winkel M, Zuber M, Hausleiter J, Lurz P, Maisano F, Leon MB, Hahn RT. Outcomes of TTVI in Patients With Pacemaker or Defibrillator Leads: Data From the TriValve Registry. JACC Cardiovasc Interv 2020; 13:554-564. [PMID: 31954676 DOI: 10.1016/j.jcin.2019.10.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/30/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The interference of a transtricuspid cardiac implantable electronic device (CIED) lead with tricuspid valve function may contribute to the mechanism of tricuspid regurgitation (TR) and poses specific therapeutic challenges during transcatheter tricuspid valve intervention (TTVI). Feasibility and efficacy of TTVI in presence of a CIED is unclear. BACKGROUND Feasibility of TTVI in presence of a CIED lead has never been proven on a large basis. METHODS The study population consisted of 470 patients with severe symptomatic TR from the TriValve (Transcatheter Tricuspid Valve Therapies) registry who underwent TTVI at 21 centers between 2015 and 2018. The association of CIED and outcomes were assessed. RESULTS Pre-procedural CIED was present in 121 of 470 (25.7%) patients. The most frequent location of the CIED lead was the posteroseptal commissure (44.0%). As compared with patients without a transvalvular lead (no-CIED group), patients having a tricuspid lead (CIED group) were more symptomatic (New York Heart Association functional class III to IV in 95.9% vs. 92.3%; p = 0.02) and more frequently had previous episodes of right heart failure (87.8% vs. 69.0%; p = 0.002). No-CIED patients had more severe TR (effective regurgitant orifice area 0.7 ± 0.6 cm2 vs. 0.6 ± 0.3 cm2; p = 0.02), but significantly better right ventricular function (tricuspid annular plane systolic excursion = 16.7 ± 5.0 mm vs. 15.9 ± 4.0 mm; p = 0.04). Overall, 373 patients (79%) were treated with the MitraClip (Abbott Vascular, Santa Clara, California) (106 [87.0%] in the CIED group). Among them, 154 (33%) patients had concomitant transcatheter mitral repair (55 [46.0%] in the CIED group, all MitraClip). Procedural success was achieved in 80.0% of no-CIED patients and in 78.6% of CIED patients (p = 0.74), with an in-hospital mortality of 2.9% and 3.7%, respectively (p = 0.70). At 30 days, residual TR ≤2+ was observed in 70.8% of no-CIED and in 73.7% of CIED patients (p = 0.6). Symptomatic improvement was observed in both groups (NYHA functional class I to II at 30 days: 66.0% vs. 65.0%; p = 0.30). Survival at 12 months was 80.7 ± 3.0% in the no-CIED patients and 73.6 ± 5.0% in the CIED patients (p = 0.30). CONCLUSIONS TTVI is feasible in selected patients with CIED leads and acute procedural success and short-term clinical outcomes are comparable to those observed in patients without a transtricuspid lead.
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Affiliation(s)
- Maurizio Taramasso
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
| | - Mara Gavazzoni
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Alberto Pozzoli
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | | | - Azeem Latib
- Cardiology Department, Montefiore Medical Center, New York, New York
| | | | - Luigi Biasco
- Cardiology Department, Cardiocentro, Lugano, Switzerland
| | - Daniel Braun
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Eric Brochet
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | - Kim A Connelly
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada
| | - Sabine de Bruijn
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Florian Deuschl
- Cardiology Department, University Heart Center Hamburg, Hamburg, Germany
| | - Rodrigo Estevez-Louriero
- Cardiology Department, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Neil Fam
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada
| | | | - Edwin Ho
- Cardiology Department, Montefiore Medical Center, New York, New York; Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada
| | | | - Ryan Kaple
- Cardiology Department, Westchester Medical Center, Valhalla, New York
| | - Susheel Kodali
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Felix Kreidel
- Cardiology Department, Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Karl-Heinz Kuck
- Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Alexander Lauten
- Cardiology Department, Charité University Hospital, Berlin, Germany
| | - Julia Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Vanessa Monivas
- Cardiology Department, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Michael Mehr
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Tamin Nazif
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Georg Nickening
- Cardiology Department, Universitatsklinikum Bonn, Bonn, Germany
| | | | - Fabien Praz
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rishi Puri
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Josep Rodés-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Ulrich Schäfer
- Cardiology Department, University Heart Center Hamburg, Hamburg, Germany
| | - Joachim Schofer
- Cardiology Department, Albertinen Heart Center, Hamburg, Germany
| | - Horst Sievert
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Gilbert H L Tang
- Cardiac Surgery Department, Mount Sinai Hospital, New York, New York
| | - Ahmed A Khattab
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland; Cardiology Department, Cardiance Clinic, Pfäffikon, Switzerland; Cardiology Department, University of Bern, Bern, Switzerland
| | - Holger Thiele
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Matthias Unterhuber
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Alec Vahanian
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | | | - John G Webb
- Cardiology Department, St. Paul Hospital, Vancouver, Canada
| | - Marcel Weber
- Cardiology Department, Universitatsklinikum Bonn, Bonn, Germany
| | - Stephan Windecker
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam Winkel
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michel Zuber
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Jörg Hausleiter
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Philipp Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Francesco Maisano
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Martin B Leon
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Rebecca T Hahn
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
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