Key result
Transcatheter tricuspid valve coaptation achieves ~81% procedural success, outperforming annuloplasty despite similar technical success.
Why the study?
Clinically significant severe tricuspid regurgitation is a common untreated pathology linked to increased mortality, and outcomes comparing coaptation versus annuloplasty transcatheter devices had not been systematically assessed.
Do transcatheter coaptation and annuloplasty devices improve technical and procedural success in patients with severe symptomatic tricuspid regurgitation?
Systematic Review (n=2,273)
Do transcatheter coaptation and annuloplasty devices improve technical and procedural success in patients with severe symptomatic tricuspid regurgitation?
Absolute Event Rate: 94.8% vs 96.7%
Transcatheter tricuspid valve intervention using coaptation or annuloplasty devices is feasible and associated with favorable procedural success and short-term clinical outcomes in high-risk patients with severe TR.
Supports consideration of transcatheter tricuspid interventions in high-risk severe TR; extends procedural outcome data for device selection in trials.
Introduction: Clinically significant severe tricuspid regurgitation (TR) is a common untreated pathology associated with increased mortality. Even though surgical valve replacement has been the mainstay option, transcatheter intervention is a novel and potentially effective tool. To the best of our knowledge, this is the first systematic review that assessed and compared clinical and echocardiographic outcomes of coaptation and annuloplasty devices in patients with clinically significant TR. Methods: PubMed, the Cochrane Central Register of Controlled Trials, and EMBASE were searched for articles published from August 2016 until February 2023. Primary endpoints were technical and procedural successes. Secondary endpoints were TR grade, NYHA, change in 6 min walk distance (6MWD), and echocardiographic parameters at 30-day follow-up. Results: We included thirty-eight studies consisting of 2273 patients with severe symptomatic TR (NYHA III-IV 77% and severe/massive/torrential TR 83.3%) and high surgical risk (mean EUROSCORE of 7.54). The technical success for the annuloplasty devices was 96.7% and for the coaptation device was 94.8%. The procedural success for the annuloplasty devices was 64.6% and for the coaptation device was 81.4%. The 6MWD increased by 17 m for the coaptation devices and increased by 44 m after 30 days for the annuloplasty devices. A reduction in TR grade to <2 was seen in 70% of patients with coaptation and 59% of patients with annuloplasty devices. Conclusions: Transcatheter tricuspid valve intervention appears to be feasible and is associated with favorable outcomes.
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Srinivasan et al. (2024) conducted a systematic review in severe symptomatic tricuspid regurgitation (n=2,273). Coaptation devices vs. Annuloplasty devices was evaluated on Technical success. Transcatheter tricuspid valve intervention using coaptation and annuloplasty devices achieved technical success rates of 94.8% and 96.7%, and procedural success rates of 81.4% and 64.6%.
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