Combining Tricuspid Valve Repair With Double Lung Transplantation in Patients With Severe Pulmonary Hypertension, Tricuspid Regurgitation, and Right Ventricular Dysfunction

Background: Scarce data exist on patients with right ventricular dysfunction (RVD) or pulmonary hypertension (PH) undergoing transcatheter tricuspid valve intervention. This study aimed to determine the early and midterm outcomes and the factors associated with mortality in this group of patients. Methods: This subanalysis of the multicenter TriValve (Transcatheter Tricuspid Valve Therapies) registry included 300 patients with severe tricuspid regurgitation with RVD (n=244), PH (n=127), or both (n=71) undergoing transcatheter tricuspid valve intervention. RVD was defined as a tricuspid annular plane systolic excursion <17 mm, and PH as an estimated pulmonary artery systolic pressure ≥50 mm Hg. Results: Mean age of the patients was 77±9 years (54% women). Procedural success was 80.7%, and 9 patients (3%) died during the hospitalization. At a median follow-up of 6 (interquartile range, 2–12) months, 54 patients (18%) died, and the independent associated factors were higher gamma-glutamyl transferase values at baseline (hazard ratio, 1.02 for each increase of 10 u/L [95% CI, 1.002–1.04]), poorer renal function defined as an estimated glomerular filtration rate <45 mL/min (hazard ratio, 2.3 [95% CI, 1.22–4.33]), and the lack of procedural success (hazard ratio, 2.11 [95% CI, 1.17–3.81]). The grade of RVD and the amount of PH at baseline were not found to be predictors of mortality. Most patients alive at follow-up improved their functional class (New York Heart Association I–II in 66% versus 7% at baseline, P <0.001). Conclusions: In patients with severe tricuspid regurgitation and RVD/PH, transcatheter tricuspid valve intervention was associated with high procedural success and a relatively low in-hospital mortality, along with significant improvements in functional status. However, about 1 out of 5 patients died after a median follow-up of 6 months, with hepatic congestion, renal dysfunction, and the lack of procedural success determining an increased risk. These results may improve the clinical evaluation of transcatheter tricuspid valve intervention candidates and would suggest a closer follow-up in those at increased risk. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03416166.

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Surgical-interventional hybrid orchestra consisting of Potts shunt, transcatheter tricuspid valve repair by Edwards-valve in a 26-year-old patient with pulmonary hypertension and right ventricular failure

World Journal of Cardiovascular Diseases ◽

10.4236/wjcd.2013.36a001 ◽

2013 ◽

Vol 03 (06) ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Sabine Recla ◽

Blanka Steinbrenner ◽

Jennifer Schreier ◽

Stephan Fichtlscherer ◽

Dorle Schmidt ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Right Ventricular ◽

Tricuspid Valve ◽

Right Ventricular Failure ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Ventricular Failure

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P5567Clinical characteristics, diagnosis and risk stratification of pulmonary hypertension in severe tricuspid regurgitation and implications for transcatheter tricuspid valve repair

European Heart Journal ◽

10.1093/eurheartj/ehz746.0511 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

P Lurz ◽

K P Rommel ◽

M Orban ◽

C Besler ◽

D Braun ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Clinical Status ◽

Tricuspid Valve Repair ◽

Systolic Pulmonary Artery Pressure ◽

Clinical Endpoint ◽

Valve Repair ◽

Severe Tricuspid Regurgitation ◽

Regurgitant Orifice Area

Abstract Objective To assess the role of pulmonary hypertension (PHT) in severe tricuspid regurgitation (TR) and its implications for transcatheter tricuspid valve repair (TTVR). Background PHT patients are often excluded from surgical TR therapies. TTVR with the MitraClipTM technique is a novel treatment option for these patients. Methods A total of 164 patients at high surgical risk (median age 78 years) and TR underwent TTVR at two centers. Seventy patients were grouped as iPHT+, defined as invasive systolic pulmonary artery pressure (PAPs) >50 mmHg. Patients were similarly stratified according to echocardiographic PAPs (ePHT). The occurrence of the combined clinical endpoint (death, heart failure hospitalization, reintervention) was investigated. Results iPHT+ patients were at higher pre-operative risk (p<0.01), had more severe symptoms (p=0.01), higher NT-pro-BNP levels (p<0.01) and more impaired biventricular function (left: p=0.03; right: p=0.02). Procedural TTVR success was achieved in 86 vs. 82% in iPHT+ and iPHT- patients respectively (p=0.52). Tricuspid valve effective regurgitant orifice area (EROA) was reduced from 0.49 cm2 to 0.20 cm2 (p<0.01) similarly in both groups. While iPHT+ conveyed risk (HR 1.7 (95% CI 1.1–2.8), p=0.03) for the occurrence of the clinical endpoint, ePHT+ paradoxically conveyed protection (HR 0.61 (95% CI 0.36–0.98), p=0.04). This discrepancy was explained by the highest event rates in patients with iPHT+/ePHT- (n=28). Conversely, iPHT+/ePHT+ patients had comparable outcomes to iPHT- patients. Conclusions PHT in TR is associated with worse clinical status and advanced HF, but not procedural failure. Symptomatic benefit can be achieved irrespective of PHT status by TTVR. Although echocardiographic PHT diagnosis is unreliable, the combination of echocardiographic and invasive assessment may identify ideal candidates for TTVR among PHT patients.

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The Prognostic Value of Soluble ST2 in Adults with Pulmonary Hypertension

Journal of Clinical Medicine ◽

10.3390/jcm8101517 ◽

2019 ◽

Vol 8 (10) ◽

pp. 1517 ◽

Cited By ~ 1

Author(s):

Geenen ◽

Baggen ◽

Kauling ◽

Koudstaal ◽

Boomars ◽

...

Keyword(s):

Heart Failure ◽

Pulmonary Hypertension ◽

Lung Transplantation ◽

Right Ventricular ◽

Prognostic Value ◽

Ventricular Dysfunction ◽

Right Ventricular Dysfunction ◽

Right Atrial ◽

Left Heart Failure ◽

Soluble St2

Soluble ST2 (sST2) is upregulated in response to myocardial stress and may serve as biomarker in adults with pulmonary hypertension (PH). This prospective cohort study investigated sST2 levels and its association with echocardiographic and hemodynamic measures, and adverse clinical outcomes in adults with PH of different etiologies. sST2 was measured during the diagnostic right heart catheterization for PH, in adult patients enrolled between May 2012 and October 2016. PH due to left heart failure was excluded. The association between sST2 and a primary endpoint composed of death or lung transplantation and a secondary composite endpoint including death, lung transplantation or heart failure, was investigated using Cox regression with adjustment for NT-proBNP. In total 104 patients were included (median age was 59 years, 66% woman, 51% pulmonary arterial hypertension). Median sST2 was 28 [IQR 20–46] ng/mL. Higher sST2 was associated with worse right ventricular dysfunction and higher mean pulmonary and right atrial pressures. Median follow-up was 3.3 [IQR 2.3–4.6] years. The primary and secondary endpoint occurred in 33 (31.7%) and 43 (41.3%) patients, respectively. sST2 was significantly associated with both endpoints (HR per 2-fold higher value 1.53, 95%CI 1.12–2.07, p = 0.007 and 1.45, 95%CI 1.10–1.90, p = 0.008, respectively). However, after adjustment for NT-proBNP, both associations did not reach statistical significance. In conclusions, higher sST2 levels are associated with more severe PH and right ventricular dysfunction and yields prognostic value in adults with PH, although not independently of NT-proBNP.

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