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Journal of Cardiothoracic Surgery

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Open Access 01-12-2023 | Tricuspid Valve Replacement | Research

Comparison of outcomes between transcatheter tricuspid valve repair and surgical tricuspid valve replacement or repair in patients with tricuspid insufficiency

Authors: Xiqiang Wang, Yanpeng Ma, Zhongwei Liu, Xiude Fan, Gongchang Guan, Shuo Pan, Junkui Wang, Yong Zhang

Published in: Journal of Cardiothoracic Surgery | Issue 1/2023

Abstract

Background

Tricuspid regurgitation is associated with significant morbidity and mortality, but with limited treatment options. The objective of this study is to compare the demographic characteristics, complications, and outcomes of transcatheter tricuspid valve repair (TTVr) versus surgical tricuspid valve replacement (STVR) or surgical tricuspid valve repair (STVr), using real-world data from the National Inpatient Sample (NIS) database.

Methods and results

Our study analyzed data from the National Inpatient Sample (NIS) database from 2016 to 2018 and identified 92, 86, and 84 patients with tricuspid insufficiency who underwent STVr, STVR, and TTVr, respectively. The mean ages of patients who received STVr, STVR, and TTVr were 65.03 years, 66.3 years, and 71.09 years, respectively, with TTVr patients significantly older than those who received STVr (P < 0.05). Patients who received STVr or STVR had higher mortality rates (8.7% and 3.5%, respectively) compared to those who received TTVr (1.2%). Patients who underwent STVr or STVR were also more likely to experience perioperative complications, including third-degree atrioventricular block (8.7% STVr vs. 1.2% TTVr, P = 0.329; 38.4% STVR vs. 1.2% TTVr, P < 0.05), respiratory failure (5.4% STVr vs. 1.2% TTVr, P = 0.369; 15.1% STVR vs. 1.2% TTVr, P < 0.05), respiratory complications (6.5% STVr vs. 1.2% TTVr, P = 0.372; 19.8% STVR vs. 1.2% TTVr, P < 0.05), acute kidney injury (40.2% STVr vs. 27.4% TTVr, P = 0.367; 34.9% STVR vs. 27.4% TTVr, P = 0.617), and fluid and electrolyte disorders (44.6% STVr vs. 22.6% TTVr, P = 0.1332; 50% STVR vs. 22.6% TTVr, P < 0.05). In addition, the average cost of care and the average length of hospital stay were higher for patients who underwent STVr or STVR than for those who received TTVr (USD$37995 ± 356008.523 STVr vs. USD$198397 ± 188943.082 TTVr, P < 0.05; USD$470948 ± 614177.568 STVR vs. USD$198397 ± 188943.082 TTVr, P < 0.05; 15.4 ± 15.19 STVr vs. 9.6 ± 10.21 days TTVr, P = 0.267; 24.7 ± 28.81 STVR vs. 9.6 ± 10.21 days TTVr, P < 0.05).

Conclusion

TTVr has shown to have favorable outcomes compared to STVr or STVR, but more research and clinical trials are required to help formulate evidence-based guidelines for the role of catheter-based management in tricuspid valve disease.

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Vahanian A, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2022;43:561–632. https://doi.org/10.1093/eurheartj/ehab395.CrossRefPubMed

Topilsky Y, et al. Burden of Tricuspid Regurgitation in Patients diagnosed in the community setting. JACC Cardiovasc Imaging. 2019;12:433–42. https://doi.org/10.1016/j.jcmg.2018.06.014.CrossRefPubMed

Nickenig G, et al. Transcatheter edge-to-edge repair for reduction of tricuspid regurgitation: 6-month outcomes of the TRILUMINATE single-arm study. Lancet. 2019;394:2002–11. https://doi.org/10.1016/s0140-6736(19)32600-5.CrossRefPubMed

Schueler R, et al. Impact of baseline tricuspid regurgitation on long-term clinical outcomes and survival after interventional edge-to-edge repair for mitral regurgitation. Clin Res Cardiol. 2017;106:350–8. https://doi.org/10.1007/s00392-016-1062-1.CrossRefPubMed

Topilsky Y, et al. Clinical presentation and outcome of tricuspid regurgitation in patients with systolic dysfunction. Eur Heart J. 2018;39:3584–92. https://doi.org/10.1093/eurheartj/ehy434.CrossRefPubMed

Kodali S, et al. Feasibility study of the transcatheter valve repair system for severe tricuspid regurgitation. J Am Coll Cardiol. 2021;77:345–56. https://doi.org/10.1016/j.jacc.2020.11.047.CrossRefPubMed

Wong WK, et al. Late outcomes of Valve Repair Versus replacement in isolated and concomitant tricuspid valve surgery: a Nationwide Cohort Study. J Am Heart Assoc. 2020;9:e015637. https://doi.org/10.1161/jaha.119.015637.CrossRefPubMedPubMedCentral

Baumgartner H, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739–91. https://doi.org/10.1093/eurheartj/ehx391.CrossRefPubMed

Beckmann A, et al. German heart surgery report 2017: the Annual updated Registry of the german society for thoracic and Cardiovascular surgery. Thorac Cardiovasc Surg. 2018;66:608–21. https://doi.org/10.1055/s-0038-1676131.CrossRefPubMed

10.

Kilic A, Saha-Chaudhuri P, Rankin JS, Conte JV. Trends and outcomes of tricuspid valve surgery in North America: an analysis of more than 50,000 patients from the Society of thoracic Surgeons database. Ann Thorac Surg. 2013;96:1546–52. https://doi.org/10.1016/j.athoracsur.2013.06.031. discussion 1552.CrossRefPubMed

11.

Fender EA, Zack CJ, Nishimura RA. Isolated tricuspid regurgitation: outcomes and therapeutic interventions. Heart. 2018;104:798–806. https://doi.org/10.1136/heartjnl-2017-311586.CrossRefPubMed

12.

Chen SW, et al. Surgical risk and outcome of repair versus replacement for late tricuspid regurgitation in redo operation. Ann Thorac Surg. 2012;93:770–5. https://doi.org/10.1016/j.athoracsur.2011.11.057.CrossRefPubMed

13.

Nickenig G, et al. Transcatheter mitral annuloplasty in chronic functional mitral regurgitation: 6-Month results with the Cardioband Percutaneous Mitral Repair System. JACC Cardiovasc Interv. 2016;9:2039–47. https://doi.org/10.1016/j.jcin.2016.07.005.CrossRefPubMed

14.

Meijerink F, et al. Transcatheter tricuspid valve repair: early experience in the Netherlands. Neth Heart J. 2021;29:595–603. https://doi.org/10.1007/s12471-021-01613-3.CrossRefPubMedPubMedCentral

15.

Lurz P, et al. Transcatheter edge-to-edge repair for treatment of Tricuspid Regurgitation. J Am Coll Cardiol. 2021;77:229–39. https://doi.org/10.1016/j.jacc.2020.11.038.CrossRefPubMed

16.

Volz MJ, et al. Functional improvement following direct interventional leaflet repair of severe tricuspid regurgitation. ESC Heart Fail. 2022. https://doi.org/10.1002/ehf2.13831.CrossRefPubMedPubMedCentral

17.

Hahn RT, et al. Early Feasibility Study of a transcatheter tricuspid valve annuloplasty: SCOUT Trial 30-Day results. J Am Coll Cardiol. 2017;69:1795–806. https://doi.org/10.1016/j.jacc.2017.01.054.CrossRefPubMed

18.

Nickenig G, et al. 6-Month Outcomes of Tricuspid Valve Reconstruction for patients with severe tricuspid regurgitation. J Am Coll Cardiol. 2019;73:1905–15. https://doi.org/10.1016/j.jacc.2019.01.062.CrossRefPubMed

19.

Taramasso M, et al. Outcomes after current transcatheter tricuspid valve Intervention: mid-term results from the International TriValve Registry. JACC Cardiovasc Interv. 2019;12:155–65. https://doi.org/10.1016/j.jcin.2018.10.022.CrossRefPubMed

20.

Axtell AL, et al. Surgery does not improve survival in patients with isolated severe tricuspid regurgitation. J Am Coll Cardiol. 2019;74:715–25. https://doi.org/10.1016/j.jacc.2019.04.028.CrossRefPubMedPubMedCentral

21.

Cai S, et al. Natural history of severe tricuspid regurgitation: outcomes after transcatheter tricuspid valve intervention compared to medical therapy. Int J Cardiol. 2020;320:49–54. https://doi.org/10.1016/j.ijcard.2020.07.018.CrossRefPubMed

22.

Fam NP, et al. Compassionate use of the PASCAL Transcatheter Valve Repair System for severe tricuspid regurgitation: a Multicenter, Observational, First-in-human experience. JACC Cardiovasc Interv. 2019;12:2488–95. https://doi.org/10.1016/j.jcin.2019.09.046.CrossRefPubMed

23.

Sarris-Michopoulos P, et al. Isolated tricuspid valve surgery-repair versus replacement: a meta-analysis. J Card Surg. 2022;37:329–35. https://doi.org/10.1111/jocs.16131.CrossRefPubMed

24.

Cepas-Guillen PL, et al. Initial results after the implementation of an Edge-To-Edge transcatheter tricuspid valve repair program. J Clin Med. 2021;10. https://doi.org/10.3390/jcm10184252.

25.

LaPar DJ, et al. Development of a risk prediction model and clinical risk score for isolated tricuspid valve surgery. Ann Thorac Surg. 2018;106:129–36. https://doi.org/10.1016/j.athoracsur.2017.11.077.CrossRefPubMed

26.

Asmarats L, Puri R, Latib A, Navia JL. Rodés-Cabau, J. Transcatheter Tricuspid Valve Interventions: Landscape, Challenges, and future directions. J Am Coll Cardiol. 2018;71:2935–56. https://doi.org/10.1016/j.jacc.2018.04.031.CrossRefPubMed

27.

Taramasso M, et al. The International Multicenter TriValve Registry: which patients are undergoing transcatheter tricuspid repair? JACC Cardiovasc Interv. 2017;10:1982–90. https://doi.org/10.1016/j.jcin.2017.08.011.CrossRefPubMed

28.

Taramasso M, et al. Outcomes of TTVI in patients with pacemaker or defibrillator leads: data from the TriValve Registry. JACC Cardiovasc Interv. 2020;13:554–64. https://doi.org/10.1016/j.jcin.2019.10.058.CrossRefPubMed

29.

Orban M, et al. Transcatheter edge-to-edge tricuspid repair for severe tricuspid regurgitation reduces hospitalizations for heart failure. JACC Heart Fail. 2020;8:265–76. https://doi.org/10.1016/j.jchf.2019.12.006.CrossRefPubMed

30.

Taramasso M, et al. Transcatheter Versus Medical treatment of patients with symptomatic severe tricuspid regurgitation. J Am Coll Cardiol. 2019;74:2998–3008. https://doi.org/10.1016/j.jacc.2019.09.028.CrossRefPubMed

Title: Comparison of outcomes between transcatheter tricuspid valve repair and surgical tricuspid valve replacement or repair in patients with tricuspid insufficiency
Authors: Xiqiang Wang
Yanpeng Ma
Zhongwei Liu
Xiude Fan
Gongchang Guan
Shuo Pan
Junkui Wang
Yong Zhang
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Tricuspid Valve Replacement
Atrioventricular Block
Tricuspid Valve Replacement
Tricuspid Valve Replacement
Intra-Aortic Balloon
Published in: Journal of Cardiothoracic Surgery / Issue 1/2023
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-023-02271-9

2024 ASCO Annual Meeting

Springer Medicine

Comparison of outcomes between transcatheter tricuspid valve repair and surgical tricuspid valve replacement or repair in patients with tricuspid insufficiency

Abstract

Background

Methods and results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods and results

Conclusion

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