Outcomes of transcatheter tricuspid valve intervention by right ventricular function: a multicentre propensity-matched analysis
Florian Schlotter, Mizuki Miura, Karl‐Patrik Kresoja, Brunilda Alushi, Hannes Alessandrini, Adrian Attinger‐Toller, Christian Besler, Luigi Biasco, Daniel Braun, Éric Brochet, Kim A. Connelly, Sabine de Bruijn, Paolo Denti, Rodrigo Estévez‐Loureiro, Neil Fam, Mara Gavazzoni, Dominique Himbert, Edwin Ho, Jean‐Michel Juliard, Daniel Kalbacher, Ryan Kaple, Felix Kreidel, Azeem Latib, Edith Lubos, Sebastian Ludwig, Michael Mehr, Vanessa Moñivas, Tamim Nazif, Georg Nickenig, Giovanni Pedrazzini, Alberto Pozzoli, Fabien Praz, Rishi Puri, Josep Rodés‐Cabau, Karl‐Philipp Rommel, Ulrich Schäfer, Joachim Schöfer, Horst Sievert, Gilbert H.L. Tang, Hölger Thiele, Matthias Unterhuber, Alec Vahanian, Ralph Stephan von Bardeleben, Maximilian von Roeder, John G. Webb, Marcel Weber, Mirjam G. Wild, Stephan Windecker, Michel Züber, Jörg Hausleiter, Francesco Maisano, Martin B. Leon, Rebecca T. Hahn, Alexander Lauten, Maurizio Taramasso, Philipp Lurz
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.