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

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.

Bibliografische Daten

OriginalspracheEnglisch
ISSN0735-1097
DOIs
StatusVeröffentlicht - 17.12.2019

Anmerkungen des Dekanats

Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PubMed 31568868