Transcatheter Tricuspid Valve Repair versus Minimally Invasive Beating-Heart Tricuspid Valve Surgery in High-Risk Patients

Background: Minimally invasive beating-heart tricuspid valve surgery (MIC-TVS) has been established as gold standard in treatment of tricuspid regurgitation (TR), but transcatheter tricuspid valve repair (TTVR) is an increasingly performed alternative in patients at high surgical risk. Up to date, there is no study comparing both treatment options in a high-risk patient cohort. This study evaluated clinical outcomes of high-risk patients with TR after TTVR in comparison to MIC-TVS.

Method: From 2016 to 2021, we performed 271 TTVR and 28 MIC-TVS. We applied propensity score-matching according to age, NYHA class, left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), glomerular filtration rate and tricuspid annulus diameter. Next we compared patient outcome.

Results: Propensity-matching yielded 20 pairs. Mean age was 72.7 years (95% CI: 67.9–77.4) in TTVR versus 73.3 years (95% CI: 69.9–77.3) in MIC-TVS (p = 0.83), LVEF was 52.6% (95% CI: 47.3–58.0) versus 55.7% (95% CI: 50.9–60.5) (p = 0.50), EuroSCORE II was 5.9% (95% CI: 3.9–7.8) versus 7.4% (95% CI: 5.4–9.4) (p = 0.25), TRI-SCORE was 5.5 (95% CI: 4.7–6.3) versus 4.9 (95% CI: 3.9–5.9), p = 0.39. TR at baseline was more often torrential in MIC-TVS patients (p = 0.02). Mortality at 30 days was 0% versus 15% (3/20; p = 0.23). There were no neurological events at 30 days follow-up in both groups. At discharge, TR reduction to none/mild was 5% in TTVR versus 55.0% in MIC-TVS (p < 0.01). The composite major adverse event (cardiovascular mortality, myocardial infarction, stroke, severe renal failure, endocarditis, reoperation for TR and cardiac rehospitalization) occurred in 20.0 versus 35.0% (p = 0.48). At 1-year, survival was significantly higher in TTVR patients (95.0 vs. 70.0%) (p = 0.04). Within the MIC-TVS cohort, survival was significantly lower in patients with a TRI-SCORE ≥6 points (84.6 vs. 42.8% at 1 year, p = 0.04). At 1 year, TR reduction to none/mild was 0% in TTVR versus 46.7% in MIC-TVS and TR was ≥severe in 25.0% versus 6.6% (p < 0.01). At follow-up, 80% of TTVR and 92.9% of MIC-TVS patients were in NYHA class I/II (p = 0.17).

Conclusion: In high-risk patients, mortality was significantly higher after MIC-TVS. In contrast, MIC-TVS showed significantly better TR reduction than TTVR at discharge and follow-up. Patients with a TRI-SCORE ≥6 points may not benefit from MIC-TVS and should carefully be discussed before treatment.

Publikationsverlauf

Artikel online veröffentlicht:
28. Januar 2023