AUTHOR=Dannenberg Varius , Koschutnik Matthias , Donà Carolina , Nitsche Christian , Mascherbauer Katharina , Heitzinger Gregor , Halavina Kseniya , Kammerlander Andreas A. , Spinka Georg , Winter Max-Paul , Andreas Martin , Mach Markus , Schneider Matthias , Bartunek Anna , Bartko Philipp E. , Hengstenberg Christian , Mascherbauer Julia , Goliasch Georg 

TITLE=Invasive Hemodynamic Assessment and Procedural Success of Transcatheter Tricuspid Valve Repair—Important Factors for Right Ventricular Remodeling and Outcome

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.891468

DOI=10.3389/fcvm.2022.891468

ISSN=2297-055X

ABSTRACT=Introduction: Severe tricuspid regurgitation (TR) is a common condition promoting right heart failure and is associated with a poor long-term prognosis. Transcatheter tricuspid valve repair (TTVR) emerged as a low-risk alternative to surgical repair techniques, however patient selection remains controversial.
Aim: We therefore aimed to investigate the impact of preprocedural invasive hemodynamic assessment and procedural success on right ventricular (RV) remodeling and outcome. 
Methods: All patients undergoing TTVR with a TR reduction ≥2 grades or with a TR reduction of one grade without precapillary/combined pulmonary hypertension (PH, mean pulmonary artery pressure (mPAP) ≥25 mmHg, mean pulmonary artery Wedge pressure ≤15 mmHg, pulmonary vascular resistance ≥3 Wood units) were assigned to the responder group. All other patients were classified as non-responders. 
Results: A total of 107 patients were enrolled, 75 were classified as responders and 32 as non-responders. We observed evidence of significant RV reverse remodeling in responders with a decrease in RV diameters (-2.9 mm, p=0.001) at a mean follow-up of 229 days (± SD) after TTVR. RV function improved in responders (fractional area change (FAC) + 5.7%, p<0.001, RV free wall strain +3.9%, p=0.006), but interestingly further deteriorated in non-responders (FAC -4.5%, p=0.003, RV free wall strain -3.9%, p=0.007). Non-responders had more persistent symptoms compared to responders (NYHA ≥3, 72% vs. 11% at follow-up). Subsequently, non-response was associated with a poor long-term prognosis in terms of death, heart failure (HF) hospitalization and re-intervention after 2 years (freedom of death, HF hospitalization and reintervention at 2 years: 16% vs. 78%, log-rank: p<0.001).
Conclusion: 
Hemodynamic assessment before TTVR and procedural success are significant factors for patient prognosis. The hemodynamic profiling prior to intervention is an important component in patient selection for TTVR. The window for edge-to-edge TTVR might be limited, but timely intervention is an important factor for better outcome and successful right ventricular reverse remodeling.