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Prognostic Implications of Residual Tricuspid Regurgitation Grading after Transcatheter Tricuspid Valve Repair.

JACC-CARDIOVASCULAR INTERVENTIONS(2024)

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摘要
BACKGROUND The safety pro file of transcatheter tricuspid valve (TTV) repair techniques is well established, but residual tricuspid regurgitation (TR) remains a concern. OBJECTIVES The authors sought to assess the impact of residual TR severity post -TTV repair on survival. METHODS We evaluated the survival rate at 2 years of 613 patients with severe isolated functional TR who underwent TTV repair in TRIGISTRY according to the severity of residual TR at discharge using a 3-grade (mild, moderate, and severe) or 4-grade scheme (mild, mild to moderate, moderate to severe, and severe). RESULTS Residual TR was none/mild in 33%, moderate in 52%, and severe in 15%. The 2-year adjusted survival rates signi ficantly differed between the 3 groups (85%, 70%, and 44%, respectively; restricted mean survival time [RMST]: P = 0.0001). When the 319 patients with moderate residual TR were subdivided into mild to moderate (n = 201, 33%) and moderate to severe (n = 118, 19%), the adjusted survival rate was also signi ficantly different between groups (85%, 80%, 55%, and 44%, respectively; RMST: P = 0.001). Survival was signi ficantly lower in patients with moderate to severe residual TR compared to patients with mild to moderate residual TR ( P = 0.006). No difference in survival rates was observed between patients with no/mild and mild to moderate residual TR ( P = 0.67) or between patients with moderate to severe and severe residual TR ( P = 0.96). CONCLUSIONS The moderate residual TR group was heterogeneous and encompassed patients with markedly different clinical outcomes. Re fining TR grade classi fication with a more granular 4-grade scheme improved outcome prediction. Our results highlight the importance of achieving a mild to moderate or lower residual TR grade during TTV repair, which could de fine a successful intervention.
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关键词
survival,transcatheter intervention,tricuspid regurgitation
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