Department of Internal Medicine II (J.V., T.T., R.K., C.O., G.N., S.Z., M.W., A.S.), Heart Center Bonn, University Hospital Bonn, Germany.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan (T.G.).
Circ Cardiovasc Interv. 2024 Jun;17(6):e013156. doi: 10.1161/CIRCINTERVENTIONS.123.013156. Epub 2024 Apr 17.
We assessed the safety profile of tricuspid transcatheter edge-to-edge repair (TEER) in patients with right ventricular (RV) dysfunction.
We identified patients undergoing TEER to treat tricuspid regurgitation from June 2015 to October 2021 and assessed tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (RVFAC). RV dysfunction was defined as TAPSE <17 mm and RVFAC <35%. The primary end point was 30-day mortality after TEER. We also investigated the change in the RV function in the early phase and clinical outcomes at 2 years.
The study participants (n=262) were at high surgical risk (EuroSCORE II, 6.2% [interquartile range, 4.0%-10.3%]). Among them, 44 patients met the criteria of RV dysfunction. Thirty-day mortality was 3.2% in patients with normal RV function and 2.3% in patients with RV dysfunction (=0.99). Tricuspid regurgitation reduction to ≤2+ was consistently achieved irrespective of RV dysfunction (76.5% versus 70.5%; =0.44). TAPSE and RVFAC declined after TEER in patients with normal RV function (TAPSE, 19.0±4.7 to 17.9±4.5 mm; =0.001; RVFAC, 46.2%±8.1% to 40.3%±9.7%; <0.001). In contrast, those parameters were unchanged or tended to increase in patients with RV dysfunction (TAPSE, 13.2±2.3 to 15.3±4.7 mm; =0.011; RVFAC, 29.6%±4.1% to 31.6%±8.3%; =0.14). Two years after TEER, compared with patients with normal RV function, patients with RV dysfunction had significantly higher mortality (27.0% versus 56.3%; <0.001).
TEER was safe and feasible to treat tricuspid regurgitation in patients with RV dysfunction. The decline in the RV function was observed in patients with normal RV function but not in patients with RV dysfunction.
我们评估了三尖瓣经导管缘对缘修复术（TEER）在右心室（RV）功能障碍患者中的安全性。
我们从 2015 年 6 月至 2021 年 10 月期间识别出接受 TEER 治疗三尖瓣反流的患者，并评估三尖瓣环平面收缩期位移（TAPSE）和右心室射血分数（RVFAC）。RV 功能障碍定义为 TAPSE<17mm 和 RVFAC<35%。主要终点是 TEER 后 30 天死亡率。我们还研究了早期 RV 功能的变化和 2 年时的临床结果。
研究参与者（n=262）有高手术风险（欧洲心脏手术风险评分 II，6.2%[四分位距，4.0%-10.3%]）。其中，44 名患者符合 RV 功能障碍标准。正常 RV 功能患者的 30 天死亡率为 3.2%，RV 功能障碍患者为 2.3%（=0.99）。无论 RV 功能障碍如何，TEER 后三尖瓣反流减少至≤2+的比例均一致（76.5%与 70.5%；=0.44）。在正常 RV 功能患者中，TEER 后 TAPSE 和 RVFAC 下降（TAPSE，19.0±4.7 至 17.9±4.5mm；<0.001；RVFAC，46.2%±8.1%至 40.3%±9.7%；<0.001）。相比之下，这些参数在 RV 功能障碍患者中没有变化或有增加趋势（TAPSE，13.2±2.3 至 15.3±4.7mm；=0.011；RVFAC，29.6%±4.1%至 31.6%±8.3%；=0.14）。TEER 后 2 年，与正常 RV 功能患者相比，RV 功能障碍患者的死亡率明显更高（27.0%与 56.3%；<0.001）。
TEER 安全且可行，可治疗 RV 功能障碍患者的三尖瓣反流。在正常 RV 功能患者中观察到 RV 功能下降，但在 RV 功能障碍患者中未观察到。
