Outcomes of TTVI in Patients With Pacemaker or Defibrillator Leads: Data From the TriValve Registry.

Taramasso, Maurizio; Gavazzoni, Mara; Pozzoli, Alberto; Alessandrini, Hannes; Latib, Azeem; Attinger-Toller, Adrian; Biasco, Luigi; Braun, Daniel; Brochet, Eric; Connelly, Kim A; de Bruijn, Sabine; Denti, Paolo; Deuschl, Florian; Estevez-Louriero, Rodrigo; Fam, Neil; Frerker, Christian; Ho, Edwin; Juliard, Jean-Michel; Kaple, Ryan; Kodali, Susheel; ... (2020). Outcomes of TTVI in Patients With Pacemaker or Defibrillator Leads: Data From the TriValve Registry. JACC. Cardiovascular Interventions, 13(5), pp. 554-564. Elsevier 10.1016/j.jcin.2019.10.058

[img] Text
Outcomes of TTVI in patients with Pacemaker or Defibrillator leads.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (1MB) | Request a copy

OBJECTIVES

The interference of a transtricuspid cardiac implantable electronic device (CIED) lead with tricuspid valve function may contribute to the mechanism of tricuspid regurgitation (TR) and poses specific therapeutic challenges during transcatheter tricuspid valve intervention (TTVI). Feasibility and efficacy of TTVI in presence of a CIED is unclear.

BACKGROUND

Feasibility of TTVI in presence of a CIED lead has never been proven on a large basis.

METHODS

The study population consisted of 470 patients with severe symptomatic TR from the TriValve (Transcatheter Tricuspid Valve Therapies) registry who underwent TTVI at 21 centers between 2015 and 2018. The association of CIED and outcomes were assessed.

RESULTS

Pre-procedural CIED was present in 121 of 470 (25.7%) patients. The most frequent location of the CIED lead was the posteroseptal commissure (44.0%). As compared with patients without a transvalvular lead (no-CIED group), patients having a tricuspid lead (CIED group) were more symptomatic (New York Heart Association functional class III to IV in 95.9% vs. 92.3%; p = 0.02) and more frequently had previous episodes of right heart failure (87.8% vs. 69.0%; p = 0.002). No-CIED patients had more severe TR (effective regurgitant orifice area 0.7 ± 0.6 cm2 vs. 0.6 ± 0.3 cm2; p = 0.02), but significantly better right ventricular function (tricuspid annular plane systolic excursion = 16.7 ± 5.0 mm vs. 15.9 ± 4.0 mm; p = 0.04). Overall, 373 patients (79%) were treated with the MitraClip (Abbott Vascular, Santa Clara, California) (106 [87.0%] in the CIED group). Among them, 154 (33%) patients had concomitant transcatheter mitral repair (55 [46.0%] in the CIED group, all MitraClip). Procedural success was achieved in 80.0% of no-CIED patients and in 78.6% of CIED patients (p = 0.74), with an in-hospital mortality of 2.9% and 3.7%, respectively (p = 0.70). At 30 days, residual TR ≤2+ was observed in 70.8% of no-CIED and in 73.7% of CIED patients (p = 0.6). Symptomatic improvement was observed in both groups (NYHA functional class I to II at 30 days: 66.0% vs. 65.0%; p = 0.30). Survival at 12 months was 80.7 ± 3.0% in the no-CIED patients and 73.6 ± 5.0% in the CIED patients (p = 0.30).

CONCLUSIONS

TTVI is feasible in selected patients with CIED leads and acute procedural success and short-term clinical outcomes are comparable to those observed in patients without a transtricuspid lead.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Praz, Fabien; Windecker, Stephan and Winkel, Mirjam Gauri

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1876-7605

Publisher:

Elsevier

Language:

English

Submitter:

Nadia Biscozzo

Date Deposited:

05 Nov 2020 14:30

Last Modified:

05 Nov 2020 14:30

Publisher DOI:

10.1016/j.jcin.2019.10.058

PubMed ID:

31954676

Uncontrolled Keywords:

transcatheter tricuspid intervention tricuspid regurgitation tricuspid valve

BORIS DOI:

10.7892/boris.147267

URI:

https://boris.unibe.ch/id/eprint/147267

Actions (login required)

Edit item Edit item
Provide Feedback