Background:

Transcatheter direct annuloplasty via Cardioband© implantation has proven effective in reducing tricuspid regurgitation (TR). Due to its anatomical proximity to the tricuspid valve annulus, impairment of the right coronary artery is a dreaded periinterventional complication, yet detailed data on incidence and clinical relevance are missing. 

Methods & Results:

A total of 173 Cardioband© procedures performed at 3 German high-volume heart centers (Cologne, Hamburg and Bad Oeynhausen) between 2017 and 2022 were retrospectively analzyed. Patients were highly symptomatic (NYHA II–IV), presented with TR grade III or higher (on a 5-grade scale) and were all adjudicated to undergo Cardioband© implantation by interdisciplinary heart team consensus.

Data concerning anchor perforation or penetration of the right coronary artery were available for 167 cases. In total, 12 RCA-perforations (defined as leaking contrast at angiography) and 3 penetrations (impaired blood flow or suspected intraluminal anchor position without subsequent contrast leakage) occurred during intervention (9%). Out of these 15 cases with RCA perforation/penetration, two patients received covered coronary stents and two required interventional pericardial punctures. One of these patients underwent emergency operation for intramural myocardial haematoma following a primary covered stent-intervention with a 35-days hospital stay and survival of one year. 

Apart of this patient, technical success, defined as “alive, device deployed, and no emergency surgery”, was reached in the remaining 14 cases with RCA perforation/penetration. 

In the overall population median troponin T (reference value <0.014 µg/l) at baseline was 0.021 µg/l, 0.295 µg/l 24h after procedure, 0.242 µg/l 48h and 0.156 µg/l 72h after procedure.

Moreover, 41 out of 164 available cases had RCA-obstruction greater than 50% after cinching (cinching stenoses without flow impairment), whereof only 3 patients got stented. Median troponin of those 41 patients was higher (0,614 µg/l) after 24 hours compared to the total cohort. 

New hemodynamic relevant arrhythmias associated to the intervention occurred in 7 out of 115 cases (6,0%) without RCA impairment (no perforation/penetration/stenosis) and in three out of 52 cases (5,8%) with RCA impairment. Two patients without RCA impairment needed a new permanent pacemaker.

Short-term follow-up data (median 58.5 days after procedure) were available for 100 patients. It showed that only one case, a patient with intraprocedural RCA obstruction, presented with angina in the meantime but did not undergo PCI. No cases of myocardial infarction, need for revascularization or acute coronary syndrome were reported.

42 out of 44 patients (95.5%) with RCA impairment and data available compared to 81 out of 87 patients (93.1%) without intraprocedural RCA impairment were still alive at follow-up.

Conclusion: 

Right coronary artery impairment occurred in 31% of patients consecutively to direct annuloplasty of secondary TR via Cardioband©. RCA perforation and penetration only occurred in 9%. Yet, these periinterventional events are rarely clinically overt and for the most cases are not associated with clinically adverse events.