Causes and Clinical Outcomes of Patients Who Failed Screening for Transcatheter Tricuspid Valve Interventions

• Published in: The American journal of cardiology 2024-06, Vol.220, p.67-76
• Main Authors: Moubarak, Ghadi, Kluis, Austin, Eisenga, John, McCullough, Kyle, Ladner, Jonathan, Salih, Mohammed, Banwait, Jasjit, DiMaio, J. Michael, Mack, Michael J., George, Timothy, Szerlip, Molly I.
• Format: Article
• Language: English
• Subjects: Clinical outcomes; Clinical trials; Congestive heart failure; Electronic health records; Heart failure; Hospitalization; Intervention; Medical records; Patients; Regurgitation; Rheumatic heart disease; screen fail; Statistical analysis; Subgroups; Surgery; Survival analysis; Therapy; transcatheter tricuspid valve replacement; tricuspid regurgitation; tricuspid transcatheter edge-to-edge repair; Tricuspid valve
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2024.03.030

•The main reason for exclusion from transcatheter tricuspid valve intervention trials was anatomic/procedural impediment.•The clinical outcomes of patients who did not undergo an intervention were poor.•Poor outcomes were found in patients excluded for anatomic impediment.•These findings underline the need for earlier referral to transcatheter tricuspid valve intervention.•We argue for further transcatheter therapy iterations to overcome these challenges. Transcatheter tricuspid valve intervention (TTVI) has recently emerged as a promising alternative to surgery for tricuspid regurgitation (TR). However, a significant proportion of patients fail screening for TTVI, and little is known about their characteristics and natural history. This study sought to investigate causes of screen failure and outcomes of patients declined for TTVI. This was a retrospective single-center study of 32 patients who were ineligible for participation in transcatheter tricuspid valve replacement and tricuspid transcatheter edge-to-edge repair trials. Patients were classified into 2 groups according to the therapy they received: optimized medical therapy (OMT) group or intervention group. The mean age was 82 ± 7.8 years and 68.8% were women. The most common reasons for TTVI exclusion were anatomic/procedural impediment (53.1%), inclusion criteria not met (40.6%), and multivalvular disease (6.3%). Overall, 19 patients (59.4%) did not undergo subsequent tricuspid intervention. The clinical outcomes of these patients who received OMT alone were poor, with a 1-year composite of cardiac death or heart failure readmission of 47.4%. These rates were worse than in patients who subsequently underwent an intervention, albeit not statistically significant (OMT: 47.7% vs 23.1% interventions, p = 0.3), and were significantly more pronounced in the subgroup of patients who were excluded for anatomic/procedural limitations (OMT: 70% vs 14.3% interventions, p = 0.05). In conclusion, patients ineligible for TTVI, particularly, those with anatomic/procedural limitations, and treated medically have poor outcomes. These data underscore the importance of earlier referral and support the need for further transcatheter therapy iterations.