Transcatheter Versus Medical Treatment of Patients With Symptomatic Severe Tricuspid Regurgitation
Maurizio Taramasso, Giovanni Benfari, Pieter van der Bijl, Hannes Alessandrini, Adrian Attinger-Toller, Luigi Biasco, Philipp Lurz, Daniel Braun, Eric Brochet, Kim A Connelly, Sabine de Bruijn, Paolo Denti, Florian Deuschl, Rodrigo Estevez-Loureiro, Neil Fam, Christian Frerker, Mara Gavazzoni, Jörg Hausleiter, Edwin Ho, Jean-Michel Juliard, Ryan Kaple, Christian Besler, Susheel Kodali, Felix Kreidel, Karl-Heinz Kuck, Azeem Latib, Alexander Lauten, Vanessa Monivas, Michael Mehr, Guillem Muntané-Carol, Tamin Nazif, Georg Nickening, Giovanni Pedrazzini, François Philippon, Alberto Pozzoli, Fabien Praz, Rishi Puri, Josep Rodés-Cabau, Ulrich Schäfer, Joachim Schofer, Horst Sievert, Gilbert H L Tang, Holger Thiele, Yan Topilsky, Karl-Philipp Rommel, Victoria Delgado, Alec Vahanian, Ralph Stephan Von Bardeleben, John G Webb, Marcel Weber, Stephan Windecker, Mirjam Winkel, Michel Zuber, Martin B Leon, Rebecca T Hahn, Jeroen J Bax, Maurice Enriquez-Sarano, Francesco Maisano, Maurizio Taramasso, Giovanni Benfari, Pieter van der Bijl, Hannes Alessandrini, Adrian Attinger-Toller, Luigi Biasco, Philipp Lurz, Daniel Braun, Eric Brochet, Kim A Connelly, Sabine de Bruijn, Paolo Denti, Florian Deuschl, Rodrigo Estevez-Loureiro, Neil Fam, Christian Frerker, Mara Gavazzoni, Jörg Hausleiter, Edwin Ho, Jean-Michel Juliard, Ryan Kaple, Christian Besler, Susheel Kodali, Felix Kreidel, Karl-Heinz Kuck, Azeem Latib, Alexander Lauten, Vanessa Monivas, Michael Mehr, Guillem Muntané-Carol, Tamin Nazif, Georg Nickening, Giovanni Pedrazzini, François Philippon, Alberto Pozzoli, Fabien Praz, Rishi Puri, Josep Rodés-Cabau, Ulrich Schäfer, Joachim Schofer, Horst Sievert, Gilbert H L Tang, Holger Thiele, Yan Topilsky, Karl-Philipp Rommel, Victoria Delgado, Alec Vahanian, Ralph Stephan Von Bardeleben, John G Webb, Marcel Weber, Stephan Windecker, Mirjam Winkel, Michel Zuber, Martin B Leon, Rebecca T Hahn, Jeroen J Bax, Maurice Enriquez-Sarano, Francesco Maisano
Abstract
Background: Tricuspid regurgitation is associated with increased rates of heart failure (HF) and mortality. Transcatheter tricuspid valve interventions (TTVI) are promising, but the clinical benefit is unknown.
Objectives: The purpose of this study was to investigate the potential benefit of TTVI over medical therapy in a propensity score matched population.
Methods: The TriValve (Transcatheter Tricuspid Valve Therapies) registry collected 472 patients from 22 European and North American centers who underwent TTVI from 2016 to 2018. A control cohort formed by 2 large retrospective registries enrolling medically managed patients with ≥ moderate tricuspid regurgitation in Europe and North America (n = 1,179) were propensity score 1:1 matched (distance ± 0.2 SD) using age, EuroSCORE II, and systolic pulmonary artery pressure. Survival was tested with Cox regression analysis. Primary endpoint was 1-year mortality or HF rehospitalization or the composite.
Results: After matching, 268 adequately matched pairs of patients were identified. Compared with control subjects, TTVI patients had lower 1-year mortality (23 ± 3% vs. 36 ± 3%; p = 0.001), rehospitalization (26 ± 3% vs. 47 ± 3%; p < 0.0001), and composite endpoint (32 ± 4% vs. 49 ± 3%; p = 0.0003). TTVI was associated with greater survival and freedom from HF rehospitalization (hazard ratio [HR]: 0.60; 95% confidence interval [CI]: 0.46 to 0.79; p = 0.003 unadjusted), which remained significant after adjusting for sex, New York Heart Association functional class, right ventricular dysfunction, and atrial fibrillation (HR: 0.39; 95% CI: 0.26 to 0.59; p < 0.0001) and after further adjustment for mitral regurgitation and pacemaker/defibrillator (HR: 0.35; 95% CI: 0.23 to 0.54; p < 0.0001).
Conclusions: In this propensity-matched case-control study, TTVI is associated with greater survival and reduced HF rehospitalization compared with medical therapy alone. Randomized trials should be performed to confirm these results.
Keywords: heart valve diseases; tricuspid regurgitation; tricuspid valve.
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed