Transcatheter Tricuspid Valve Replacement and Repair: Pooled Analysis of the Outcomes and Complications of Novel Emerging Treatments

Abstract

Background: Tricuspid regurgitation is a poor prognostic marker of end-stage heart failure. Treatment options for severe tricuspid regurgitation are currently limited because these procedures have the highest mortality rates of all valve procedures. Isolated tricuspid valve surgery is reserved for rare cases during surgical viability evaluation with repair favored over tricuspid valve replacement, owing to the slightly more favorable mortality and downstream complication associated with the latter. Transcatheter tricuspid valve repair or replacement (collectively, TVTT), on the other hand, are extremely promising interventions due to the minimally invasive nature of these treatments. Multiple devices are currently being developed and tested for TTVT to offer surgeons a safer alternative than the aforementioned traditionally high-risk surgical procedures. Objective: The aim of this study is to examine the complications of these procedures from day 0 of procedure to up to 1 year of follow up. Methods: Six studies were included, 3 were registries (TriVALVE, TRILUMINATE, TRAMI), surveying a total of 336 patients. Complications following the procedures were pooled and analyzed. Results: From procedure to up to 1 year, there was 14.3% mortality (49/342), 0.3% incidence of myocardial infarction and TIA/stroke (1/342), 2% device embolization and/ or leaflet detachment (7/342), 5.2% major/minor bleeding (18/342), 0.9% AKI (3/342), 1.1% infections and arrhythmias (4/342). Conclusions: Despite a narrow sample size due to the novelty of these procedures and varying lengths of follow-up (30 days to 1 year), transcatheter tricuspid valve repair and replacement prove to be promising interventions. Mortality was significant at 14.6%, but patients with severe tricuspid regurgitation have a poor prognosis overall without intervention along with higher comparative mortality rates. Research aimed at further investigating TVTT procedures and prospective clinical trials to establish these treatments as mainstays for severe tricuspid regurgitation is necessary.