Insights From the TriValve Registry: What is the Impact of TVG After Tricuspid TEER?

Increased discharge tricuspid valve gradient (TVG) is not significantly associated with adverse outcomes after tricuspid transcatheter edge-to-edge repair (TEER), according to a study presented at THT 2023 and simultaneously published March 20 in JACC: Cardiovascular Interventions.

Augustin Coisne, MD, PhD, et al., conducted a retrospective analysis of 308 patients captured from the TriValve registry from August 2015 to March 2022 to evaluate the association between the mean TVG and the clinical outcomes among patients who underwent tricuspid TEER for significant tricuspid regurgitation. The primary endpoint was the composite of all-cause mortality and heart failure hospitalizations.

Patients were divided into quartiles based on their mean TVG (quartile 1 [n=77], 0.9±0.3 mm Hg; quartile 2 [n=115], 1.8±0.3 mm Hg; quartile 3 [n=65], 2.8±0.3 mm Hg; and quartile 4 [n=51], 4.7±2.0 mm Hg). Outcomes were assessed up to the one-year follow-up.

Results showed that while the baseline TVG and the number of implanted chips were associated with a higher post-TEER TVG, there was no significant difference across TVG quartiles in the one-year composite endpoints (quartiles 1-4: 35%, 30%, 40% and 34%, respectively; p=0.60). Likewise, no significant difference was seen in NYHA class III -IV. The primary endpoint occurred in 63 (20.4%) patients; all-cause mortality occurred in 34 (11.0%) patients and HF hospitalization in 48 (15.6%) patients across the quartiles.

Even after adjustment for clinical and echocardiographic characteristics and also exploring post-TEER TVG as a continuous variable, the results were similar across the quartiles.

The authors note that, to their knowledge, "this study represents the largest analysis of postprocedural TVG and its impact on outcomes after tricuspid TEER" and that "further investigations on higher gradients and longer follow-up are needed to better guide the intraprocedural decision-making process."

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Acute Heart Failure, Echocardiography/Ultrasound, Invasive Cardiovascular Angiography and Intervention

Keywords: Tricuspid Valve Insufficiency, Tricuspid Valve, Retrospective Studies, Patient Discharge, Follow-Up Studies, Echocardiography, Heart Failure, Registries

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