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Combined Tricuspid and Mitral Versus Isolated Mitral Valve Repair for Severe MR and TR: An Analysis From the TriValve and TRAMI Registries.
- Source :
-
JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2020 Mar 09; Vol. 13 (5), pp. 543-550. Date of Electronic Publication: 2020 Jan 15. - Publication Year :
- 2020
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Abstract
- Objectives: The aim of this study was to retrospectively compare the characteristics, procedural courses, and outcomes of patients presenting with concomitant mitral regurgitation (MR) and tricuspid regurgitation (TR) in the TriValve (Transcatheter Tricuspid Valve Therapies) and TRAMI (Transcatheter Mitral Valve Interventions) registries.<br />Background: Transcatheter mitral edge-to-edge valve repair (TMVR) has been shown to be successful in patients with severe MR. Lately, edge-to-edge repair has also emerged as a possible treatment for severe TR in patients at high risk for cardiac surgery. In patients with both severe MR and TR, the yield of concomitant transcatheter mitral and tricuspid valve repair (TMTVR) for patients at high surgical risk is unknown.<br />Methods: The characteristics, procedural data, and 1-year outcomes of all patients in the international multicenter TriValve registry and the German multicenter TRAMI registry, who presented with both severe MR and TR, were retrospectively compared. Patients in TRAMI (n = 106) underwent isolated TMVR, while those in TriValve (n = 122) additionally underwent concurrent TMTVR in compassionate and/or off-label use.<br />Results: All 228 patients (mean age 77 ± 8 years, 44.3% women) presented with significant dyspnea at baseline (New York Heart Association functional class III or IV in 93.9%), without any differences in the rates of pulmonary hypertension and chronic pulmonary disease. The proportion of patients with left ventricular ejection fraction <30% was higher in the TMVR group (34.9% vs. 18.0%; p < 0.001), while patients in the TMTVR group had lower glomerular filtration rates. At discharge, MR was comparably reduced in both groups. At 1 year, overall all-cause mortality was 34.0% in the TMVR group and 16.4% in the TMTVR group (p = 0.035, Cox regression). On multivariate analysis, TMTVR was associated with a 2-fold lower mortality rate (hazard ratio: 0.52; p = 0.02). The rate of patients in New York Heart Association functional class ≤II at 1 year did not differ (69.4% vs. 67.0%; p = 0.54).<br />Conclusions: Concurrent TMTVR was associated with a higher 1-year survival rate compared with isolated TMVR in patients with both MR and TR. Further randomized trials are needed to confirm these results.<br /> (Copyright © 2020. Published by Elsevier Inc.)
- Subjects :
- Aged
Aged, 80 and over
Europe
Female
Heart Valve Prosthesis
Hemodynamics
Humans
Male
Mitral Valve diagnostic imaging
Mitral Valve physiopathology
Mitral Valve Insufficiency diagnostic imaging
Mitral Valve Insufficiency mortality
Mitral Valve Insufficiency physiopathology
North America
Postoperative Complications etiology
Recovery of Function
Registries
Retrospective Studies
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
Tricuspid Valve diagnostic imaging
Tricuspid Valve physiopathology
Tricuspid Valve Insufficiency diagnostic imaging
Tricuspid Valve Insufficiency mortality
Tricuspid Valve Insufficiency physiopathology
Cardiac Catheterization adverse effects
Cardiac Catheterization instrumentation
Cardiac Catheterization mortality
Heart Valve Prosthesis Implantation adverse effects
Heart Valve Prosthesis Implantation instrumentation
Heart Valve Prosthesis Implantation mortality
Mitral Valve surgery
Mitral Valve Insufficiency surgery
Tricuspid Valve surgery
Tricuspid Valve Insufficiency surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7605
- Volume :
- 13
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 31954679
- Full Text :
- https://doi.org/10.1016/j.jcin.2019.10.023