Feasibility of a Novel Transcatheter Valve Repair System to Treat Tricuspid Regurgitation in ccTGA

Patients with congenitally corrected transposition of the great arteries (ccTGA) with significant systemic tricuspid valve regurgitation and systemic right ventricular dysfunction have prohibitive surgical risk in adulthood. The PASCAL transcatheter valve repair system enables minimally invasive percutaneous tricuspid valve repair in the complex anatomy of patients with ccTGA. (Level of Difficulty: Intermediate.)

Left atrial appendage closure with WATCHMAN in Asian patients: 2 year outcomes from the WASP registry

Background

Left atrial appendage closure is a non-pharmacological alternative for stroke prevention in high-risk non-valvular atrial fibrillation patients, but has not been widely studied in Asian patients. The prospective WASP registry assessed real-world outcomes for patients undergoing WATCHMAN implant in the Asia-Pacific region.

Methods

Data were collected from consecutive patients across 9 centres. Major endpoints included procedural success, safety and long-term outcomes including occurrence of bleeding, stroke/transient ischaemic attack/systemic embolism and all-cause mortality.

Results

Subjects (n = 201) had a mean age of 70.8 ± 9.4 years, high stroke risk (CHA₂DS₂-VASc: 3.9 ± 1.7), elevated bleeding risk (HAS-BLED: 2.1 ± 1.2) with 53% patients from Asian countries. Successful implantation occurred in 98.5% of patients; 7-day device/procedure-related SAE rate was 3.0%. After 2 years of follow-up, the rates of ischaemic stroke/TIA/SE and major bleeding were 1.9 and 2.2 per 100-PY, respectively, representing relative reductions of 77% and 49% versus expected rates per risk scores. The relative risk reductions versus expected rates were more pronounced in Asians vs. Non-Asians (89% vs 62%; 77% vs 14%). Other significant findings included larger mean LAA ostium diameter for Asians vs. Non-Asians (23.4 ± 4.1 mm vs. 21.2 ± 3.2 mm, p < 0.001) and hence requirement for larger median device size (27 mm for Asians, 24 mm for non-Asians [p < 0.0001]).

Conclusion

Real-world experience of left atrial appendage closure with WATCHMAN has demonstrated low peri-procedural risk, and long-term efficacy for stroke and bleeding prevention in a primarily Asian cohort.