Transcatheter Tricuspid Valve Intervention in Right Ventricular Dysfunction and Pulmonary Hypertension

HomeCirculation: Cardiovascular InterventionsVol. 14, No. 2Transcatheter Tricuspid Valve Intervention in Right Ventricular Dysfunction and Pulmonary Hypertension Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree ArticlePDF/EPUBTranscatheter HypertensionWrongly Forgotten or Appropriately Ignored? Carey Kimmelstiel, MD Charles D. Resor, MD, MSc KimmelstielCarey Kimmelstiel Correspondence to: Tufts Medical Center the University School of Medicine, Boston, MA. Email E-mail Address: [email protected] https://orcid.org/0000-0002-1902-1739 Cardiac Catheterization Laboratory Division Cardiology, Search for more papers by this author ResorCharles Resor Originally published5 Feb 2021https://doi.org/10.1161/CIRCINTERVENTIONS.121.010482Circulation: Interventions. 2021;14:e010482is related toTranscatheter Patients With HypertensionOther version(s) articleYou are viewing most recent version article. Previous versions: February 5, 2021: Ahead Print Catheter-based treatment valvular heart disease plays a prominent role professional lives virtually all regular readers journal. Therapy left sided lesions has revolutionized therapy patients with aortic stenosis mitral regurgitation. regurgitation (TR) is ubiquitous. More than one-half undergoing surgery undergo concomitant tricuspid valve (TV) surgery.1 When untreated, TV portends poorer prognosis.2 Percutaneous TR its infancy. treatments common abnormality hampered many factors—the difficult image, anatomy valve, its, components subvalvular apparatus, displays significant interpatient variability. Further complicating attempts at transcatheter intervention (TTVI) other factors, including greater risk device entanglement dense, chordal network tearing thinner leaflets edge-to-edge repair, compromise right coronary artery annuloplasty devices, host factors that not necessarily considerations repair. Importantly, clinically recognized cases will involve an inherent structural itself, rather, be functional—often consequence ventricular enlargement annular dilation due pressure/volume overload from etiology distant TV.See Article Muntané-Carol et alIn current issue Circulation: Interventions, al3 report outcomes cohort dysfunction (RVD) pulmonary hypertension (PH) The Trivalve Registry—an international registry TTVI high-risk patients, conducted over 9 years using 8 separate devices. In absence completed randomized clinical trials (RCT), prior publications Registry have formed bulk field’s experience TTVI, addition Triluminate single-arm study4 several smaller cohorts. A 2019 publication propensity-matched, case-control study, comparing medical therapy,5 demonstrated was associated lower 1-year mortality (23% versus 36%; P=0.001) hospitalization 46%; P<0.001) compared alone. Propensity matching notwithstanding, confounding selection bias such study mandate cautious interpretation results. Among remaining studies been analyses midterm results entire cohort6 (73%, procedural success; 3%, 30-day mortality; 54%, New York Heart Association [NYHA] class I–II follow-up) repair (77%, 20%, 68%, NYHA follow-up).7Allowing differences patient populations, outcome definitions, follow-up, generally consistent cohorts demonstrating high rates success, reduction, functional improvement low in-hospital mortality. However, lack control groups makes it challenging put described into context informs care.In on 300 RVD PH total 507 Registry. had severe symptomatic were referred following team assessment documenting elevated surgical risk. three-quarters treated commercially available Mitraclip device. Procedural success defined as successful implantation echocardiographically determined residual ≤2/4. In-hospital 18% dying median follow-up 6 months, although, incomplete may underestimate actual eventuated when baseline status almost two-thirds reporting I II symptoms only 7% baseline. This likely population having transthoracic echocardiographic <2/4 just 2% Not surprisingly, estimated systolic pressure changed last performing multivariable analyses, interaction between illness severity evident highest mortality, 58% 1 year, seen renal failure. From presented data, examining dysfunction, hepatic congestion, unsuccessful presence 2 these predicts excess 50% year.As analysis already captured previous publications, what does add? Against backdrop guidelines discouraging isolated setting PH8 RCTs exclude highlights prevalence disorders can achieved subset—important data few alternative therapies. nascent field catheter-based TR, descriptive are, potentially, considerable benefit care decisions arena. Further, suggests optimistic outlook group previously considered whom therapeutic address primary physiological abnormality. Nonetheless, interpret. While easily allow controlled least comparison RVD/PH subset overall could help context.More importantly though, place spectrum established RCTs, which remain way assess efficacy where bias, regression mean, hamper nonrandomized studies. Several underway aiming document committed devices varying mechanisms action, primarily those addressing via circumferential compression. addition, dedicated replacement various stages development hold promise TTVI. Should demonstrate efficacy, attention then focused defining populations benefit. article salutary PH; however, liver approach futility sickest patients. Similar Généraux staging scheme stenosis,9 proximal upstream pathology portend worse perhaps indicate need earlier TR.After forgotten ignored interventions finally receiving deserved study. safety feasibility facilitated broader allowed. now looking whether effectively intervene whose too advanced surgery, soon look ought before currently problematic features ameliorated intervention. But first, fundamental question remains: merely innocent downstream effect important target causal pathway failure we know regurgitation? Observational one feasible relatively safe across populations. Only apply guideline-directed both groups, tell us if truly beneficial so, populations.Disclosures None.FootnotesThe opinions expressed editors American Association.For Disclosures, see page 194.Correspondence protected]orgReferences1. Alqahtani F, Berzingi CO, Aljohani S, Mohamad Hijazi M, Al-Hallak A, Alkhouli M. Contemporary trends use J Am Assoc. 2017; 6:e007597. doi: 10.1161/JAHA.117.007597LinkGoogle Scholar2. Rodés-Cabau J, Hahn RT, Latib Laule Lauten Maisano Schofer Campelo-Parada Puri R, Vahanian A. Transcatheter therapies treating Coll Cardiol. 2016; 67:1829–1845. 10.1016/j.jacc.2016.01.063CrossrefMedlineGoogle Scholar3. G, Taramasso Miura Gavazzoni Pozzoli Alessandrini H, Attinger-Toller Biasco L, Braun D, al.. hypertension: insights TriValve registry. Circ Cardiovasc Interv. 2021; 14:184–192. 10.1161/CIRCINTERVENTIONS.120.009685LinkGoogle Scholar4. Nickenig Weber Lurz P, von Bardeleben RS, Sitges Sorajja Hausleiter Denti Trochu JN, Näbauer reduction regurgitation: 6-month TRILUMINATE Lancet. 2019; 394:2002–2011. 10.1016/S0140-6736(19)32600-5CrossrefMedlineGoogle Scholar5. Benfari van der Bijl Brochet E, Connelly KA, 74:2998–3008. 10.1016/j.jacc.2019.09.028CrossrefMedlineGoogle Scholar6. Asami Outcomes after intervention: mid-term trivalve JACC 12:155–165. 10.1016/j.jcin.2018.10.022CrossrefMedlineGoogle Scholar7. Mehr Besler C, Ruf T, Yzeiraj Schiavi Mangieri Vaskelyte 12:1451–1461. 10.1016/j.jcin.2019.04.019CrossrefMedlineGoogle Scholar8. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton O’Gara PT, Ruiz CE, Skubas NJ, al.; ACC/AHA Task Force Members. 2014 AHA/ACC guideline management disease: executive summary: College Cardiology/American practice guidelines. Circulation. 2014; 129:2440–2492. 10.1161/CIR.0000000000000029LinkGoogle Scholar9. Généreux Pibarot Redfors B, Mack MJ, Makkar RR, Jaber WA, Svensson LG, Kapadia Tuzcu EM, Thourani VH, Staging classification based extent cardiac damage. Eur J. 38:3351–3358. 10.1093/eurheartj/ehx381CrossrefMedlineGoogle Scholar Back top Next FiguresReferencesRelatedDetailsRelated articlesTranscatheter HypertensionGuillem Muntané-Carol, al. 2021;14 2021Vol Issue 2Article InformationMetrics © 2021 Association, Inc.https://doi.org/10.1161/CIRCINTERVENTIONS.121.010482PMID: 33541103 publishedFebruary Keywordsmitral valvehypertension, pulmonarytricuspid insufficiencyprognosisEditorialsPDF download Advertisement