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. 2025 Sep;18(9):e015702.
doi: 10.1161/CIRCINTERVENTIONS.125.015702. Epub 2025 Sep 1.

Hemodynamic Effects of Transcatheter Tricuspid Valve Annuloplasty With Cardioband and Their Associations With Clinical Outcomes

Jan Althoff  1 , Alev Kalkan  2 , Thorsten Gietzen  1 , Karl Finke  1 , Caroline Hasse  1 , Jennifer von Stein  1   3 , Jan Wrobel  1 , Athanasios Feidakis  1 , Laura Marx  1 , Stephan Baldus  1 , Maria I Körber  1 , Roman Pfister  1 , Christos Iliadis  1
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Hemodynamic Effects of Transcatheter Tricuspid Valve Annuloplasty With Cardioband and Their Associations With Clinical Outcomes

Jan Althoff et al. Circ Cardiovasc Interv. 2025 Sep.

Abstract

Background: Transcatheter tricuspid valve annuloplasty (TTVA) with the Cardioband system is a safe and effective option for high-risk patients with symptomatic severe tricuspid regurgitation (TR). Hemodynamics play a crucial role in these patients. However, it remains unclear if hemodynamic changes after TTVA are linked to clinical outcomes.

Methods: Consecutive patients with severe functional TR who underwent TTVA between 2019 and 2022 were retrospectively analyzed. Right heart catheterization was performed before and after cinching to assess hemodynamic parameters, including XV height (difference between the V-wave and the nadir of right atrial pressure). The primary end point was 2-year survival.

Results: Fifty-eight patients with complete hemodynamic assessment were included. All patients presented with torrential (40%), severe (38%), or massive (22%) TR. TR was reduced by ≥2 grades in 83% and by ≥1 grade in 97%. Hemodynamics following TTVA showed significant increases in median cardiac index (2.4-2.8 L/[min·m²]), pulmonary artery pulsatility index (1.73-2.13), and right ventricle cardiac power index (0.15-0.21 W/m²). Right atrial pressure (mean/V-wave) decreased significantly, with the most notable change in XV height (12.5 to 7 mm Hg; P<0.001). Lower postprocedural XV height independently predicted 2-year survival (P=0.002) and was significantly associated with lower TR grade at follow-up (P=0.002) and right ventricle reverse remodeling (P<0.001). Immediate right ventricle remodeling was also associated with 2-year survival (P=0.024).

Conclusions: Postprocedural XV height was independently associated with 2-year survival and linked to TR reduction and right ventricle remodeling. TTVA improves hemodynamics even in advanced TR, and hemodynamic markers may support risk stratification.

Keywords: atrial pressure; hemodynamics; pulmonary artery; tricuspid valve; valvular heart diseases.

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Conflict of interest statement

Dr Iliadis has received travel support from Abbott and Edwards Lifesciences and consultant honoraria from Abbott Vascular and Edwards Lifesciences. Dr Körber has received travel support and consultant honoraria from Abbott Medical, Edwards. Dr von Stein has received lecturing honoraria from Edwards Lifesciences. Dr Pfister has received speaker fees and consultant honoraria from Abbott Medical and Edwards Lifesciences. Dr Baldus has received honoraria for consultation from Abbott and Edwards Lifesciences. The other authors report no conflicts.

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