July 11, 2022Frontiers in Cardiovascular Medicine51 citationsOpen Access
Clinical and Echocardiographic Outcomes of Transcatheter Tricuspid Valve Interventions: A Systematic Review and Meta-Analysis
Key Result
Successful transcatheter tricuspid valve intervention was associated with a 58% risk reduction in 1-year all-cause mortality compared to unsuccessful procedures (OR 0.42).
Study Design
Type
Meta-Analysis (n=1,216)
Multicenter
Yes
Structured PICO
Do transcatheter tricuspid valve interventions improve survival and reduce regurgitation severity in high-risk patients with tricuspid regurgitation?
P
Population
1,216 older adults (mean age 76.6 years, 60.5% female) with severe tricuspid regurgitation undergoing transcatheter tricuspid valve interventions across 27 studies, followed for up to 139 weeks.
I
Intervention
Transcatheter tricuspid valve interventions (TTVIs)
C
Comparator
Lack of procedural success (for mortality comparison) or baseline (for echocardiographic outcomes)
O
Outcome
All-cause mortality at 30-day and 1-year post-TTVIhard clinical
Transcatheter tricuspid valve interventions significantly reduce TR severity, increase forward stroke volume, and successful procedures are associated with improved 1-year survival.
Main Result
Odds Ratio: 0.42 (95% CI 0.27–0.66)
p-value: p=<0.001
Limitations
- Selection bias relative to the non-randomized nature of the included studies
- High heterogeneity in some primary analyses
- Lack of direct comparison to medical therapy in randomized trials
Abstract
Background Medically managed tricuspid regurgitation (TR) has detrimental outcomes. Transcatheter tricuspid valve interventions (TTVIs) represent an alternative to surgery in high-risk patients; however, only early experiences exist. Aim The aim of this study was to analyze the clinical and echocardiographic outcomes of TTVI. Methods MEDLINE, ISI Web of Science, and SCOPUS databases were searched for studies published up to June 2021. Studies reporting data on outcome post-TTVIs were included. This study was designed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) requirements. The primary endpoint was all-cause mortality at 30-day and 1-year post-TTVI. Results Out of 2,718 studies, 27 were included. Notably, 30-day and 1-year all-cause mortalities were 5% (95% confidence interval CI: 4–8%, p 0.001) and 25% (95% CI: 12–45%, p = 0.016). Procedural success was associated with a 58% risk reduction in 1-year mortality vs. lack thereof (odds ratio 0.42, 95% CI: 0.27–0.66, p 0.001). TTVI is associated with a significant reduction in TR severity (TR EROA, mean difference MD 0.31 cm 2 ; 95% CI: 0.23–0.39 cm 2 , p 0.001; regurgitant volume, MD 23.54 ml; 95% CI: 17.4–29.68 ml, p = 0.03) and increase in forward stroke volume (FSV, MD 3.98 ml; 95% CI: 0.11–7.86 ml, p = 0.04). Conclusion TTVI significantly reduces TR severity and increases FSV and is associated with improved survival at 1 year compared with patients without procedural success. Long-term outcomes compared with medical therapy await the results of ongoing pivotal trials; nonetheless, TTVIs appear to be a promising alternative to surgery for TR.