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Tricuspid Transcatheter-Edge-to-Edge-Repair and Transcatheter Tricuspid Valve Replacement for Tricuspid
Julius Jelisejevas1,2,3, Brian Chiang1,3, Ali Husain1,3,4
1Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Background:
Transcatheter tricuspid valve replacement (TTVR) is typically reserved for patients in whom tricuspid valve transcatheter edge-to-edge repair (T-TEER) is deemed unsuitable or unlikely to provide effective treatment. Comparative data evaluating patient profiles, disease stage, and outcomes between T-TEER and TTVR are limited. We aimed to analyze and compare patient profiles, selection, and outcomes with either T-TEER or TTVR.
Methods:
A total of 43 consecutive patients from May 2018 to April 2023 were retrospectively divided into 2 groups: Group-1 underwent T-TEER; and Group-2 underwent TTVR. Primary endpoints are as follows: inpatient mortality; and 30-day and 12-month mortality. Secondary endpoints are as follows: echocardiographic tricuspid regurgitationgrading; new pacemaker implantation; and heart failure-related readmissions at 30 days and 12 months.
Results:
A total of 43 patients underwent intervention (T-TEER, n = 14; TTVR, n = 29;). The mean age was 77.6 ± 10.3 years, and 38 patients (88%) were diagnosed with functional tricuspid regurgitation. The in-hospital mortality rate was 7%; the 30-day mortality rate was 12% with heart failure readmission for 14%.The 12-month mortality rate was 33%, with heart failure readmission for 37%. No in-hospital or 30-day mortality occurred in the T-TEER group. The 12-month mortality rate was 29% in the T-TEER group vs 34% in the TTVR group. The TTVR cohort showed numerically younger patients (76.2 ± 10.6 vs 80.4 ± 9.6 years, P = 0.24) and numerically higher TRI-scores (for tricuspid; 6.0, interquartile range [IQR], 4.0-7.0 vs 4.5, 1.5-5.75, P = 0.09). The calculated GLIDE-score (gap, location, image quality, density, en-face TR morphology) was significantly lower in the T-TEER cohort (P < 0.01). The length of hospitalization was significantly longer in the TTVR group (1, interquartile range, 1-4 vs 1, 1-1; P = 0.02).
Conclusions:
Our findings suggest that patients undergoing T-TEER vs TTVR may represent different disease stages. Further data are required to determine the best patient selection for T-TEER vs TTVR to optimize patient outcomes.
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