TY - JOUR
T1 - Invasive Hemodynamic Assessment and Procedural Success of Transcatheter Tricuspid Valve Repair-Important Factors for Right Ventricular Remodeling and Outcome
AU - Dannenberg, Varius
AU - Koschutnik, Matthias
AU - Donà, Carolina
AU - Nitsche, Christian
AU - Mascherbauer, Katharina
AU - Heitzinger, Gregor
AU - Halavina, Kseniya
AU - Kammerlander, Andreas A
AU - Spinka, Georg
AU - Winter, Max-Paul
AU - Andreas, Martin
AU - Mach, Markus
AU - Schneider, Matthias
AU - Bartunek, Anna
AU - Bartko, Philipp E
AU - Hengstenberg, Christian
AU - Mascherbauer, Julia
AU - Goliasch, Georg
N1 - Funding Information:
VD received consulting fees from Abbott, and educational grants from Edwards Lifesciences. JM received proctor fees from Abbott, consulting fees from Edwards Lifesciences, Boston Scientific, Shockwave Medical, and educational grants from Edwards Lifesciences. CH received proctor fees from Edwards Lifesciences and Boston Scientific, Educational grants from Abbott, Edwards Lifesciences, Boston Scientific, and Medtronic. MA received proctor/speaker/consulting fees from Abbott, Edwards, and Medtronic and institutional research funding (Edwards, Abbott, Medtronic, LSI). 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.
Funding Information:
Many thanks to Sophie Lindenthal for her assistance with the graphic design and the IT4Science team of the Medical University of Vienna for data provision.
Publisher Copyright:
Copyright © 2022 Dannenberg, Koschutnik, Donà, Nitsche, Mascherbauer, Heitzinger, Halavina, Kammerlander, Spinka, Winter, Andreas, Mach, Schneider, Bartunek, Bartko, Hengstenberg, Mascherbauer and Goliasch.
PY - 2022/6/2
Y1 - 2022/6/2
N2 - Introduction: Severe tricuspid regurgitation (TR) is a common condition promoting right heart failure and is associated with a poor long-term prognosis. Transcatheter tricuspid valve repair (TTVR) emerged as a low-risk alternative to surgical repair techniques. However, patient selection remains controversial, particularly regarding the benefits of TTVR in patients with pulmonary hypertension (PH).Aim: We aimed to investigate the impact of preprocedural invasive hemodynamic assessment and procedural success on right ventricular (RV) remodeling and outcome.Methods: All patients undergoing TTVR with a TR reduction of ≥1 grade without precapillary or combined PH [mean pulmonary artery pressure (mPAP) ≥25 mmHg, mean pulmonary artery Wedge pressure ≤ 15 mmHg, pulmonary vascular resistance ≥3 Wood units] were assigned to the responder group. All patients with a TR reduction of ≥1 grade and precapillary or combined PH were classified as non-responders. Patients with a TR reduction ≥2 grade were directly classified as responders, and patients without TR reduction were directly assigned as non-responders.Results: A total of 107 patients were enrolled, 75 were classified as responders and 32 as non-responders. We observed evidence of significant RV reverse remodeling in responders with a decrease in RV diameters (-2.9 mm, p = 0.001) at a mean follow-up of 229 days (±219 SD) after TTVR. RV function improved in responders [fractional area change (FAC) + 5.7%, p < 0.001, RV free wall strain +3.9%, p = 0.006], but interestingly further deteriorated in non-responders (FAC -4.5%, p = 0.003, RV free wall strain -3.9%, p = 0.007). Non-responders had more persistent symptoms than responders (NYHA ≥3, 72% vs. 11% at follow-up). Subsequently, non-response was associated with a poor long-term prognosis in terms of death, heart failure (HF) hospitalization, and re-intervention after 2 years (freedom of death, HF hospitalization, and reintervention at 2 years: 16% vs. 78%, log-rank: p < 0.001).Conclusion: Hemodynamic assessment before TTVR and procedural success are significant factors for patient prognosis. The hemodynamic profiling prior to intervention is an essential component in patient selection for TTVR. The window for edge-to-edge TTVR might be limited, but timely intervention is an important factor for a better outcome and successful right ventricular reverse remodeling.
AB - Introduction: Severe tricuspid regurgitation (TR) is a common condition promoting right heart failure and is associated with a poor long-term prognosis. Transcatheter tricuspid valve repair (TTVR) emerged as a low-risk alternative to surgical repair techniques. However, patient selection remains controversial, particularly regarding the benefits of TTVR in patients with pulmonary hypertension (PH).Aim: We aimed to investigate the impact of preprocedural invasive hemodynamic assessment and procedural success on right ventricular (RV) remodeling and outcome.Methods: All patients undergoing TTVR with a TR reduction of ≥1 grade without precapillary or combined PH [mean pulmonary artery pressure (mPAP) ≥25 mmHg, mean pulmonary artery Wedge pressure ≤ 15 mmHg, pulmonary vascular resistance ≥3 Wood units] were assigned to the responder group. All patients with a TR reduction of ≥1 grade and precapillary or combined PH were classified as non-responders. Patients with a TR reduction ≥2 grade were directly classified as responders, and patients without TR reduction were directly assigned as non-responders.Results: A total of 107 patients were enrolled, 75 were classified as responders and 32 as non-responders. We observed evidence of significant RV reverse remodeling in responders with a decrease in RV diameters (-2.9 mm, p = 0.001) at a mean follow-up of 229 days (±219 SD) after TTVR. RV function improved in responders [fractional area change (FAC) + 5.7%, p < 0.001, RV free wall strain +3.9%, p = 0.006], but interestingly further deteriorated in non-responders (FAC -4.5%, p = 0.003, RV free wall strain -3.9%, p = 0.007). Non-responders had more persistent symptoms than responders (NYHA ≥3, 72% vs. 11% at follow-up). Subsequently, non-response was associated with a poor long-term prognosis in terms of death, heart failure (HF) hospitalization, and re-intervention after 2 years (freedom of death, HF hospitalization, and reintervention at 2 years: 16% vs. 78%, log-rank: p < 0.001).Conclusion: Hemodynamic assessment before TTVR and procedural success are significant factors for patient prognosis. The hemodynamic profiling prior to intervention is an essential component in patient selection for TTVR. The window for edge-to-edge TTVR might be limited, but timely intervention is an important factor for a better outcome and successful right ventricular reverse remodeling.
KW - patient selection
KW - pulmonary hypertension
KW - right ventricular remodeling
KW - transcatheter repair
KW - tricuspid regurgitation
UR - http://www.scopus.com/inward/record.url?scp=85138695436&partnerID=8YFLogxK
U2 - 10.3389/fcvm.2022.891468
DO - 10.3389/fcvm.2022.891468
M3 - Journal article
C2 - 35722132
SN - 2297-055X
VL - 9
SP - 891468
JO - Frontiers in Cardiovascular Medicine
JF - Frontiers in Cardiovascular Medicine
M1 - 891468
ER -