Tricuspid annulus remodelling after transcatheter edge-to-edge repair for reduction of tricuspid regurgitation

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Clinically relevant tricuspid regurgitation is a prevalent valvular disease that has a significant impact on survival. The remarkable progress made in cardiac imaging and in interventional cardiology in the last decades, permits today a better understanding of tricuspid valve and right ventricle morphology and pathophysiology. This allowed to develop multiple transcatheter devices for tricuspid valve interventions. Structural valve interventions are considered nowadays valuable treatment options in anatomically eligible patient at high surgical risk. Transcatheter tricuspid valve interventions are directed to increasing leaflet coaptation either directly by bringing the leaflets together (leaflet approximation devices) or indirectly by reducing the dilated annulus (annuloplasty devices). Efficacy and clinical outcome are promising, but the effect on right ventricle and tricuspid annular reverse remodelling is still under evaluation. Purpose Aim of the study is to evaluate the acute tricuspid annulus remodelling after percutaneous leaflet repair, using a leaflet approximation device for reduction of tricuspid regurgitation. Methods This is a retrospective dual-center cohort study that includes 22 consecutive patients, treated with TriClip in our Hospital. Tricuspid annulus geometry was evaluated using three-dimensional transoesophageal echocardiography examinations conducted during the procedure before and after Triclip implantation. The 3D data sets were analysed using the multiplanar reformatting method. Results The mean age of the study cohort was 80 years, and 90,9% were female. Tricuspid regurgitation was graded severe or greater at pre-operative examination in all patients, mostly due to annular dilation. Procedure was successfully in all patients, with at least 1-grade reduction of tricuspid regurgitation before hospital dismissal. A significative reduction of mean septal-lateral diameter (4,09 ± 0,45 cm vs 3,55 ± 0,57 cm, p = < 0,0001), mean major diameter (4,60 ± 0,56 cm vs 4,24 ± 0,58 cm, p = 0,0011), planimetric area (13,70 ± 2,68 cm2 vs 11,00 ± 2,49 cm2, p = <0,0001) and perimeter (13,50 ± 1,36 cm vs 12,40 ± 1,49 cm, p = 0,0001) of the tricuspid annulus was observed. The eccentricity index (obtained dividing septal-lateral by antero-posterior diameter) was 0,99±0,17 before TriClip implantation and 0,91± 0,19 after (p = 0,0336). Conclusions In this small real-world population, edge-to-edge repair using TriClip was found to be effective and safe. Tricuspid transcatheter repair with a leaflet approximation device lead also to a reduction in the tricuspidal annular dimensions. This is to date the first study that shows positive changes in tricuspid annular geometry, that could have potentially relevant therapeutic implications.