Transcatheter Tricuspid Repair Effective in Electronic-Implant Recipients

By David Douglas

January 29, 2020

NEW YORK (Reuters Health) - Transcatheter tricuspid-valve interventions (TTVIs) can successfully reduce tricuspid regurgitation (TR) in patients with cardiac implantable electronic devices (CIED) without compromising safety, according to a retrospective study.

"This is the first large series to show the feasibility of transcatheter tricuspid repair in patients with a previous CIED lead through the tricuspid valve, which has so far be considered a relative contraindication (or at least a factor increasing complexity)," said lead author Dr. Maurizio Taramasso of the University Hospital of Zurich, Switzerland.

"This analysis of the international trivalve registry showed that actually it is as effective as in a normal anatomy," he told Reuters Health by email.

The presence of an endocardial lead to provide pacing or defibrillation in the right side of the heart may interfere with the tricuspid-valve components, contributing to or being the main mechanism of TR, Dr. Taramasso and colleagues note in JACC: Cardiovascular Interventions.

To investigate what impact this might have, the researchers compared data from the multicenter TriValve Registry on 121 patients with trans-tricuspid CIEDs and 349 TTVI patients without CIEDs. All patients had severe symptomatic TR. Most of the tricuspid valves were treated with a MitraClip (87.6% of those with a CIED and 76.5% of those without).

Procedural success in the CIED group (78.6%) did not differ significantly from that in the no-CIED group (80.0%), and in-hospital mortality was 2.9% and 3.7%, respectively.

Symptomatic improvement was also similar in both groups with NYHA class I-II at 30 days at 66% and 65%. At one year, survival was 73.6% in the CIED patients and 80.7% in those with no CIED (P=0.3).

In an editorial, Dr. Erin A. Fender of Christiana Care Health System, in Newark, Delaware, calls for further studies, but concludes that "these findings should encourage operators to consider TTVI in CIED patients with symptomatic severe TR, particularly given the limited alternative treatment options available to this cohort."

Dr. Taramasso and several of his coauthors report financial ties to device makers.

SOURCE: https://bit.ly/2O7dMAV and https://bit.ly/3aYD0LE JACC: Cardiovascular Interventions, online January 15, 2020.

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