The International Multicenter TriValve Registry Which Patients Are Undergoing Transcatheter Tricuspid Repair?

Maurizio Taramasso, Rebecca T. Hahn, Hannes Alessandrini, Azeem Latib, Adrian Attinger-Toller, Daniel Braun, Eric Brochet, Kim A. Connelly, Paolo Denti, Florian Deuschl, Andrea Englmaier, Neil Fam, Christian Frerker, Joerg Hausleiter, Jean-Michel Juliard, Ryan Kaple, Felix Kreidel, Karl Heinz Kuck, Shingo Kuwata, Marco Ancona, Margarita Malasa, Tamim Nazif, Georg Nickenig, Fabian Nietlispach, Alberto Pozzoli, Ulrich Schäfer, Joachim Schofer, Robert Schueler, Gilbert Tang, Alec Vahanian, John G. Webb, Ermela Yzeiraj, Francesco Maisano, Martin B. Leon

This study sought to develop a large, international registry to evaluate the diffusion of these approaches and investigate patient characteristics and initial clinical results. Several transcatheter tricuspid valve therapies are emerging as therapeutic options for patients with severe symptomatic tricuspid regurgitation (TR), generally a high-risk surgical population. The TriValve (Transcatheter Tricuspid Valve Therapies) registry included 106 high-risk patients (76 ± 9 years of age; 60.4% women; European System for Cardiac Operative Risk Evaluation II 7.6 ± 5.7%) from 11 cardiac centers, with severe TR. A total of 35% of the patients had prior left heart valve intervention (surgical in 29 of 106 and transcatheter in 8 of 106 patients). Right ventricular (RV) dysfunction (tricuspid annular plane systolic excursion <17 mm) was present in 56.3% of the patients; 95% of the patients were in New York Heart Association functional class III to IV. The etiology of TR was functional in 95.2%, and the mean tricuspid annulus was 45.4 ± 11 mm. In 76.9% of the patients, the main location of the regurgitant jet was central; pre-procedural systolic pulmonary artery pressure was 39.7 ± 13.8 mm Hg; and the inferior vena cava was severely dilated in most of the patients (27.4 ± 6.8 mm). Implanted devices included MitraClip (n = 58), Trialign (n = 17), TriCinch (n = 15), FORMA (n = 7), Cardioband (n = 5), and caval valve implantation (n = 3). One case had combined Trialign + MitraClip. Patients treated with the different techniques were similar in terms of European System for Cardiac Operative Risk Evaluation II and degree of RV dysfunction. In 68% of the cases the tricuspid intervention was performed as an isolated procedure. Procedural success was achieved in 62% of cases. At 30-day follow-up, all-cause mortality was 3.7%, with an overall incidence of major adverse cardiac and cerebrovascular events of 26%; 58% of the patients were New York Heart Association functional class I or II at 30 days. Patients currently undergoing transcatheter tricuspid valve therapy are mostly high risk, with a functional etiology and very severe central regurgitation, and do not have severely impaired RV function. Initial results suggest that transcatheter tricuspid valve therapy is feasible with different techniques, but clinical efficacy requires further investigation.