Universität zu Köln

Mehr, Michael, Karam, Nicole, Taramasso, Maurizio, Ouarrak, Taoufik, Schneider, Steffen, Lurz, Philipp, von Bardeleben, Ralph Stephan, Fam, Neil, Pozzoli, Alberto, Lubos, Edith, Boekstegers, Peter, Schillinger, Wolfgang, Plicht, Bjoern, Eggebrecht, Holger, Baldus, Stephan, Senges, Jochen, Maisano, Francesco ORCID: 0000-0002-3691-1709 and Hausleiter, Joerg (2020). Combined Tricuspid and Mitral Versus Isolated Mitral Valve Repair for Severe MR and TR An Analysis From the TriValve and TRAMI Registries. JACC-Cardiovasc. Interv., 13 (5). S. 543 - 551. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1876-7605

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Abstract

OBJECTIVES The aim of this study was to retrospectively compare the characteristics, procedural courses, and outcomes of patients presenting with concomitant mitral regurgitation (MR) and tricuspid regurgitation (TR) in the TriValve (Transcatheter Tricuspid Valve Therapies) and TRAMI (Transcatheter Mitral Valve Interventions) registries. BACKGROUND Transcatheter mitral edge-to-edge valve repair (TMVR) has been shown to be successful in patients with severe MR. Lately, edge-to-edge repair has also emerged as a possible treatment for severe TR in patients at high risk for cardiac surgery. In patients with both severe MR and TR, the yield of concomitant transcatheter mitral and tricuspid valve repair (TMTVR) for patients at high surgical risk is unknown. METHODS The characteristics, procedural data, and 1-year outcomes of all patients in the international multicenter TriValve registry and the German multicenter TRAMI registry, who presented with both severe MR and TR, were retrospectively compared. Patients in TRAMI (n = 106) underwent isolated TMVR, while those in TriValve (n = 122) additionally underwent concurrent TMTVR in compassionate and/or off-label use. RESULTS All 228 patients (mean age 77 +/- 8 years, 44.3% women) presented with significant dyspnea at baseline (New York Heart Association functional class III or IV in 93.9%), without any differences in the rates of pulmonary hypertension and chronic pulmonary disease. The proportion of patients with left ventricular ejection fraction <30% was higher in the TMVR group (34.9% vs. 18.0%; p < 0.001), while patients in the TMTVR group had lower glomerular filtration rates. At discharge, MR was comparably reduced in both groups. At 1 year, overall all-cause mortality was 34.0% in the TMVR group and 16.4% in the TMTVR group (p = 0.035, Cox regression). On multivariate analysis, TMTVR was associated with a 2-fold lower mortality rate (hazard ratio: 0.52; p = 0.02). The rate of patients in New York Heart Association functional class <= II at 1 year did not differ (69.4% vs. 67.0%; p = 0.54). CONCLUSIONS Concurrent TMTVR was associated with a higher 1-year survival rate compared with isolated TMVR in patients with both MR and TR. Further randomized trials are needed to confirm these results. (C) 2020 Published by Elsevier on behalf of the American College of Cardiology Foundation.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Mehr, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Karam, Nicole UNSPECIFIED UNSPECIFIED UNSPECIFIED Taramasso, Maurizio UNSPECIFIED UNSPECIFIED UNSPECIFIED Ouarrak, Taoufik UNSPECIFIED UNSPECIFIED UNSPECIFIED Schneider, Steffen UNSPECIFIED UNSPECIFIED UNSPECIFIED Lurz, Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED von Bardeleben, Ralph Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Fam, Neil UNSPECIFIED UNSPECIFIED UNSPECIFIED Pozzoli, Alberto UNSPECIFIED UNSPECIFIED UNSPECIFIED Lubos, Edith UNSPECIFIED UNSPECIFIED UNSPECIFIED Boekstegers, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Schillinger, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Plicht, Bjoern UNSPECIFIED UNSPECIFIED UNSPECIFIED Eggebrecht, Holger UNSPECIFIED UNSPECIFIED UNSPECIFIED Baldus, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Senges, Jochen UNSPECIFIED UNSPECIFIED UNSPECIFIED Maisano, Francesco UNSPECIFIED orcid.org/0000-0002-3691-1709 UNSPECIFIED Hausleiter, Joerg UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-341340
DOI:	10.1016/j.jcin.2019.10.023
Journal or Publication Title:	JACC-Cardiovasc. Interv.
Volume:	13
Number:	5
Page Range:	S. 543 - 551
Date:	2020
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1876-7605
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language TO-EDGE REPAIR; NATIVE VALVULAR REGURGITATION; TRANSCATHETER TREATMENT; EUROPEAN ASSOCIATION; HEART-FAILURE; OUTCOMES; SOCIETY; SURGERY; IMPACT; RECOMMENDATIONS Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/34134