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Transcatheter Repair for Tricuspid Regurgitation
Quick Takes
- Transcatheter tricuspid valve repair is feasible and is associated with a decrease in proportion of patients with severe tricuspid regurgitation and severe symptomatology.
- Additional study is required to better understand the optimal devices and patient selection for the procedure.
Study Questions:
What are the outcomes of transcatheter tricuspid valve repair for severe tricuspid valve regurgitation (TR)?
Methods:
A meta-analysis was performed of existing studies. Devices included the Cardioband, FORMA, MitraClip, PASCAL, and Trialign. Outcomes included successful implantation, residual severe TR, post-procedural New York Heart Association (NYHA) functional class III-IV, 6-minute walking test (6MWT), and echocardiographic parameters.
Results:
A pooled analysis was performed of seven studies enrolling 454 patients undergoing transcatheter tricuspid valve repair. A large majority of patients underwent repair with MitraClip (n = 334). Mean age was 76.7 years and the etiology of TR was functional in 90% of patients, while 95% had at least severe TR and 91% were in NYHA functional class II-IV. When compared to baseline, a lower proportion of patients had at least severe TR (relative risk [RR], 0.38; 95% confidence interval [CI], 0.2-0.7; p = 0.004) and were in NYHA class III-IV (RR, 0.23; 95% CI, 0.2-0.3; p < 0.001). Patients also experienced an increase in their 6MWT capacity (+64.6 meters; p < 0.001), with no change in left and right ventricular systolic function.
Conclusions:
The authors concluded that transcatheter repair for TR appears to be feasible, effective, and associated with improved clinical outcomes.
Perspective:
This study investigated the role of transcatheter approaches for repair of TR. The mean age of patients was over 76 years, with most patients having functional TR as opposed to anatomically abnormal valves. The most commonly used device was the MitraClip. The study was potentially limited by heterogeneity, both of the patient population and of the valve interventions, although multiple statistical tools were utilized to mitigate its impact. This pooled analysis study suggests a role for transcatheter valve repair, although further evaluation will be required to understand the optimal patient populations as well as valve repair techniques.
Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Congenital Heart Disease, CHD and Pediatrics and Imaging, CHD and Pediatrics and Interventions, Acute Heart Failure, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound
Keywords: Cardiac Surgical Procedures, Echocardiography, Geriatrics, Heart Defects, Congenital, Heart Failure, Heart Valve Diseases, Heart Valve Prosthesis, Tricuspid Valve Insufficiency, Ventricular Function
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