Transcatheter Tricuspid Valve Replacement for Residual Tricuspid Regurgitation After TEER

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BACKGROUND: Residual or recurrent tricuspid regurgitation (TR) after prior transcatheter tricuspid edge-to-edge (T-TEER) repair occurs in about 12% of patients within 1 year. Since surgical tricuspid valve repair or replacement is of high risk, treatment options remain scarce. Data regarding the feasibility, safety, and treatment strategies using transcatheter valve replacement (TTVR) after T-TEER are sparse. AIMS: Here, we aimed to summarize our early experience in TTVR after failed T-TEER, analyze its feasibility and summarize the results in a distinct algorithm. METHODS: Patients undergoing TTVR (n = 21) at the University Hospital of Duesseldorf were prospectively analyzed and stratified according prior T-TEER procedures with implanted devices. Groups were compared in terms of procedural success, periprocedural complications, and patient outcomes. Individual treatment decisions for patients after T-TEER were analyzed. RESULTS: Five patients had residual/recurrent severe to torrential TR and underwent TTVR after T-TEER, whereas 16 patients were primarily referred for TTVR. Preprocedural wire-based intentional clip excision (WICE) was performed in 60% of these patients. Patients did not differ regarding procedural success (100% in both groups, p = 0.99) and periprocedural complications (0 [TTVR after TEER] vs. 5.6% [primary TTVR], p = 0.99 for the combined endpoint of in-hospital death, stroke, myocardial infarction, re-intervention or surgery, and major bleeding). A pacemaker was required in one patient of each group, p = 0.4). Procedural times were higher among patients with prior T-TEER. Treatment decisions for patients after T-TEER were integrated into a treatment algorithm. CONCLUSION: The valve after clip concept is feasible and the proposed algorithm may support procedural planning.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.