Haemodynamic effect of transcatheter tricuspid valve annuloplasty and its association with clinical outcomes

Abstract Background Transcatheter tricuspid valve annuloplasty (TTVA) with Cardioband is a safe and effective treatment option in patients with symptomatic severe tricuspid regurgitation (TR) and high surgical risk. However, it is not known if TR reduction after TTVA improves haemodynamics. Furthermore, it is unclear if a change in haemodynamics after TTVA is associated with outcomes. Purpose To assess the haemodynamic effect and its association with outcomes in patients undergoing TTVA for severe TR. Methods Consecutive patients with severe functional TR admitted for TTVA in our Heart Centre between 2019 and 2022 were retrospectively analysed. All patients underwent right-heart catheterization immediately prior anchor implantation and after successful cinching. Recorded waveforms included pulmonary artery and pulmonary capillary wedge pressures as well as right-atrial (RA), and right-ventricular (RV) pressure levels (mean, nadir, A-wave, V-wave). XV height was calculated as the difference between the right-atrial pressure at the nadir and the V-wave. Results 58 patients with severe TR and full haemodynamic assessment were included. Median age was 80 years (75-82) and 78% were female. Median left-ventricular ejection fraction was 55% (51-60). Median TRI-SCORE was 5 points (3-6). Most patients (40%) presented with TR V°, followed by III° (38%), and TR IV° (22%). TR reduction of ≥2 grades was observed in 48 patients (83%), while 56 (97%) experienced a reduction of ≥1 grade. Intraprocedural success according to TVARC was achieved in 34 of 58 procedures (59%), and median EROA was reduced from 0.66 (0.51-0.95) to 0.21 (0.13-0.40). Haemodynamic improvement was shown by means of increase of median cardiac index (from 2.4 to 2.8 l/min/m2), median pulmonary artery pulsatility index (from 1.73 to 2.13), and median RV cardiac power index (from 0.15 to 0.21 W/m2). RA pressures were reduced after TTVA, with median XV height reflecting the most pronounced pressure reduction (from 12.5 to 7 mmHg). Spearman rank correlation analysis revealed a significant positive association between XV height and TR grade (ρ = 0.62, 0.42 – 0.76, p 0.001). Postprocedural XV height was associated with reverse RV remodelling through RV basal diameter reduction at a median follow-up (FU) of 304 days (80 – 407, p 0.001). Additionally, lower postprocedural XV height was significantly associated with a lower TR grade in FU echocardiography (p=0.002) and postprocedural XV height was the only haemodynamic parameter which was independently associated with 1-year survival in multivariable Cox regression analysis (HR 1.17 1.02-1.34, p=0.021). Conclusion TTVA can provide haemodynamic improvement even in advanced TR stages. Postprocedural XV height correlated significantly with TR reduction and was associated with RV remodeling and improved clinical outcomes at FU. Importantly, haemodynamic parameters may offer additional value in risk assessment and procedural guidance.