Transcatheter Tricuspid Valve Repair in Prohibitive Risk Patients: Impact on Quality of Life and Major Organ Systems

• Published in: Canadian journal of cardiology 2022-12, Vol.38 (12), p.1921-1931
• Main Authors: Patrascu, Alexandru I., Binder, Donat, Alashkar, Ibrahim, Schnabel, Peter, Stähle, Wilfried, Weinmann, Kai, Schneider, Jochen, Conzelmann, Lars O., Mehlhorn, Uwe, Ott, Ilka
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cardiac Catheterization - adverse effects; Heart Valve Prosthesis Implantation - adverse effects; Humans; Quality of Life; Recovery of Function; Severity of Illness Index; Time Factors; Treatment Outcome; Tricuspid Valve - surgery; Tricuspid Valve Insufficiency
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2022.09.006

Percutaneous repair for severe tricuspid regurgitation (TR) is emerging as a viable option, but patient selection is challenging and predetermined by comorbidities. This study evaluated mid-term outcomes of transcatheter tricuspid valve repair (TTVR) in very sick inoperable patients and explored the concept of risk-based therapeutic futility. TTVR patients treated in our centre were prospectively assigned to prohibitive-risk (PR) and high-risk (HR) subgroups, based on Society of Thoracic Surgeons (STS) Score, frailty indices, and major organ system compromise. Efficacy and safety outcomes were compared at baseline, 30 days, and 6 months. Thirty-three patients (mean age 81.9 ± 5.1 years) completed follow-up from May 2021 to March 2022: 18 PR (mean STS Score 15.5 ± 7%) and 15 HR (mean STS Score 6.4 ± 1.7%). The primary efficacy end point of at least 1 grade of TR reduction by 30 days was recorded in 93.9% of all patients, with no device-related adverse events. Improvement in initial New York Heart Association functional class III/IV occurred in 74% of PR and 93% of HR patients. Six-minute walk test increased by 81 ± 43.6 metres (P < 0.001) and 85.8 ± 47.9 metres (P < 0.001), respectively. Renal function tests improved by 15% (P = 0.048) and 7% (P = 0.050), while liver enzymes decreased by 18% (P = 0.020) and 28% (P = 0.052). Right ventricular systolic function increased in both subgroups by at least 24% (P < 0.001). Six-month mortality was 12.1%, with 6 hospitalisations for acute heart failure. TR reduction significantly affected quality of life, functional capacity, cardiac remodelling, and multiorgan involvement similarly in PR and HR patients. TTVR is feasible in very sick symptomatic patients, regardless of predicted risk. La réparation percutanée d’une grave insuffisance tricuspide (IT) semble devenir une option viable, mais la sélection des patients candidats à cette intervention reste difficile et est déterminée par la présence de troubles concomitants. Dans cette étude, les résultats à moyen terme de la réparation percutanée de la valve tricuspide (RPVT) ont été évalués chez des patients inopérables et très malades. Nous proposons également une exploration du concept de futilité thérapeutique en fonction des risques. Les patients ayant subi une RPVT dans notre centre ont été répartis de façon prospective dans deux sous-groupes, soit à risque prohibitif (RP) ou à risque élevé (RE), selon le score de la Society of Thoracic Surgeons (STS), les indices d