Acute hemodynamic instability occurred in 8.5% of patients post-TTVR and was associated with significantly higher intrahospital mortality compared to those without AHI (35.2% vs 0.1%; P<0.001).
Cohort (n=200)
Yes
What is the frequency, outcomes, and risk factors of acute hemodynamic instability following transcatheter tricuspid valve replacement?
Acute hemodynamic instability is a life-threatening early complication following TTVR, occurring in 8.5% of patients and strongly associated with elevated left-sided filling pressures and impaired renal function.
Absolute Event Rate: 35.2% vs 0.1%
p-value: p=<0.001
BACKGROUND: Transcatheter tricuspid valve replacement (TTVR) eliminates tricuspid regurgitation, leading to acute hemodynamic changes. It is unclear whether this might lead to acute hemodynamic instability (AHI). OBJECTIVES: The aim of this study was to report the frequency, outcomes, and risk factors of AHI following TTVR. METHODS: Patients undergoing TTVR at 5 international centers were included. AHI after TTVR was defined as class ≥ C shock according to the Society for Cardiovascular Angiography and Interventions classification. RESULTS: The study included 200 patients with a mean age of 78 ± 11 years (64% women). The frequency of AHI was 8.5%, and in all patients the onset was within 24 hours after the procedure. Compared with patients without postprocedural AHI, intrahospital mortality was significantly higher in AHI patients (35.2% vs 0.1%; P < 0.001). Univariate regression identified low glomerular filtration rate, reduced left ventricular ejection fraction, decreased ratio of tricuspid annular plane systolic excursion to mean pulmonary artery pressure, and elevated pulmonary capillary wedge pressure as significant factors of AHI. CONCLUSIONS: AHI is a life-threatening complication in the early postprocedural period following TTVR. Elevated left-sided filling pressures, pulmonary hypertension, and impaired renal function are associated with an increased risk for AHI, suggesting that patient selection and preprocedural optimization are critical.
Kirchner et al. (Sun,) conducted a cohort in Transcatheter Tricuspid Valve Replacement (n=200). Acute Hemodynamic Instability (AHI) vs. No AHI was evaluated on Intrahospital mortality (p=<0.001). Acute hemodynamic instability occurred in 8.5% of patients post-TTVR and was associated with significantly higher intrahospital mortality compared to those without AHI (35.2% vs 0.1%; P<0.001).