Cannata Francesco, Sticchi Alessandro, Russo Giulio, Stankowski Kamil, Hahn Rebecca T, Alessandrini Hannes, Andreas Martin, Braun Daniel, Connelly Kim A, Denti Paolo, Estevez-Loureiro Rodrigo, Fam Neil, Harr Claudia, Hausleiter Joerg, Himbert Dominique, Kalbacher Daniel, Adamo Marianna, Latib Azeem, Lubos Edith, Ludwig Sebastian, Lurz Philipp, Monivas Vanessa, Nickenig Georg, Pedrazzini Giovanni, Pozzoli Alberto, Praz Fabien, Rodes-Cabau Josep, Rommel Karl-Philipp, Schofer Joachim, Sievert Horst, Tang Gilbert, Thiele Holger, Kresoja Karl-Patrik, Metra Marco, Stephan von Bardeleben Ralph, Webb John, Windecker Stephan, Leon Martin, Maisano Francesco, De Marco Federico, Pontone Gianluca, Taramasso Maurizio
Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy.
Cardiac Catheterisation Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
Eur Heart J Cardiovasc Imaging. 2024 Dec 31;26(1):135-147. doi: 10.1093/ehjci/jeae227.
Transcatheter tricuspid valve interventions (TTVI) are increasingly used to treat patients with significant tricuspid regurgitation (TR). The evolution of concurrent mitral regurgitation (MR) severity after TTVI is currently unknown and may be pivotal for clinical decision-making. The aim of this study was to assess the evolution of MR after TTVI and to identify predictors of MR worsening and improvement.
This analysis is a substudy of the TriValve Registry, an international registry designed to collect data on TTVI. This substudy included all patients with echocardiographic data on MR evolution and excluded those with a concomitant tricuspid and mitral transcatheter valve intervention or with a history of mitral valve intervention. The co-primary outcomes were MR improvement and worsening at two timepoints: pre-discharge and 2-month follow-up. This analysis included 359 patients with severe TR, mostly (80%) treated with tricuspid transcatheter edge-to-edge repair (T-TEER). MR improvement was found in 106 (29.5%) and 99 (34%) patients, while MR worsening was observed in 34 (9.5%) and 33 (11%) patients at pre-discharge and 2-month follow-up, respectively. Annuloplasty and heterotopic replacement were associated with MR worsening. Independent predictors of MR improvement were: atrial fibrillation, T-TEER, acute procedural success, TR reduction, left ventricular end-diastolic diameter> 60 mm, and beta-blocker therapy. Patients with moderate-to-severe/severe MR following TTVI showed significantly higher death rates.
MR degree variation is common after TTVI, with most cases showing improvement. Clinical and procedural characteristics may predict the MR evolution, in particular procedural success and T-TEER play key roles in MR outcomes. TTVI may be beneficial, even in the presence of functional MR.
经导管三尖瓣介入治疗（TTVI）越来越多地用于治疗严重三尖瓣反流（TR）患者。目前尚不清楚TTVI后二尖瓣反流（MR）严重程度的变化情况，而这可能对临床决策至关重要。本研究的目的是评估TTVI后MR的变化情况，并确定MR恶化和改善的预测因素。
本分析是TriValve注册研究的一项子研究，该国际注册研究旨在收集TTVI的数据。这项子研究纳入了所有有MR变化超声心动图数据的患者，并排除了同时进行三尖瓣和二尖瓣经导管瓣膜介入治疗的患者或有二尖瓣介入治疗史的患者。共同主要结局是在两个时间点（出院前和2个月随访）的MR改善和恶化情况。本分析纳入了359例严重TR患者，其中大多数（80%）接受了三尖瓣经导管缘对缘修复术（T-TEER）。出院前和2个月随访时，分别有106例（29.5%）和99例（34%）患者的MR得到改善，而分别有34例（9.5%）和33例（11%）患者的MR恶化。瓣环成形术和异位置换与MR恶化相关。MR改善的独立预测因素包括：心房颤动、T-TEER、手术即刻成功、TR减轻、左心室舒张末期直径>60 mm以及β受体阻滞剂治疗。TTVI后中重度/重度MR患者的死亡率显著更高。
TTVI后MR程度变化很常见，大多数病例显示改善。临床和手术特征可能预测MR的变化，特别是手术成功和T-TEER在MR结局中起关键作用。即使存在功能性MR，TTVI可能也是有益的。
