Thirty-day outcomes of the Cardioband tricuspid system for patients with symptomatic functional tricuspid regurgitation: The TriBAND study

BACKGROUND

Severe tricuspid regurgitation (TR) has limited treatment options and is associated with high morbidity and mortality.

AIMS

We evaluated the safety and effectiveness of the Cardioband tricuspid valve reconstruction system from the ongoing European single-arm, multicentre, prospective TriBAND post-market clinical follow-up study.

METHODS

Eligible patients had chronic symptomatic functional TR despite diuretic therapy and were deemed candidates for transcatheter tricuspid repair by the local Heart Team.

RESULTS

Sixty-one patients had ≥severe functional TR. At baseline, 85% of patients were in NYHA Class III-IV, 94% had ≥severe TR (core laboratory-assessed) with 6.8% EuroSCORE II and 53% LVEF. Device success was 96.7%. At discharge, 59% (p<0.001) of patients achieved ≤moderate TR and 78% had at least one grade TR reduction. At 30 days, all-cause mortality and composite MAE rates were 1.6% and 19.7%, respectively; septolateral annular diameter was reduced by 20%, where 69% of patients achieved ≤moderate TR and 85% of patients had at least one grade TR reduction (all p<0.001). Mid-RVEDD, RA volume, and IVC diameter decreased by 10% (p=0.005), 21% (p<0.001), and 11% (p=0.022), respectively; 74% were in NYHA Class I-II (p<0.001) with improvements in overall KCCQ score by 17 points (p<0.001).

CONCLUSIONS

In the TriBAND study, the Cardioband tricuspid system demonstrated favourable outcomes at discharge and 30 days in a challenging patient population with symptomatic ≥severe functional TR. Results showed significant reductions in annular diameter and TR severity, accompanied by early evidence of right heart remodelling and improvements in functional status and quality of life.

Effects of a diuretic regimen on body weight and echocardiographic parameters of the tricuspid valve in patients scheduled for transcatheter tricuspid annuloplasty

Background

Echocardiographic severity of tricuspid regurgitation is known to be highly variable and strongly related to the volume status of the individual patient. Interventional therapies for tricuspid valve repair or replacement are dependent on reliable measurements in order to select the appropriate device size.

Purpose

In patients scheduled for transcatheter tricuspid valve annuloplasty, we sought to evaluate the effects of a diuretic regimen started at the screening visit on body weight and tricuspid valve dimensions at the time point of transcatheter intervention.

Methods

After successful screening for transcatheter tricuspid annuloplasty, an individualized intensified diuretic regimen was initiated in 15 patients. At baseline and at the timepoint of the intervention, body weight and 3D echocardiographic dimensions of the tricuspid valve were documented and compared.

Results

The cohort comprised 6 males and 9 females (mean age 77±7 years) with severe or higher degree functional tricuspid regurgitation. In all patients not more than mild pulmonary artery hypertension was present (PaP mean 29±5 mmHg). The interval between the screening visit and the timepoint of the procedure was 64±50 days. At baseline mean body weight was 72±12 kg. In 11 patients a reduction of the body weight could be achieved, with a median weight reduction of 2.2 kg (min/max 1.2/6.4 kg). Overall, the average relative reduction of the tricuspid annulur perimeter was 13% (p&lt;0,001), of the tricuspid valve area 2.7% (n.s.), the anterseptal diameter 3.3% (n.s.), while the bicommissural diameter remained almost unchanged (0.4%; n.s.). The average predicted required band length changed by only 1.5% (n.s.). The strongest correlations were found between the absolute change in body weight and the change of the tricuspid valve area (r=0.48), relative change in body weight and relative change of tricuspid valve area (r=0.52), absolute change in body weight and absolute change in predicted band length (r=0.48), and relative changes of the respective variables (r=0.52). More importantly, in 13 out of 15 patients the band size which would have been selected was identical between the screening and the annuloplasty procedure. Only in two patients a smaller device was implanted than predicted at the screening visit.

Conclusion

Instituting a diuretic therapy in candidates for transcatheter tricuspid annuloplasty prior to the procedure helps to keep tricuspid valve dimensions in a stable range. Changes in body weight in patients with functional tricuspid regurgitation are correlated to changes of tricuspid valve dimensions.

Funding Acknowledgement

Type of funding sources: None.

Transcatheter Treatment of Secondary Tricuspid Regurgitation With Direct Annuloplasty: Results From a Multicenter Real-World Experience

[Figure: see text].

Transient acute right coronary artery deformation during transcatheter interventional tricuspid repair with the Cardioband tricuspid system

BACKGROUND

The Cardioband tricuspid valve reconstruction system is a size-adjustable tricuspid reconstruction device for interventional treatment of tricuspid regurgitation (TR). Contraction of the device after successful implantation can be associated with an acute deformation of the right coronary artery (RCA).

AIMS

The aim of this study was to provide data on the persistence and clinical significance of acute RCA deformation following Cardioband implant procedures.

METHODS

Data from all patients with intraprocedural RCA deformation during Cardioband implantation were collected from four centres between October 2018 and January 2020. Control angiographies were performed in all of these patients before discharge.

RESULTS

RCA deformation occurred in 14 out of 51 patients. Follow-up coronary angiography showed a complete resolution of deformation in all cases while patients remained clinically asymptomatic and had an uneventful post-interventional course. Intraprocedural coronary stent implantation was performed in two of the earlier cases according to the personal assessment of the implanters.

CONCLUSIONS

RCA deformation is relatively frequent following interventional tricuspid annuloplasty but appears to be completely reversible in the absence of flow impairment or vascular damage. Based on our early experience watchful waiting is the most appropriate strategy to avoid unnecessary coronary interventions.

State-of-the-Art Review: Anatomical and Imaging Considerations During Transcatheter Tricuspid Valve Repair Using an Annuloplasty Approach

Transcatheter techniques for the treatment of tricuspid regurgitation (TR) are being more frequently used and several new devices are in development. Since 90% of patients with TR have secondary TR, catheter based systems which reduce the dilated tricuspid annulus area are of particular interest. In order to perform an annuloplasty procedure effectively and safely, knowledge about the anatomy of the tricuspid valve apparatus and especially of the annulus in relation to the important neighboring structures such as the aortic root, the RCA, the electrical pathways and the CS is fundamental. In addition, comprehensive understanding of the device itself, the delivery system, its maneuverability and the individual procedural steps is required. Furthermore, the use of multi-modality imaging is important. For each step of the procedure the appropriate imaging modality as well as the optimal; imaging planes are crucial to provide the necessary information to best guide the individual procedural step.

Early single center experience with a novel transcatheter anuloplasty system for the treatment of functional tricuspid regurgitation

Background

Functional tricuspid regurgitation (TR) is increasingly recognized as relevant, but undertreated clinical entity. Since surgical repair or replacement of the tricuspid valve is associated with high mortality, many patients with with severe tricuspid regurgitation are not referred to surgery. Transcatheter anuloplasty is a new interventional treatment option for tricuspid regurgitation. We report the outcome of a consecutive single-center series of 11 patients treated with this technique.

Methods

Clinical and procedural data as well as mid-term outcome of a series comprising 11 consecutive patients (9 female, mean age 80±5 years, mean LV-EF 53±7, mean PAP 27±4 mmHg) who underwent transcatheter tricuspid anuloplasty for secondary tricuspid regurgitation in a 12-month period (Octover 2018–October 2019) were systematically collected, including pre- and post-procedural transthoracic/transesophageal echocardiogryphy (TTE/TEE). Patients were selected for the procedure based on clinical, echocardiographic and CT findings. All patients were treated using the Cardioband® system (Hersteller, Ort) in general anesthesia under 4D-TEE guidance.

Results

Mean procedural duration was 259±46 min across all 11 patients. Device success was 91%. In one patient extensive tricuspid annular excursions prevented anuloplasty band implantation. The mean grade of TR severity was reduced from 3.5 to 2.1, p=0,00016 (vena contracta decreased from 11±4 to 6±3 mm, p=0,0047).73% of all patients achieved pos-procedure TR severity ≤2. Procedural complications were infrequent: one patient required coronary stent implantation to the RCA kinking and in an further patient, transient 3rd degree AV bock occurred during the procedure. No patient died during the index hospital stay or during the follow up period (median follow up of 4 months). The NYHA classification improved from a median of III before the procedure to a median of II at follow-up (p=0,00022).

Conclusion

Transcatheter tricuspid annuloplasty permits effective treatment of functional tricuspid regurgitation with a low complication rate and sustained symptomatic improvement.

Funding Acknowledgement

Type of funding source: None

Changes of tricuspid valve geometry after interventional implantation of an anuloplasty band

Background

Implantation of an anuloplasty band (Cardioband, Edwards Lifesciences) is a new treatment option for patients with functional tricuspid regurgitation (TR). The initial clinical results are promising. Nevertheless very few details about the mechanism of reducing TR beyond the basic principle of reducing the annular perimeter are known. Therefore we sought to study the changes of the tricuspid valve geometry after Cardioband implantation.

Methods

In all patients, that were treated by Cardioband implantation for tricuspid valve implantation at our institution, fluoroscopic images of the implant were optained at an angle, which would correspond to an echocardiographic “enface” view of the tricuspid valve. In these images the area enclosed by the implant, the perimeter of this area, the septal to lateral diameter, the anterior to posterior diameter and the length of the implant before and after contracting the band was measured. In all patients an echocardiographic evaluation of the tricuspid regurgitation before and after cardioband implantation was performed. These clinical finding were correlated to changes of the above mentioned dimension in the fluoroscopic images.

Results

Between October 2018 und January 2019 17 patients with severe tricuspid regurgitation were treated by Cardioband implantation. In one patient the procedure had to be aborted due to extensive movement of the tricuspid annulus. In the remaining 16 patients (mean age 78±8 years, 7 males) the procedure could be completed successfully and the required measurements were done. The mean severity grade (5 grade scale) of the TR was 3.5±0.6 before and 2±0.7 (p&lt;0.0001) after the implantation, the corresponding mean vena contracta changed from 12±4 mm to 6±3 mm (p&lt;0.000, 51% reduction). The area decreased after band contraction from 10.6±1.4 cm2 to 4.7±1.4 cm2 (p&lt;0.0001; 56% reduction), the perimeter from 13.4±1.8 cm to 9.6±1.6 cm (p&lt;0.0001; 28% reduction) the septal to lateral diameter from 2.8±0.5 cm to 1.6±0.2 cm (p&lt;0.0001; 40% reduction), the anterior to posterior diameter from 4.8±0.9 cm to 3.8±1.0 cm (p&lt;0.005; 19% reduction) and the measured device length from 8.6 cm±1.0 to 5.8±0.8 cm (p&lt;0.0001; 32% reduction). The strongest correlation was seen between area reduction and reduction of the vena contracta (r=0.5), reduction of the septal to lateral dimension as well as the reduction of the device length had a weaker correlation (r=0.3 and r=0.2). The reduction of the anterior posterior diameter and perimeter reduction showed no relevant correlation with regard to TR reduction.

Conclusion

In our patient population Cardioband implantation lead to effective TR reduction. Area reduction and reduction of the septal to lateral diameter of the tricuspid valve seem to have the strongest impact. These findings may be considered when implantations techniques are being optimized or when new devices for TR treatment are developed.

Funding Acknowledgement

Type of funding source: None

Spinocerebellar ataxia 14: Novel mutation in exon 2 ofPRKCG in a German family

We describe a novel mutation in the gene coding for protein kinase C gamma (PRKCG) in patients of a German family affected with slowly progressive gait ataxia, dysarthria, and nystagmus. The G/T missense mutation occurred in exon 2 of PRKCG and results in a substitution of glycine by valine (G63V) in the evolutionarily highly conserved cysteine-rich region 1/C1 domain of PRKCG. Among the 20 mutations described to date, this is the first mutation located in exon 2 of PRKCG.