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. 2021 Oct 25;14(20):2260-2270.
doi: 10.1016/j.jcin.2021.07.048. Epub 2021 Aug 23.

Leaflet Configuration and Residual Tricuspid Regurgitation After Transcatheter Edge-to-Edge Tricuspid Repair

Atsushi Sugiura  1 , Tetsu Tanaka  1 , Refik Kavsur  1 , Can Öztürk  1 , Johanna Vogelhuber  1 , Nihal Wilde  1 , Marc Ulrich Becher  1 , Sebastian Zimmer  1 , Georg Nickenig  1 , Marcel Weber  2
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Free article

Leaflet Configuration and Residual Tricuspid Regurgitation After Transcatheter Edge-to-Edge Tricuspid Repair

Atsushi Sugiura et al. JACC Cardiovasc Interv. .
Free article

Abstract

Objectives: This study aimed to assess the anatomical leaflet variation and investigate its impact on the procedural outcome in patients undergoing transcatheter edge-to-edge tricuspid repair.

Background: Tricuspid regurgitation (TR) is associated with a poor prognosis.

Methods: The study participants were consecutive patients who underwent transcatheter edge-to-edge tricuspid repair with the MitraClip, TriClip, or PASCAL systems from June 2015 to July 2020 at the Bonn Heart Center. The tricuspid leaflet morphologies were imaged using 2-dimensional and 3-dimensional transesophageal echocardiography. The severity of TR was assessed according to the 5-grade scheme. The primary endpoint was residual TR ≥3+ within 30 days.

Results: Of the 145 study participants, 103 (71.1%) participants were categorized as the 3-leaflet configuration, while 42 (28.9%) were categorized as the 4-leaflet configuration. Successful device implantation was achieved in 136 (93.8%) patients, with no statistical difference between the 3-leaflet and 4-leaflet configuration groups. However, compared with patients with a 3-leaflet configuration, patients with 4-leaflet configuration more frequently had residual TR ≥3+ (18.4% vs 38.1%; P = 0.018). In the multivariable model, the 4-leaflet configuration was associated with an increased risk of residual TR ≥3+ (odds ratio: 2.65; 95% CI 1.15-6.10; P = 0.022), independent of baseline TR grade, coaptation gap width, and TR jet location. After 1-year follow-up, compared with patients with residual TR <3+, patients with residual TR ≥3+ had a significantly higher incidence of the composite of all-cause mortality or heart failure hospitalization (27.7% vs 56.1%; P = 0.016).

Conclusions: A 4-leaflet configuration of the tricuspid valve is observed in approximately one-third of patients undergoing transcatheter edge-to-edge tricuspid repair, which is associated with an increased risk of residual TR after the procedure.

Keywords: edge-to-edge; leaflet configuration; morphology; transcatheter; tricuspid regurgitation.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Nickenig has received research funding from the Deutsche Forschungsgemeinschaft, the German Federal Ministry of Education and Research, the European Union, Abbott, Edwards Lifesciences, Medtronic, and St. Jude Medical; and has honoraria for lectures or advisory boards from Abbott, Edwards Lifesciences, Medtronic, and St. Jude Medical. Dr Weber has received lecture or proctoring fees from Abbott and Edwards. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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