Transcatheter Versus Medical Treatment of Patients With Symptomatic Severe Tricuspid Regurgitation

Maurizio Taramasso, Giovanni Benfari, Pieter van der Bijl, Hannes Alessandrini, Adrian Attinger-Toller, Luigi Biasco, Philipp Lurz, Daniel Braun, Eric Brochet, Kim A. Connelly, Sabine de Bruijn, Paolo Denti, Florian Deuschl, Rodrigo Estevez-Loureiro, Neil Fam, Christian Frerker, Mara Gavazzoni, Jörg Hausleiter, Edwin Ho, Jean Michel JuliardRyan Kaple, Christian Besler, Susheel Kodali, Felix Kreidel, Karl Heinz Kuck, Azeem Latib, Alexander Lauten, Vanessa Monivas, Michael Mehr, Guillem Muntané-Carol, Tamin Nazif, Georg Nickening, Giovanni Pedrazzini, François Philippon, Alberto Pozzoli, Fabien Praz, Rishi Puri, Josep Rodés-Cabau, Ulrich Schäfer, Joachim Schofer, Horst Sievert, Gilbert H.L. Tang, Holger Thiele, Yan Topilsky, Karl Philipp Rommel, Victoria Delgado, Alec Vahanian, Ralph Stephan Von Bardeleben, John G. Webb, Marcel Weber, Stephan Windecker, Mirjam Winkel, Michel Zuber, Martin B. Leon, Rebecca T. Hahn, Jeroen J. Bax, Maurice Enriquez-Sarano, Francesco Maisano

Research output: Contribution to journalArticle

23 Scopus citations

Abstract

Background: Tricuspid regurgitation is associated with increased rates of heart failure (HF) and mortality. Transcatheter tricuspid valve interventions (TTVI) are promising, but the clinical benefit is unknown. Objectives: The purpose of this study was to investigate the potential benefit of TTVI over medical therapy in a propensity score matched population. Methods: The TriValve (Transcatheter Tricuspid Valve Therapies) registry collected 472 patients from 22 European and North American centers who underwent TTVI from 2016 to 2018. A control cohort formed by 2 large retrospective registries enrolling medically managed patients with ≥ moderate tricuspid regurgitation in Europe and North America (n = 1,179) were propensity score 1:1 matched (distance ± 0.2 SD) using age, EuroSCORE II, and systolic pulmonary artery pressure. Survival was tested with Cox regression analysis. Primary endpoint was 1-year mortality or HF rehospitalization or the composite. Results: After matching, 268 adequately matched pairs of patients were identified. Compared with control subjects, TTVI patients had lower 1-year mortality (23 ± 3% vs. 36 ± 3%; p = 0.001), rehospitalization (26 ± 3% vs. 47 ± 3%; p < 0.0001), and composite endpoint (32 ± 4% vs. 49 ± 3%; p = 0.0003). TTVI was associated with greater survival and freedom from HF rehospitalization (hazard ratio [HR]: 0.60; 95% confidence interval [CI]: 0.46 to 0.79; p = 0.003 unadjusted), which remained significant after adjusting for sex, New York Heart Association functional class, right ventricular dysfunction, and atrial fibrillation (HR: 0.39; 95% CI: 0.26 to 0.59; p < 0.0001) and after further adjustment for mitral regurgitation and pacemaker/defibrillator (HR: 0.35; 95% CI: 0.23 to 0.54; p < 0.0001). Conclusions: In this propensity-matched case-control study, TTVI is associated with greater survival and reduced HF rehospitalization compared with medical therapy alone. Randomized trials should be performed to confirm these results.

Original languageEnglish (US)
Pages (from-to)2998-3008
Number of pages11
JournalJournal of the American College of Cardiology
Volume74
Issue number24
DOIs
StatePublished - Dec 17 2019

Keywords

  • heart valve diseases
  • tricuspid regurgitation
  • tricuspid valve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Taramasso, M., Benfari, G., van der Bijl, P., Alessandrini, H., Attinger-Toller, A., Biasco, L., Lurz, P., Braun, D., Brochet, E., Connelly, K. A., de Bruijn, S., Denti, P., Deuschl, F., Estevez-Loureiro, R., Fam, N., Frerker, C., Gavazzoni, M., Hausleiter, J., Ho, E., ... Maisano, F. (2019). Transcatheter Versus Medical Treatment of Patients With Symptomatic Severe Tricuspid Regurgitation. Journal of the American College of Cardiology, 74(24), 2998-3008. https://doi.org/10.1016/j.jacc.2019.09.028