Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Circ Cardiovasc Interv. 2021 Dec;14(12):e010557. doi: 10.1161/CIRCINTERVENTIONS.121.010557. Epub 2021 Nov 24.
Investigational transcatheter edge-to-edge repair (TEER) for severe tricuspid regurgitation (TR) has shown promise as an alternative to surgery, but factors influencing outcomes, optimal patient selection, and procedural timing remain incompletely defined. Given the limitations of determining TR severity by conventional echocardiography, our objectives were to determine whether invasive right atrial (RA) pressures performed during the procedure are related to patient outcomes.
This study was a retrospective review of patients who underwent off-label tricuspid TEER using MitraClip (Abbott Vascular, Menlo Park, CA) for significant TR at a single institution. Intraprocedural mean RA pressure, RA peak V-wave, RA pressure nadir, and systolic increase in RA pressure (XV height) were recorded.
Thirty-eight patients underwent tricuspid TEER; 33 underwent concomitant mitral TEER for mitral regurgitation. The study cohort was 39% female with a mean age of 78.6±14.3 years. Median follow-up was 339 days (interquartile range, 100-601). Any reduction in mean RA pressure, RA peak V-wave, RA nadir, and XV height occurred in 74%, 82%, 45%, and 87% of patients, respectively. At 1 year, event-free survival was 47%. Postprocedure XV height correlated with TR severity as determined by echocardiography (<0.0001). The highest quartile of postprocedure XV height (>8 mm Hg) had worse event-free survival compared with those who had concluding XV height ≤8 mm Hg (=0.02). Attainment of a concluding XV height less than or equal to median value was associated with a lower creatinine the next day (1.27±0.47 versus 1.64±0.47 mg/dL, =0.04).
Intraprocedural XV height correlates with TR severity after tricuspid TEER, and lower concluding pressures are associated with improved outcomes. Analysis of RA pressures may serve as a complementary tool for the evaluation of disease severity and procedural guidance.
经导管缘对缘修复术（TEER）治疗严重三尖瓣反流（TR）的研究结果显示，其作为一种替代手术的方法具有良好的前景，但影响手术效果的因素、最佳患者选择和手术时机仍未完全明确。鉴于传统超声心动图确定 TR 严重程度的局限性，我们的目的是确定术中测量的右心房（RA）压力与患者预后之间的关系。
本研究为回顾性分析，研究对象为在一家单中心医院接受 MitraClip（雅培血管，门洛帕克，CA）进行的三尖瓣 TEER 治疗的重度 TR 患者。术中记录平均 RA 压力、RA 峰值 V 波、RA 压力最低点和 RA 压力收缩期升高（XV 高度）。
38 例患者接受了三尖瓣 TEER 治疗；33 例患者同时接受了二尖瓣 TEER 治疗二尖瓣反流。研究队列中 39%为女性，平均年龄为 78.6±14.3 岁。中位随访时间为 339 天（四分位距 100-601）。平均 RA 压力、RA 峰值 V 波、RA 压力最低点和 XV 高度分别有 74%、82%、45%和 87%的患者降低。术后 1 年无事件生存率为 47%。术后 XV 高度与超声心动图确定的 TR 严重程度相关（<0.0001）。术后 XV 高度最高四分位数（>8mm Hg）的无事件生存率比 XV 高度较低的患者（=0.02）差。术后 XV 高度≤中位数的患者次日肌酐水平较低（1.27±0.47 与 1.64±0.47mg/dL，=0.04）。
术中 XV 高度与三尖瓣 TEER 后 TR 严重程度相关，较低的终末压力与较好的预后相关。RA 压力分析可能成为评估疾病严重程度和指导手术的辅助工具。
