Right ventricular remodeling and clinical outcomes following transcatheter tricuspid valve intervention

• Published in: Catheterization and cardiovascular interventions Vol. 103; no. 2; pp. 367 - 375
• Main Authors: Dershowitz, Lyle, Lawlor, Matthew K., Hamid, Nadira, Kampaktsis, Polydoros, Ning, Yuming, Vahl, Torsten P., Nazif, Tamim, Khalique, Omar, Ng, Vivian, Kurlansky, Paul, Leon, Martin, Hahn, Rebecca, Kodali, Susheel, George, Isaac
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.02.2024
• Subjects: Aged; Aged, 80 and over; Blood pressure; Clinical outcomes; Congestive heart failure; Female; Heart failure; Heart Failure - diagnostic imaging; Heart Failure - therapy; Humans; Male; Pulmonary arteries; Pulmonary artery; Regurgitation; Retrospective Studies; right ventricular remodeling; transcatheter tricuspid intervention; Treatment Outcome; tricuspid regurgitation; Tricuspid valve; Tricuspid Valve - diagnostic imaging; Tricuspid Valve - surgery; Tricuspid Valve Insufficiency - complications; Tricuspid Valve Insufficiency - diagnostic imaging; Tricuspid Valve Insufficiency - surgery; Ventricle; Ventricular Remodeling; tricuspid regurgitation; transcatheter tricuspid intervention; right ventricular remodeling
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.30850

Aims Characterize the impact of residual tricuspid regurgitation (TR) on right ventricle (RV) remodeling and clinical outcomes after transcatheter tricuspid valve intervention. Methods We performed a single‐center retrospective analysis of transcatheter tricuspid valve repair (TTVr) or replacement (TTVR) patients. The primary outcomes were longitudinal tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), pulmonary artery systolic pressure (PASP), and RV dimensions (RVd). We used multivariable linear mixed models to evaluate association with replacement versus repair and degree of TR reduction with changes in these echo measures over time. Multivariable Cox regression was used to identify associations between changes in these echo measures and a composite clinical outcome of death, heart failure hospitalization, or re‐do tricuspid valve intervention. Results We included a total of 61 patients; mean age was 77.5 ± 11.7 and 62% were female. TTVR was performed in 25 (41%) and TTVr in 36 (59%). Initially, 72% (n = 44) had ≤ severe TR and 28% (n = 17) had massive or torrential TR. The median number of follow up echos was 2: time to 1st follow‐up was 50 days (interquartile range [IQR]: 20, 91) and last follow‐up was 147 (IQR: 90, 327). Median TR reduction was 1 (IQR: 0, 2) versus 4 (IQR: 3, 6) grades in TTVr versus TTVR (p < 0.0001). In linear mixed modeling, TTVR was associated with decline in TAPSE and PASP, and TR reduction was associated with decreased RVd. In multivariable Cox regression, greater RVd was associated with the clinical outcome (hazard ratio: 9.27, 95% confidence interval: 1.23–69.88, p = 0.03). Conclusion Greater TR reduction is achieved by TTVR versus TTVr, which is in turn associated with RV reverse remodeling. RV dimension in follow‐up is associated with increased risk of a composite outcome of death, heart failure hospitalization, or re‐do tricuspid valve intervention.