Author + information
- Received August 18, 2019
- Revision received September 20, 2019
- Accepted September 23, 2019
- Published online September 27, 2019.
- Maurizio Taramasso, MD PhD1,∗∗ (, )@m_taramasso,
- Giovanni Benfari, MD2,∗,
- Pieter van der Bijl, MD3,
- Hannes Alessandrini, MD4,
- Adrian Attinger-Toller, MD5,
- Luigi Biasco, MD6,
- Philipp Lurz, MD PhD7,
- Daniel Braun, MD8,
- Eric Brochet, MD9,
- Kim A. Connelly, MD10,
- Sabine de Bruijn, MD11,
- Paolo Denti, MD12,
- Florian Deuschl, MD13,
- Rodrigo Estevez-Loureiro, MD PhD14,
- Neil Fam, MD10,
- Christian Frerker, MD4,15,
- Mara Gavazzoni, MD1,
- Jo¨rg Hausleiter, MD8,
- Edwin Ho, MD10,16,
- Jean-Michel Juliard, MD9,
- Ryan Kaple, MD17,
- Christian Besler, MD7,
- Susheel Kodali, MD18,
- Felix Kreidel, MD19,
- Karl-Heinz Kuck, MD4,
- Azeem Latib, MD16,
- Alexander Lauten, MD20,
- Vanessa Monivas, MD14,
- Michael Mehr, MD8,
- Guillem Muntané-Carol, MD21,
- Tamin Nazif, MD18,
- Georg Nickening, MD22,
- Giovanni Pedrazzini, MD6,
- François Philippon, MD21,
- Alberto Pozzoli, MD1,
- Fabien Praz, MD23,
- Rishi Puri, MD21,
- Josep Rodés-Cabau, MD21,
- Ulrich Scha¨fer, MD13,
- Joachim Schofer, MD24,
- Horst Sievert, MD11,
- Gilbert H.L. Tang, MD, MSC, MBA25,
- Holger Thiele, MD7,
- Yan Topilsky, MD2,26,
- Karl-Philipp Rommel, MD7,
- Victoria Delgado, MD3,
- Alec Vahanian, MD9,
- Ralph Stephan Von Bardeleben, MD19,
- John G. Webb, MD5,
- Marcel Weber, MD22,
- Stephan Windecker, MD23,
- Mirjam Winkel, MD23,
- Michel Zuber, MD1,
- Martin B. Leon, MD18,
- Rebecca T. Hahn, MD18,
- Jeroen J. Bax, MD3,
- Maurice Enriquez-Sarano, MD2 and
- Francesco Maisano, MD1
- 1Cardiac Surgery Department, University Hospital of Zurich, Univeristy of Zurich, Switzerland
- 2Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
- 3Department of Cardiology, Leiden University Medical Center, the Netherlands
- 4Asklepios Klinik St. Georg, Hamburg, Germany
- 5St. Paul Hospital, Vancouver, Canada
- 6Cardiocentro, Lugano, Switzerland
- 7Heart Center Leipzig - University Hospital, Leipzig, Germany
- 8Klinikum der Universita¨;t Mu¨nchen, Munich, Germany
- 9Hôpital Bichat, Université, Paris VI, Paris, France
- 10Toronto Heart Center, St. Michael’s Hospital, Toronto, Ontario, Canada
- 11CardioVascular Center Frankfurt, Frankfurt am Main, Germany
- 12San Raffaele University Hospital. Milan, Italy
- 13University Heart Center Hamburg, Hamburg, Germany
- 14Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
- 15University Hospital of Köln, Köln, Germany
- 16Montefiore Medical Center, New York, New York
- 17Westchester Medical Center, Valhalla, New York, New York
- 18New York-Presbyterian/Columbia University Medical Center, New York, New York
- 19Department of Cardiology, University Medical Center Mainz, Mainz, Germany
- 20Charité University Hospital, Berlin, Germany
- 21Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
- 22Universitatsklinikum Bonn, Bonn, Germany
- 23Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- 24Albertinen Heart Center, Hamburg, Germany
- 25Mount Sinai Hospital, New York
- 26Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Israel
- ↵∗Correspondence to: Maurizio Taramasso MD University Hospital of Zürich, Cardiovascular Surgery Department Rämistrasse 100 8091 Zurich, Switzerland. Telephone: +41442553728 Fax: +41442551616.
Background Tricuspid Regurgitation (TR) is associated with increased rates of heart failure (HF) and mortality. Transcatheter tricuspid valve interventions (TTVI) are promising, but the clinical benefit is unknown.
Objectives To investigate the potential benefit of TTVI over medical therapy in a propensity score matched population.
Methods The TriValve (Transcatheter Tricuspid Valve Therapies) registry collected 472 patients from 22 European and North American centers, who underwent TTVI from 2016 to 2018. A control cohort formed by two large retrospective registries enrolling medically managed patients with ≥moderate TR in Europe and North America (1179 pts) were propensity score 1:1 matched (distance ± 0.2 SD) using age, Euroscore II, and systolic pulmonary artery pressure. Survival was tested with Cox regression analysis. Primary endpoint was 1-year mortality or HF rehospitalization or the composite.
Results After matching, 268 adequately matched pairs of patients were identified. Compared to controls, TTVI patients had lower 1-year mortality (23 ±3% vs 36 ±3%, p=0.001), rehospitalization (26 ±3% vs 47 ±3% p<0.0001), and composite endpoint (32 ±4% vs 49 ±3%; p=0.0003).
TTVI was associated with greater survival and freedom from HF rehospitalization (HR 0.60 [0.46-0.79], p=0.003 unadjusted) which remained significant after adjusting for sex, NYHA class, right ventricular dysfunction and atrial fibrillation (HR 0.39 [0.26-0.59], p<0.0001) and after further adjustment for mitral regurgitation and pacemaker/defibrillator (HR 0.35 [0.23.54], p<0.0001).
Conclusions In this propensity matched case-control study, TTVI is associated with greater survival and reduced HF rehospitalization compared with medical therapy alone. Randomized trials should be performed to confirm these results.
↵∗ MT and GB equally contributed and should be both considered as first authors
Dr. Taramasso is a consultant for Abbott Vascular, Boston Scientific, 4TECH, and CoreMedic; and has received speaker honoraria from Edwards Lifesciences. Dr. Latib has served on the advisory board for Medtronic and Abbott Vascular; on the Speakers Bureau for Abbott Vascular; on the scientific advisory board for Millipede; and as a consultant for 4Tech, Mitralign, and Millipede. Dr. Braun has received speaker honoraria and travel support from Abbott Vascular. Dr. Brochet has received speaker fees from Abbott Vascular. Dr. Denti has served as a consultant for Abbott Vascular, 4Tech, Neovasc, and InnovHeart; and has received honoraria from Abbott. Dr. Deuschl has served as a proctor and consultant for Valtech/Edwards Lifesciences and Neovasc; has received speaker honoraria from Abbott; and has received unre- stricted travel grants from Boston Scientific, Abbott, Edwards Lifesciences, and Neovasc. Dr. Hausleiter has received speaker honoraria from Abbott Vascular and Edwards Lifesciences. Dr. Himbert has served as a proctor and consultant for Edwards Lifesciences. Dr. Kreidel has received speaker honoraria and consulting fees from Abbott and Edwards Lifesciences. Dr. Kuck has served as a consultant for Abbott Vascular, St. Jude Medical, Biotronik, Medtronic, Biosense Webster. Boston Scientific, Edwards Lifesciences, and Mitralign; and is cofounder of Cardiac Implants. Dr. Lauten has received research support from Abbott and Edwards Lifesciences; and has been a consultant to Abbott, Edwards Lifesciences, and TricValve. Dr. Lurz has received speaker fees from Abbott. Dr. Mehr has received a travel grant from Bristol-Myers Squibb. Dr. Nazif has been a consultant to Edwards Lifesciences, Boston Scientific, and Medtronic. Dr. Praz has been a consultant to Edwards Lifesciences. Dr. Rodés-Cabau has received institutional research grants from Edwards Lifesciences. Dr. Scha¨fer has received lecture fees, study honoraria, travel expenses from, and has been a member of an advisory board for Abbott. Prof. H. Sievert has received study honoraria, travel expenses, and consulting fees from 4tech Cardio, Abbott, Ablative Solutions, Ancora Heart, Bavaria Medizin Technologie GmbH, Bioventrix, Boston Scientific, Carag, Cardiac Dimensions, Celonova, Comed B.V., Contego, CVRx, Edwards, Endologix, Hemoteq, Lifetech, Maquet Getinge Group, Medtronic, Mitralign, Nuomao Medtech, Occlutech, pfm Medical, Recor, Renal Guard, Rox Medical, Terumo, Vascular Dynamics, and Vivasure Medical. Dr. Tang has served as a consultant, advisory board member, and faculty trainer for Abbott Structural Heart. Dr. Vahanian has served as a consultant for Abbott Vascular, Edwards Lifesciences, and MitralTech; and has received speakers fees from Abbott Vascular and Edwards Lifesciences. Dr. Webb has received research support from Edwards Lifesciences; and served as a consultant for Abbott Vascular, Edwards Lifesciences, and St. Jude Medical. Dr. Windecker has received institutional research grants from Abbott, Amgen, Boston Scientific, Biotronik, Edwards Lifesciences, Medtronic, St Jude, and Terumo. Dr. Maisano has served as a consultant for Abbott Vascular, Edwards Lifesciences, Cardiovalve, Valtech, and Medtronic; and is cofounder of 4Tech. Dr. Leon has served as a nonpaid member of the scientific advisory board of Edwards Lifesciences; and has been a consultant to Abbott Vascular and Boston Scientific. Dr. Hahn has served as a consultant for Abbott Vascular, NaviGate, and GE Healthcare, Dr. Kodali is conslultant for Claret Medical, Abbott Vascular, Meril Lifesciences, Admedus and has equity of Thubrikar Aortic Valve, Inc, Dura Biotech, Biotrace Medical, MID; Dr. Topilsky declares consultation fee and research grants from Edwards Liefisciences; Dr. Delgado declares speaker fees from Abbott Vascular; Dr. Bax reported speaker fees from Abbott Vascular and Boehringer Ingelheim; Dr. Sarano declared Research Grant from Edwards Lifescience; All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 18, 2019.
- Revision received September 20, 2019.
- Accepted September 23, 2019.
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