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. 2023 Aug 7:10:1189920.
doi: 10.3389/fcvm.2023.1189920. eCollection 2023.

Procedural success of transcatheter annuloplasty in ventricular and atrial functional tricuspid regurgitation

Fabian Barbieri  1 , Isabel Mattig  1   2   3 , Niklas Beyhoff  1   3 , Tharusan Thevathasan  1   3   4 , Elena Romero Dorta  1 , Carsten Skurk  1   3 , Karl Stangl  1   2 , Ulf Landmesser  1   2   3 , Mario Kasner  1 , Henryk Dreger  1   2 , Markus Reinthaler  1   5
Affiliations

Procedural success of transcatheter annuloplasty in ventricular and atrial functional tricuspid regurgitation

Fabian Barbieri et al. Front Cardiovasc Med. .

Abstract

Background: Transcatheter annuloplasty is meant to target annular dilatation and is therefore mainly applied in functional tricuspid regurgitation (TR). Due to recent recognition of varying disease pathophysiology and differentiation of ventricular and atrial functional TR (VFTR and AFTR), comparative data regarding procedural success for both disease entities are required.

Methods: In this consecutively enrolled observational cohort study, 65 patients undergoing transcatheter annuloplasty with a Cardioband® device were divided into VFTR (n = 35, 53.8%) and AFTR (n = 30, 46.2%). Procedural success was assessed by comparing changes in annulus dilatation, vena contracta (VC) width, effective regurgitation orifice area (EROA), as well as reduction in TR severity.

Results: Overall, improvement of TR by at least two grades was achieved in 59 patients (90.8%), and improvement of TR by at least three grades was realised in 32 patients (49.2%). Residual TR of ≤2 was observed in 52 patients (80.0%). No significant differences in annulus diameter reduction [VFTR: 11 mm (9-13) vs. AFTR: 12 mm (9-16), p = 0.210], VC reduction [12 mm (8-14) vs. 12 mm (7-14), p = 0.868], and EROA reduction [0.62 cm2 (0.45-1.10) vs. 0.54 cm2 (0.40-0.70), p = 0.204] were reported. Improvement by at least two grades [27 (90.0%) vs. 32 (91.4%), p = 1.0] and three grades [14 (46.7%) vs. 18 (51.4%), p = 0.805] was similar in VFTR and AFTR, respectively. No significant difference in the accomplishment of TR grade of ≤2 [21 (70.0%) vs. 31 (88.6%), p = 0.118] was noted.

Conclusion: According to our results from a real-world scenario, transcatheter annuloplasty with the Cardioband® device may be applied in both VFTR and AFTR with evidence of significant procedural TR reduction.

Keywords: Cardioband®; atrial functional tricuspid regurgitation; interventional echocardiography; transcatheter annuloplasty; ventricular functional tricuspid regurgitation.

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Conflict of interest statement

FB reports grant support from Abbott Laboratories and Boston Scientific, speaker honoraria from Edwards Lifesciences, as well as consulting fees from Boston Scientific. IM received grants from Pfizer Pharmaceuticals, Abbott Laboratories, and Edwards Lifesciences as well as lecture fees from Sanofi. UL received personal fees from Abbott Laboratories, Biotronik, and Boston Scientific. HD reports research support from Abbott Laboratories and speaker honoraria from Abbott Laboratories and Edwards Lifesciences. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Apical four-chamber view of a patient with atrial functional tricuspid regurgitation. Tricuspid regurgitation is mainly caused by right atrial enlargement with consequent tricuspid annulus dilatation (red arrow). The right ventricle is triangular shaped (yellow line) without remodelling or dilatation (blue arrow), and the coaptation line is found at the height of the tricuspid annulus (<10 mm tenting height).
Figure 2
Figure 2
Apical four-chamber view of a patient with ventricular functional tricuspid regurgitation. Tricuspid regurgitation is mainly driven by severe leaflet tethering (green arrow) due to right ventricular dilatation (yellow line) and remodelling. The mid-right ventricular dilatation (blue arrow) was therefore more pronounced than tricuspid annulus dilatation (red arrow), and the line of coaptation was below the tricuspid annulus (>10 mm tenting height).
Figure 3
Figure 3
Procedural success displayed as change in severity of tricuspid regurgitation after transcatheter annuloplasty. Numbers in each column present the percentage of prevalence, and values smaller than 5% are not displayed due to limitation of space.
See this image and copyright information in PMC

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