Author + information
- Received September 10, 2019
- Revision received December 16, 2019
- Accepted December 17, 2019
- Published online March 30, 2020.
- Mathias Orban, MDa,b,∗,
- Karl-Philipp Rommel, MDc,∗,
- Edwin C. Ho, MDd,e,∗,
- Matthias Unterhuber, MDc,
- Alberto Pozzoli, MDe,
- Kim A. Connelly, MD, PhDd,
- Simon Deseive, MDa,b,
- Christian Besler, MDc,
- Geraldine Ong, MD, MScd,
- Daniel Braun, MDa,
- Jeremy Edwards, MDd,
- Mizuki Miura, MD, PhDe,
- Gökhan Gülmez, MDe,
- Lukas Stolz, cand.meda,
- Mara Gavazzoni, MDe,
- Michel Zuber, MDe,f,
- Martin Orban, MDa,b,
- Michael Nabauer, MDa,
- Francesco Maisano, MDe,
- Holger Thiele, MDc,
- Steffen Massberg, MDa,b,
- Maurizio Taramasso, MD, PhDe,
- Neil P. Fam, MD, MScd,†,
- Philipp Lurz, MD, PhDc,† and
- Jörg Hausleiter, MDa,b,†∗ ()
- aMedizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- bMunich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
- cHeart Center Leipzig at University Leipzig, Leipzig, Germany
- dDivision of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- eDivision of Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
- fDivision of Cardiology, University Hospital of Zurich, Zurich, Switzerland
- ↵∗Address for correspondence:
Prof. Dr. Med. Jörg Hausleiter, Marchioninistrasse 15, D-81377 München, Germany.
Objectives The goal of this study was to evaluate the effect of transcatheter edge-to-edge tricuspid valve repair (TTVR) for severe tricuspid regurgitation (TR) on hospitalization for heart failure (HHF) and HF-related endpoints.
Background Patients with severe TR need effective therapies beyond conservative treatment. The impact of TTVR on HHF and HF-related endpoints is unknown.
Methods Isolated TTVR was performed in 119 patients. Assessments were conducted of New York Heart Association functional class, 6-min walk distance, Minnesota Living with Heart Failure Questionnaire scores, N-terminal pro–B-type natriuretic peptide level, and medication. HHFs were analyzed in the preceding 12 months before and until the longest available follow-up after TTVR. Results were compared with those of 114 patients who underwent combined mitral and tricuspid valve repair.
Results Procedural success with a reduction to moderate or less TR and no in-hospital death was achieved in 82% of patients. With a median follow-up of 360 days (interquartile range: 187 to 408 days), a durable TR reduction to moderate or less was achieved in 72% of patients (p < 0.001). TTVR reduced the annual rate of HHF by 22% (1.21 to 0.95 HHF/patient-year; p = 0.02), with concomitant clinical improvement in New York Heart Association functional class (patients in class II or lower: 9% to 67%; p < 0.001), 6-min walk distance (+39 m; p = 0.001), and Minnesota Living with Heart Failure Questionnaire score (−6 points; p = 0.02). N-terminal pro–B-type natriuretic peptide level decreased numerically by 783 pg/ml. Diuretic dose before TTVR was increased, but HF medication did not change after TTVR. Procedural success was associated with improved 1-year survival (79% vs. 60%; p = 0.04) and event-free-survival (death + first HHF: 67% vs. 40%; p = 0.001). Transcatheter mitral and tricuspid valve repair–treated patients had comparable outcomes.
Conclusions TTVR for severe TR is associated with a reduction of HHF and improved clinical outcomes.
- heart failure
- percutaneous edge-to-edge repair
- right heart
- transcatheter tricuspid valve repair
- tricuspid regurgitation
- tricuspid valve
↵∗ Drs. Orban, Rommel, and Ho contributed equally to this work.
↵† Drs. Fam, Lurz, and Hausleiter contributed equally to this work as senior authors.
Klinikum der Universität München has received grant support from Abbott Vascular. Dr. Connelly has received honoraria from Abbott. Drs. Braun and Nabauer have received speaker honoraria from Abbott Vascular. Dr. Miura has served as a consultant for Japan Lifeline. Dr. Zuber has received research support from VISCARDIA; and honoraria and consultation fees from Abbott, Cardiovalve, SwissVortex, Pfizer, Canon, and Edwards Lifesciences SA. Dr. Martin Orban has received speaker honoraria from Sedana Medical and AstraZeneca. Dr. Nabauer has received lecture fees from Abbott Laboratories and Edwards Lifesciences. Dr. Maisano has served as a consultant for Abbott Vascular, Edwards Lifesciences, Cardiovalve, Valtech, and Medtronic; and is cofounder of 4Tech. Dr. Taramasso is a consultant for Abbott Vascular, Boston Scientific, 4Tech, and CoreMedic; and has received speaker honoraria from Edwards Lifesciences. Dr. Fam is a consultant for Edwards; and received speaker honoraria from Abbott Vascular. Dr. Lurz has received speaker honoraria from Abbott Vascular. Dr. Hausleiter has received speaker honoraria from Abbott Vascular and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 10, 2019.
- Revision received December 16, 2019.
- Accepted December 17, 2019.
- 2020 American College of Cardiology Foundation
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