Abstract 63 Reduction of tricuspid regurgitation as predictor of successful percutaneous edge-to-edge repair: clinical outcomes comparison between patients with residual severe and moderate-or-less regurgitation

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02087-y
Reduction of tricuspid regurgitation as predictor of successful percutaneous edge-to-edge repair: clinical outcomes comparison between patients with residual severe and moderate-or-less regurgitation
I. A. Patrascu¹, D. Binder¹, I. Alashkar¹, P. Schnabel¹, W. Stähle¹, J. Schneider¹, K. Weinmann², I. Ott¹, für die Studiengruppe: PF-TriValve
¹Medizinische Klinik I, Kardiologie, Helios Klinikum Pforzheim, Pforzheim; ²Helios Klinikum Pforzheim, Pforzheim;
BACKGROUND: Percutaneous edge-to-edge repair for high-grade tricuspid regurgitation (TR) is emerging as a viable option, but defining procedure-related clinical success is challenging, as considerable reduction is not possible in all patients with massive or torrential TR. This study compared clinical outcomes of successful transcatheter tricuspid valve repair (TTVR), in patients with residual severe vs moderate-or-less TR. METHODS: Eligible patients had chronic symptomatic functional TR despite diuretic therapy, were deemed inoperable by the local Heart Team, but considered suitable candidates for TTVR. TR was assessed by the current five-grade classification. Efficacy and safety outcomes were compared at baseline and 30 days, with follow-up between January 2021 and May 2022. This is a single-center non-randomized prospective registry trial. RESULTS: Forty-three patients had ≥severe (III/V) functional TR, with 28 patients (65%) presenting with massive (IV/V) and 6 (14%) with torrential (V/V) TR. Mean age was 81.8±4.9 years, with 9.1±6.7% EuroSCORE II. The primary efficacy endpoint of at least one-grade TR reduction by 30 days was recorded in 91% of all patients, with 17 patients presenting with residual severe TR (STR subgroup) and 22 (MTR subgroup) with moderate-or-less (≤II/V). By follow-up no patients died, no device related complications occurred, and MACE rate was 9.3%. Improvement in initial NYHA class III/IV occurred in 71% of STR and 77% of MTR patients. KCCQ Score increased by 17±10.6 pts. (p<0.001) in the first group vs 21±11.8 in the second (p<0.001). Six-minute walk test improved by 69.6±48.7 meters (p<0.001) in STR vs 74.2±63 (p<0.001) in MTR patients. Renal function equally improved in both groups [GFR 50±16ml/min/1,73m2 to 57.8±20.4 (p=0.012) vs 57.4±18.5 to 65.5±21.2 (p=0.002)], while liver enzymes decreased [AST 27.5±9.3U/L to 22.9±7.3 (p=0.039) vs 37.2±25.6 to 26.8±7.3 (p=0.069)]. CONCLUSIONS: Although TTVR should always aim for trace to mild TR, considerable reduction is not always possible. This study indicates that even one-grade TR reduction can significantly impact quality of life, functional capacity and multiorgan involvement, similarly in patients with residual severe and moderate-or-less TR.
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