Transcatheter Edge-to-Edge Tricuspid Repair for Severe Tricuspid Regurgitation Reduces Hospitalizations for Heart Failure

Abstract

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.

Keywords: MitraClip; PASCAL; heart failure; percutaneous edge-to-edge repair; right heart; transcatheter tricuspid valve repair; tricuspid regurgitation; tricuspid valve.