Transcatheter Tricuspid Valve Intervention in Patients With Previous Left Valve Surgery.

Muntané-Carol, Guillem; Taramasso, Maurizio; Miura, Mizuki; Gavazzoni, Mara; Pozzoli, Alberto; Alessandrini, Hannes; Latib, Azeem; Attinger-Toller, Adrian; Biasco, Luigi; Braun, Daniel; Brochet, Eric; Connelly, Kim A; Sievert, Horst; Denti, Paolo; Lubos, Edith; Ludwig, Sebastian; Kalbacher, Daniel; Estevez-Loureiro, Rodrigo; Fam, Neil; Frerker, Christian; ... (2021). Transcatheter Tricuspid Valve Intervention in Patients With Previous Left Valve Surgery. The Canadian journal of cardiology, 37(7), pp. 1094-1102. Elsevier 10.1016/j.cjca.2021.02.010

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BACKGROUND

Scarce data exist on patients with previous left valve surgery (PLVS) undergoing transcatheter tricuspid valve intervention (TTVI). This study sought to investigate the procedural and early outcomes in patients with PLVS undergoing TTVI.

METHODS

This was a subanalysis of the multicenter TriValve registry including 462 patients, 82 (18%) with PLVS. Data were analyzed according to the presence of PLVS in the overall cohort and in a propensity score-matched population including 51 and 115 patients with and without PLVS, respectively.

RESULTS

Patients with PLVS were younger (72 ± 10 vs 78 ± 9 years; p < 0.01) and more frequently female (67.1% vs 53.2%; P = 0.02). Similar rates of procedural success (PLVS 80.5%; no-PLVS 82.1%; P = 0.73), and 30-day mortality (PLVS 2.4%, no-PLVS 3.4%; P = 0.99) were observed. After matching, there were no significant differences in both all-cause rehospitalisation (PLVS 21.1%, no-PLVS 26.5%; P = 0.60) and all-cause mortality (PLVS 9.8%, no-PLVS 6.7%; P = 0.58). At last follow-up (median 6 [interquartile range 1-12] months after the procedure), most patients (81.8%) in the PLVS group were in NYHA functional class I-II (P = 0.12 vs no-PLVS group), and TR grade was ≤ 2 in 82.6% of patients (P = 0.096 vs no-PVLS group). A poorer right ventricular function and previous heart failure hospitalization determined increased risks of procedural failure and poorer outcomes at follow-up, respectively.

CONCLUSIONS

In patients with PLVS, TTVI was associated with high rates of procedural success and low early mortality. However, about one-third of patients required rehospitalisation or died at midterm follow-up. These results would support TTVI as a reasonable alternative to redo surgery in patients with PLVS and suggest the importance of earlier treatment to improve clinical outcomes.

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