Mid-Term Valve-Related Outcomes After Transcatheter Tricuspid Valve-in-Valve or Valve-in-Ring Replacement

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Transcatheter aortic and pulmonary valves are used for stenosis or regurgitation post-surgical tricuspid valve (TV) intervention.
• Intermediate-term outcomes for transcatheter tricuspid valve replacement (TTVR) remain largely unknown, particularly regarding valve function, thrombus, and endocarditis.

Purpose of the Study:

• To evaluate mid-term, valve-related outcomes in a large cohort of patients undergoing TTVR after prior surgical TV repair or replacement.

Main Methods:

• An international registry collected data on 306 patients who underwent TTVR between 2008 and 2017.
• Mid-term outcomes were modeled, and risk factors for adverse events were assessed, including valve function, thrombus, and endocarditis.

Main Results:

• At 3 years, 64% of patients were alive without TV reintervention or valve-related events. Cumulative 3-year incidence was 17% for death, 12% for reintervention, and 8% for adverse outcomes (endocarditis, thrombosis, dysfunction).
• Endocarditis occurred in 8 patients (1.5% per patient-year), and 8 patients developed clinically relevant valve thrombosis. Prior endocarditis was not a risk factor for adverse outcomes.
• No significant difference in valve-related outcomes was observed across different TTVR valve types.

Conclusions:

• Transcatheter tricuspid valve replacement demonstrates uncommon rates of TV dysfunction, endocarditis, and leaflet thrombosis in mid-term follow-up.
• Patients with a history of endocarditis are not at increased risk for adverse events post-TTVR.
• Leaflet thrombosis, though rare, is a significant adverse outcome requiring further research into optimal prophylactic therapy.