• Isolated Transcatheter Tricuspid Valve Repair Shows Benefits for TR: Meta-Analysis

    Isolated transcatheter tricuspid valve repair (ITTVR) may offer significant benefits for patients with tricuspid regurgitation (TR), according to a new meta-analysis of clinical studies.

    Published online Monday and in the Oct. 25 issue of JACC: Cardiovascular Interventions, the study noted that major advances in transcatheter tricuspid valve repair (TTVR) technologies have fueled global interest in the percutaneous correction of TR – adding that novel TTVR devices are being steadily developed and tested.

    “Nevertheless, most reports on the performance of such devices encompass small cohorts of patients, and pooled data from the most recent studies regarding the safety and efficacy outcomes of TTVR are scarce,” said the authors, led by Pier Paolo Bocchino, MD, from the University of Turin, Italy – adding that no data exist regarding the overall performance of such devices on ITTVR.

    As a result, Bocchino and colleagues performed a meta-analysis pooling clinical data and echocardiographic outcomes of 14 clinical studies to assess different ITTVR strategies for significant TR.

    “Patients undergoing ITTVR for significant TR experienced significant improvements in New York Heart Association (NYHA) functional status and 6-minute walking distance and a significant reduction in TR severity at mid-term follow-up,” they said.

    Study details

    Bocchino and colleagues first performed a systematic analysis of published research to identify trials evaluating the efficacy and safety of ITTVR for significant TR in adults. Fourteen studies with 771 patients were included in the final meta-analysis, with primary outcomes identified by the team of: improvement in NYHA functional class and 6-minute walking distance (6MWD) and the presence of severe or greater TR at the last available follow-up of each individual study.

    At a weighted mean follow-up of 212 days, 209 patients (35%) were in NYHA functional class III or IV compared with 586 patients (84%) at baseline (risk ratio [RR]: 0.23; 95% confidence interval [CI]: 0.13-0.40; P < 0.001). Six-minute walking distance was also found to significantly improved, from 237 m to 294 m (mean difference +50 m; 95% CI: +34 to +66 m; P < 0.001).

    Furthermore, just 147 patients (24%) were classified with scores of “severe” or greater TR after ITTVR, compared with 616 (96%) at baseline (RR: 0.29; 95% CI: 0.20-0.42; P < 0.001).

    “Patients undergoing ITTVR experienced significant improvements in NYHA functional status and 6MWD as well as a significant reduction in TR severity at mid-term follow-up; moreover, echocardiographic quantitative parameters of TR consistently and persistently improved following ITTVR, with no significant difference regarding biventricular systolic function,” said Bocchino and colleagues. However, they added that prospective studies and randomized controlled trials addressing the impact of ITTVR on clinical outcomes at long-term follow-up are also warranted.

     

     

    Updated analysis

    Writing in an accompanying editorial, Bernard Chevalier, MD, and Antoinette Neylon, MD, from the Cardiovascular Institute Paris Sud (ICPS), France, noted that a better knowledge of the natural history of TR, alongside the limited efficacy of isolated tricuspid surgical repair/replacement have paved the way for percutaneous interventions using mainly mitral devices in the early experience.

    The expert commentators added that multiple single-arm retrospective and prospective studies have shown good feasibility for ITTVR in TR, with a positive impact on heart failure symptoms.

    Indeed, they noted that a previous systematic review and pooled analysis of trials showed confirmed that transcatheter repair for severe TR is feasible, effective, and associated with improved clinical outcomes at mid-term follow-up.

    The editorialists noted, however, that the new meta-analysis, which updates the previous one, focuses solely on ITTVR.

    “The current analysis, with a pooled mortality rate of 11% and a 35% rate of NYHA functional class III/ IV patients at 212 days, suggests that attention should be paid to precise grading of severe TR, [right ventricular] function, and right-side hemodynamic evaluations during the ITTR screening process, particularly in the setting of future randomized clinical trials aiming to demonstrate the benefit of ITTR over medical treatment,” they concluded.

    Sources:

    Bocchino PP, Angelini F, Vairo A, et al. Clinical Outcomes Following Isolated Transcatheter Tricuspid Valve Repair: A Meta-Analysis and Meta-Regression Study. JACC Cardiovasc Interv 2021;14:2285-2295.

    Chevalier B, Neylon A. Isolated Transcatheter Tricuspid Repair for Functional Regurgitation: Are We Selecting the Right Patients? JACC Cardiovasc Interv 2021;14:2166-2296-2297.

    Image Credit: SciePro – stock.adobe.com

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