Residual Tricuspid Regurgitation After Mitral Transcatheter Edge-to-Edge Repair: Accomplice or Bystander?

Predictors of Residual Severe Tricuspid Regurgitation After Transcatheter Mitral Valve RepairJournal the Society for Cardiovascular Angiography & Interventions100612PreviewSevere tricuspid regurgitation (TR) may persist after a mitral transcatheter edge-to-edge repair (M-TEER) and is associated with worsened clinical outcomes survival. It unclear which patients concomitant (MR) TR will have reduction M-TEER. The aim this study was to identify predictors residual (TEER). Full-Text PDF Open Access has been worse increasing severity. Community-based echocardiographic studies asymptomatic demonstrated prevalence at least moderate or greater can range from 3% 8%, 1-year–adjusted mortality rates 29.5% severe 45.6%.1d'Arcy J.L. Coffey S. Loudon M.A. et al.Large-scale community screening reveals major burden undiagnosed valvular heart disease in older people: OxVALVE Population Cohort Study.Eur Heart J. 2016; 37: 3515-3522Crossref PubMed Scopus (300) Google Scholar,2Chorin E. Rozenbaum Z. Topilsky Y. al.Tricuspid long-term outcomes.Eur J Cardiovasc Imaging. 2020; 21: 157-165PubMed Scholar 2020 ACC/AHA guidelines define staging system 3 principal stages: progressive (stage B), C), symptomatic D).3Otto C.M. Nishimura R.A. Bonow R.O. al.2020 guideline management disease: report American College Cardiology/American Association joint committee on practice guidelines.Circulation. 143: e72-e227PubMed class I recommendation that valve surgery be performed stage C D undergoing left-sided surgery. Progressive B by definition clinically no hemodynamic consequences. A examining who underwent isolated showed those annular diastolic diameter >40.0 mm (or >21.0 mm/m2) did not undergo annuloplasty had New York functional worsening more than 2 grades 5-10 years follow-up.4Dreyfus G.D. Corbi P.J. Chan K.M. Bahrami T. Secondary dilatation: should criteria surgical repair?.Ann Thorac Surg. 2005; 79: 127-132Abstract Full Text (672) This supported 2a time For are suitable conventional candidates repair/replacement, therapies considered. Currently, commercially available FDA-approved therapy exists United States. Therefore, these often evaluated (m-TEER) goal improving reducing pulmonary arterial (PA) pressures due (MR). Unlike strength recommendations guiding intervention, rigorous evidence coexisting MR lacking. Approximately 60% m-TEER also significantly decreased 1-year survival compared lesser degrees m-TEER.5Geyer M. Keller K. Bachmann al.Concomitant severity its secondary determine prognosis repair.Clin Res Cardiol. 2021; 110: 676-688Crossref (16) consistent subgroup analyses Interventions (TRAMI) Getting Reduction Insufficiency Percutaneous Clip Implantation (GRASP) registries 12-month mortality, rehospitalization failure, adverse cardiovascular cerebrovascular events.6Ohno Attizzani G.F. Capodanno D. al.Association percutaneous MitraClip System: 30-day follow-up GRASP Registry.Eur Imag. 2014; 15: 1246-1255Crossref (111) Scholar,7Kalbacher Schäfer U. von Bardeleben R.S. al.Impact high-risk implantation: results TRAMI registry.EuroIntervention. 2017; 12: e1809-e1816Crossref (52) Basman al8Basman Kodra Pirelli L al.Predictors repair.J Soc Angiogr Interv. 2023; 2100612Google present prospectively collected registry data analyzed retrospectively single-hospital comprising 4 high volume centers. Their 1-month transthoracic echocardiography (TTE) m-TEER. improvement defined as grade 1+ resulting (2+) less TR. half successful experienced significant reduction. Multivariate ≥3+ only predictor Univariate were right atrial area unsuccessful Other factors such arrhythmia, previous cardiac implantable electronic device, mechanism MR, dilation, ventricular (RV) function, PA systolic pressure, left (LV) dimensions reach statistical significance. authors commended their largest analysis date However, several limitations noted. First, methodologic challenges small sample size single-system limit study’s potential larger scale effect. number operators experience known, affect procedural success outcomes. In addition, all baseline covariates TTE-based parameters although transesophageal (TEE) guidance Baseline TEE valuable missed repository important analyzable predictors. example, coaptation gap, directly studied context, shown tricuspid-TEER strategy success.9Donal Sitges Panis V. gap location following repair: insights TriClip bRIGHT study.Eur 2022; 43: 2127PubMed Because >90% pathology al functional, correlation ultimate could very relevant. other pertinent examined quantification proximal isovelocity surface measurements. degenerative qualitative quantitative characterization myxomatous flail width/gap understand cohort contextualize observed Even though 45% degree LV dysfunction quantified. Rather, binary variable does accurately capture effect varying cardiomyopathy consequent Procedural information average clips per case, type clip(s), end-procedural/short-term mean gradient. Iatrogenic stenosis increase resultant Regarding span study, when would Pre-procedure post-procedure brain natriuretic peptide levels TTE inferior vena cava assessment an gauge status assessment. Finally, quantifying based instead routinely cited 5-grade relevance future derivation. authors’ primary conclusion intuitive but necessarily additive. Physiologically, it explained effective pressure leading acknowledge inability account presence intrinsic hypertension. Although found risk factor TR, TTE-derived vascular resistance explored covariate. univariate analyses, RV dysfunction. dysfunction, similar LV, treated categorically (moderate severe). Quantification ejection fraction, area, dilation assessed pre- post-cardiac magnetic resonance imaging help refine our understanding role atrioventricular remodeling Strain strengthened findings. One free-wall global longitudinal strain 12 months m-TEER, strain.10Peters A.P. Leya Baldridge A. al.Temporal trends regurgitation.Struct Heart. 5: 634-636Abstract (0) suggest able reverse remodel response improvements pressure. Longitudinal changes play predicting recently published 5-year COAPT trial ongoing REPAIR-MR PRIMARY trials expand patient populations.11Stone GW, Abraham W, Lindenfeld J, al. Five-year regurgitation. N Engl Med. Published online March 5, 2023. https://doi.org/10.1056/NEJMoa2300213Google If reaches comparable ubiquity aortic replacement, one reported warranted salient generalizability confined experience. Limited absence longer-term cap ability practice-changing. Despite limitations, provide essential insight into Future cohorts using multimodality elucidate bystander responsive accomplice continue portend poor even author(s) declared conflicts interest respect research, authorship, and/or publication article.