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. 2023 Apr;10(2):1003-1012.
doi: 10.1002/ehf2.14262. Epub 2022 Dec 13.

Initial experience with transcatheter tricuspid valve repair in patients with cardiac amyloidosis

Isabel A Hoerbrand  1 , Martin J Volz  1 , Fabian Aus dem Siepen  1 , Matthias Aurich  1 , Philipp Schlegel  1 , Nicolas A Geis  1 , Ute Hegenbart  2 , Mathias H Konstandin  1   3 , Norbert Frey  1   3 , Philip W Raake  1   3
Affiliations

Initial experience with transcatheter tricuspid valve repair in patients with cardiac amyloidosis

Isabel A Hoerbrand et al. ESC Heart Fail. 2023 Apr.

Abstract

Aims: Wildtype transthyretin amyloid cardiomyopathy is an under-recognized cause of heart failure in elderly patients. Transcatheter tricuspid valve repair is a newly emerging therapeutic option for severe tricuspid regurgitation (TR). We present first insights into safety and possible benefits of this procedure in patients with cardiac amyloidosis.

Methods and results: Eight patients with cardiac non-hereditary (wildtype) transthyretin (ATTRwt) amyloidosis and severe to torrential TR, undergoing successful transcatheter tricuspid valve repair, were included in the analysis and compared to a control group of 21 patients without cardiac amyloidosis. All patients presented with an advanced stage of amyloid cardiomyopathy. Primary endpoint was reduction in TR at 3 months follow-up. Secondary endpoints were feasibility, safety, hospitalization or death, clinical improvement, cardiac biomarkers, and structural and functional right heart parameter obtained by echocardiography. Transcatheter tricuspid valve repair resulted in a significant reduction of TR (IV to II, P = 0.008) in all eight patients with cardiac amyloidosis (100%). Device success (amyloidosis 75% vs. control group 86%, P = 0.597) and overall probability of hospitalization or death (amyloidosis 13% vs. control group 25%, P = 0.646) were similar compared with those in the control group at 3 months follow-up. Transcatheter tricuspid valve repair led to an improvement of New York Heart Association functional class (P = 0.031) and 6 min walking distance (from 313 ± 118 to 337 ± 106, P = 0.012). TR reduction in amyloidosis patients was less extensive compared with that in control group (TR-reduction 1.6 ± 0.3, P = 0.008 vs. control group 2.3 ± 0.3, P < 0.0001). Furthermore, these patients showed no significant improvement of structural right heart parameters.

Conclusions: Transcatheter tricuspid valve repair is a safe and feasible new treatment option in patients with amyloid cardiomyopathy and has the potential to improve TR-grade and clinical status. However, the benefit appears to be less pronounced compared with patients without cardiac amyloidosis.

Keywords: Amyloid cardiomyopathy; Cardiac amyloidosis; Transcatheter tricuspid valve repair; Tricuspid regurgitation.

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Conflict of interest statement

Dr. Raake received speaker honoraria from Edwards and Abbott. The other authors report no conflicts.

Figures

Figure 1
Figure 1
Mortality and heart failure hospitalization in amyloidosis and control group after transcatheter tricuspid valve repair (TTVR). Mortality and hospitalization due to heart failure is shown in patients with amyloidosis and in the control group after TTVR. P values indicate significance from log‐rank test and refer to all patients with complete 3 months follow‐up or death before follow‐up. HF, heart failure.
Figure 2
Figure 2
Tricuspid regurgitation (TR) grade and New York Heart Association (NYHA) functional class in cardiac amyloidosis (A) and control group (B) pre‐ and post‐transcatheter tricuspid valve repair (TTVR). The pre‐procedural and 3 months post‐procedural status of TR grade and NYHA fictional class in patients with amyloidosis (A) and in the control group (B) is shown. TR is displayed according to the newly proposed five‐level grading system. Mean TR reduction is shown of each group. P values refer to all patients with complete 3 months follow‐up.
Figure 3
Figure 3
Development of echocardiographic parameters in cardiac amyloidosis (A) and control group (B) pre‐ and post‐transcatheter tricuspid valve repair (TTVR). Displayed is the status before (pre) and 3 months after (post) intervention in patients with amyloidosis (A) and in the control group (B). P values refer to all patients with complete 3 months follow‐up. LVEF, left ventricular ejection fraction; RV, right ventricle; RA, right atrium; BSA, body surface area; VCI, vena cava inferior.
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