Prognostic Value of Tricuspid Valve Gradient After Transcatheter Edge-to-Edge Repair: Insights From the TriValve Registry

Augustin Coisne; Andrea Scotti; Maurizio Taramasso; Juan F Granada; Sebastian Ludwig; Josep Rodés-Cabau; Philipp Lurz; Jörg Hausleiter; Neil Fam; Susheel K Kodali; Alberto Pozzoli; Hannes Alessandrini; Luigi Biasco; Eric Brochet; Paolo Denti; Rodrigo Estevez-Loureiro; Christian Frerker; Edwin C Ho; Vanessa Monivas; Georg Nickenig; Fabien Praz; Rishi Puri; Horst Sievert; Gilbert H L Tang; Martin Andreas; Ralph Stephan Von Bardeleben; Karl-Philipp Rommel; Guillem Muntané-Carol; Mara Gavazzoni; Daniel Braun; Edith Lubos; Daniel Kalbacher; Kim A Connelly; Jean-Michel Juliard; Claudia Harr; Giovanni Pedrazzini; François Philippon; Joachim Schofer; Holger Thiele; Matthias Unterhuber; Dominique Himbert; Marina Ureña Alcázar; Mirjam G Wild; Ulrich Jorde; Stephan Windecker; Francesco Maisano; Martin B Leon; Rebecca T Hahn; Azeem Latib

doi:10.1016/j.jcin.2023.01.375

Prognostic Value of Tricuspid Valve Gradient After Transcatheter Edge-to-Edge Repair: Insights From the TriValve Registry

JACC Cardiovasc Interv. 2023 Mar 10:S1936-8798(23)00452-1. doi: 10.1016/j.jcin.2023.01.375. Online ahead of print.

Authors

Augustin Coisne¹, Andrea Scotti², Maurizio Taramasso³, Juan F Granada⁴, Sebastian Ludwig⁵, Josep Rodés-Cabau⁶, Philipp Lurz⁷, Jörg Hausleiter⁸, Neil Fam⁹, Susheel K Kodali¹⁰, Alberto Pozzoli¹¹, Hannes Alessandrini¹², Luigi Biasco¹³, Eric Brochet¹⁴, Paolo Denti¹⁵, Rodrigo Estevez-Loureiro¹⁶, Christian Frerker¹⁷, Edwin C Ho¹⁸, Vanessa Monivas¹⁹, Georg Nickenig²⁰, Fabien Praz²¹, Rishi Puri²², Horst Sievert²³, Gilbert H L Tang²⁴, Martin Andreas²⁵, Ralph Stephan Von Bardeleben²⁶, Karl-Philipp Rommel⁷, Guillem Muntané-Carol⁶, Mara Gavazzoni³, Daniel Braun⁸, Edith Lubos²⁷, Daniel Kalbacher²⁸, Kim A Connelly⁹, Jean-Michel Juliard¹⁴, Claudia Harr¹², Giovanni Pedrazzini²⁹, François Philippon⁶, Joachim Schofer¹², Holger Thiele⁷, Matthias Unterhuber⁷, Dominique Himbert¹⁴, Marina Ureña Alcázar¹⁴, Mirjam G Wild²¹, Ulrich Jorde¹⁸, Stephan Windecker²¹, Francesco Maisano¹⁵, Martin B Leon³⁰, Rebecca T Hahn³⁰, Azeem Latib³¹

Affiliations

¹ Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, New York, New York, USA; Universitè Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Lille, France.
² Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, New York, New York, USA.
³ Heart Center Hirslanden Zürich, Zürich, Switzerland.
⁴ Cardiovascular Research Foundation, New York, New York, USA.
⁵ Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.
⁶ Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
⁷ Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany.
⁸ Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany.
⁹ Division of Cardiology, Toronto Heart Center, St. Michael's Hospital, Toronto, Ontario, Canada.
¹⁰ Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, New York, USA.
¹¹ Division of Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.
¹² Asklepios Clinic St. Georg, Hamburg, Germany.
¹³ Azienda Sanitaria Locale Torino 4, Ciriè, Italy; Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland.
¹⁴ Division of Cardiology, Bichat Hospital, Paris, France.
¹⁵ Division of Cardiology and Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy.
¹⁶ Interventional Cardiology Clinic, University Hospital Alvaro Cunqueiro, Vigo, Spain.
¹⁷ University Heart Center, Schleswig-Holstein University, Lübeck, Germany.
¹⁸ Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
¹⁹ Division of Cardiology, Puerta de Hierro University Hospital, Madrid, Spain.
²⁰ Division of Cardiology, Bonn University Hospital, Bonn, Germany.
²¹ Division of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland.
²² Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
²³ Division of Cardiology, Cardiovascular Center Frankfurt, Frankfurt am Main, Germany.
²⁴ Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA.
²⁵ Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
²⁶ Division of Cardiology, University Medical Center, Mainz, Germany.
²⁷ Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.
²⁸ Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Luebeck/Kiel, Germany.
²⁹ Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland; Division of Cardiology, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland.
³⁰ Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, New York, USA.
³¹ Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA. Electronic address: alatib@gmail.com.

PMID: 36948892
DOI: 10.1016/j.jcin.2023.01.375

Abstract

Background: Data regarding the impact of the tricuspid valve gradient (TVG) after tricuspid transcatheter edge-to-edge repair (TEER) are scarce.

Objectives: This study sought to evaluate the association between the mean TVG and clinical outcomes among patients who underwent tricuspid TEER for significant tricuspid regurgitation.

Methods: Patients with significant tricuspid regurgitation who underwent tricuspid TEER within the TriValve (International Multisite Transcatheter Tricuspid Valve Therapies) registry were divided into quartiles based on the mean TVG at discharge. The primary endpoint was the composite of all-cause mortality and heart failure hospitalization. Outcomes were assessed up to the 1-year follow-up.

Results: A total of 308 patients were included from 24 centers. Patients were divided into quartiles of the mean TVG as follows: quartile 1 (n = 77), 0.9 ± 0.3 mm Hg; quartile 2 (n = 115), 1.8 ± 0.3 mm Hg; quartile 3 (n = 65), 2.8 ± 0.3 mm Hg; and quartile 4 (n = 51), 4.7 ± 2.0 mm Hg. The baseline TVG and the number of implanted clips were associated with a higher post-TEER TVG. There was no significant difference across TVG quartiles in the 1-year composite endpoint (quartiles 1-4: 35%, 30%, 40%, and 34%, respectively; P = 0.60) or the proportion of patients in New York Heart Association class III to IV at the last follow-up (P = 0.63). The results were similar after adjustment for clinical and echocardiographic characteristics (composite endpoint quartile 4 vs quartile 1-quartile 3 adjusted HR: 1.05; 95% CI: 0.52-2.12; P = 0.88) or exploring post-TEER TVG as a continuous variable.

Conclusions: In this retrospective analysis of the TriValve registry, an increased discharge TVG was not significantly associated with adverse outcomes after tricuspid TEER. These findings apply for the explored TVG range and up to the 1-year follow-up. Further investigations on higher gradients and longer follow-up are needed to better guide the intraprocedural decision-making process.

Keywords: transcatheter edge-to-edge repair; transcatheter tricuspid valve intervention; tricuspid regurgitation; tricuspid valve gradient.