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Transcatheter Tricuspid Edge-to-Edge Repair for Tricuspid Regurgitation
Study Questions:
What is the impact on kidney and liver function of transcatheter edge-to-edge tricuspid valve repair (TTVR) for severe tricuspid regurgitation (TR)?
Methods:
In a single-center review, patients with severe TR and advanced (functional class III-IV) right-sided heart failure who underwent edge-to-edge TTVR between March 2016 and June 2018 were evaluated at baseline, 30 days, and 6 months. Kidney function was assessed using serum creatinine and glomerular filtration rate (GFR). Liver function was assessed using aspartate transaminase (AST), alanine transaminase (ALT), gamma-glutamyl transpeptidase, and bilirubin levels.
Results:
Over the study period, 126 patients were treated for TR (59 isolated TTVR, and 67 with concomitant transcatheter mitral valve repair [TMVR]). Of 126 patients, 110 (87.3%) survived at 6 months. TR grade ≥3+ was present in 96% at baseline and 14% at 6 months. Among survivors, renal function remained stable, including among patients with moderate to severe chronic kidney disease (mean GFR 37.5 at baseline vs. 40.1 ml/min/1.73 m2 at 6 months, p = 0.39). Of tests addressing liver function, significant improvement at 6 months for the entire cohort was observed only for ALT (30.7 vs. 24.9 U/L, p < 0.001). Among patients with abnormal baseline liver function, significant reductions also were observed for AST (50.5-39.9 U/L, p = 0.02) and bilirubin (1.8-1.5 mg/dl, p = 0.03).
Conclusions:
TR reduction by edge-to-edge TTVR was associated with improved liver function among patients with abnormal liver function at baseline, whereas kidney function remained stable. The authors concluded that edge-to-edge TTVR is an attractive option among patients with severe TR and liver dysfunction, who are at even higher surgical risks compared with patients who still have normal organ function.
Perspective:
This single-center study suggests that edge-to-edge TTVR is associated with improved hepatic function among patients with severe TR, advanced right-sided heart failure, and pre-existing hepatic dysfunction. Data reflecting cardiac output, hepatic synthetic function, and impact on heart failure are not reported. However, this study suggests that, presumably by treating passive hepatic congestion, transcatheter treatment of TR can help improve hepatic dysfunction.
Keywords: Alanine Transaminase, Aspartate Aminotransferases, Bilirubin, Cardiac Output, Cardiac Surgical Procedures, Creatinine, gamma-Glutamyltransferase, Glomerular Filtration Rate, Heart Failure, Heart Valve Diseases, Kidney Diseases, Liver Diseases, Metabolic Syndrome, Mitral Valve, Renal Insufficiency, Chronic, Secondary Prevention, Transcatheter Aortic Valve Replacement, Tricuspid Valve, Tricuspid Valve Insufficiency
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