Objectives

The goal of this study was to evaluate the effect of transcatheter edge-to-edge tricuspid valve repair (TTVR) for severe tricuspid regurgitation (TR) on hospitalization for heart failure (HHF) and HF-related endpoints.

Background

Patients with severe TR need effective therapies beyond conservative treatment. The impact of TTVR on HHF and HF-related endpoints is unknown.

Methods

Isolated TTVR was performed in 119 patients. Assessments were conducted of New York Heart Association functional class, 6-min walk distance, Minnesota Living with Heart Failure Questionnaire scores, N-terminal pro–B-type natriuretic peptide level, and medication. HHFs were analyzed in the preceding 12 months before and until the longest available follow-up after TTVR. Results were compared with those of 114 patients who underwent combined mitral and tricuspid valve repair.

Results

Procedural success with a reduction to moderate or less TR and no in-hospital death was achieved in 82% of patients. With a median follow-up of 360 days (interquartile range: 187 to 408 days), a durable TR reduction to moderate or less was achieved in 72% of patients (p < 0.001). TTVR reduced the annual rate of HHF by 22% (1.21 to 0.95 HHF/patient-year; p = 0.02), with concomitant clinical improvement in New York Heart Association functional class (patients in class II or lower: 9% to 67%; p < 0.001), 6-min walk distance (+39 m; p = 0.001), and Minnesota Living with Heart Failure Questionnaire score (−6 points; p = 0.02). N-terminal pro–B-type natriuretic peptide level decreased numerically by 783 pg/ml. Diuretic dose before TTVR was increased, but HF medication did not change after TTVR. Procedural success was associated with improved 1-year survival (79% vs. 60%; p = 0.04) and event-free-survival (death + first HHF: 67% vs. 40%; p = 0.001). Transcatheter mitral and tricuspid valve repair–treated patients had comparable outcomes.

Conclusions

TTVR for severe TR is associated with a reduction of HHF and improved clinical outcomes.

中文翻译：

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经导管边缘到边缘的三尖瓣修复可解决严重的三尖瓣关闭不全，减少因心力衰竭而住院。

目标

这项研究的目的是评估经导管的边缘对边缘三尖瓣修复（TTVR）对严重三尖瓣关闭不全（TR）的影响，以治疗心衰（HHF）和HF相关终点。

背景

患有严重TR的患者除了保守治疗外还需要有效的治疗方法。TTVR对HHF和HF相关终点的影响尚不清楚。

方法

119例患者进行了孤立的TTVR。对纽约心脏协会功能性课程，步行6分钟的步行路程，明尼苏达州心衰患者问卷调查得分，N端前B型利尿钠肽水平和药物进行了评估。在TTVR之前和之前的12个月内，对HHF进行了分析，直到进行最长的随访。将结果与114例二尖瓣和三尖瓣联合修补术的患者进行比较。

结果

在82％的患者中，将TR降低至中度或更低或无院内死亡的方法获得了成功。中位随访360天（四分位间距：187至408天），在72％的患者中将TR持久降低至中度或更低（p <0.001）。TTVR将HHF的年率降低了22％（每患者年1.21至0.95 HHF； p = 0.02），同时伴随着纽约心脏协会功能级别的临床改善（II级或更低级别的患者：9％至67％； p <0.001），6分钟步行距离（+39 m； p = 0.001）和明尼苏达州心衰患者问卷调查得分（-6分； p = 0.02）。N端前B型利尿钠肽水平从数值上降低783 pg / ml。TTVR前利尿剂剂量增加，但TTVR后HF药物未改变。手术成功与改善的1年生存率（79％比60％； p = 0.04）和无事件生存率（死亡+首次HHF：67％vs. 40％； p = 0.001）相关。经导管二尖瓣和三尖瓣修复治疗的患者预后相似。

结论

TTVR用于严重TR与减少HHF和改善临床结局有关。