Biphasic Right Ventricular Reverse Remodeling Following Tricuspid Valve Transcatheter Edge-to-Edge Repair.

Abstract

Background: Transcatheter tricuspid valve edge-to-edge repair (T-TEER) has been reported to be associated with right ventricular reverse remodeling (RVRR). Data on the temporal evolution of this phenomenon are scarce.

Objectives: The aim of this study was to evaluate RVRR over the course of 2-year follow-up after T-TEER using sequential 3-dimensional echocardiograms (3DE).

Methods: The study included T-TEER patients with available 3DE at baseline and discharge. Further follow-ups were scheduled at 1 month, 6 months, as well as 1 and 2 years. The 3DE evaluation included right ventricular volumes (right ventricular end-diastolic volume [RVEDV^3D]; right ventricular end-systolic volume [RVESV^3D]), right ventricular ejection fraction (RVEF^3D), and RV longitudinal strain of the free wall and the septum.

Results: The study included 231 patients (median age 82 [IQR: 79-86] years, 48% women). We observed a biphasic pattern of RVRR following T-TEER consisting of early RV volume unloading (phase 1, reduced RVEDV^3D) and later structural remodeling (phase 2, reduced RVESV^3D). Whereas RVEDV^3D was significantly reduced early after the procedure (-9.7% from baseline to discharge; P < 0.001), RVESV^3D remained unchanged at 1-month follow-up. Reduction in RVESV^3D was observed at 6-month follow-up for the first time (-5.4% from baseline to 6-month follow-up; P < 0.001). Reduction in both RVEDV^3D and RVESV^3D peaked at 1-year follow-up and remained stable until 2 years after T-TEER. RV function declined early after T-TEER and gradually increased over the course of follow-up (RVEF^3D at baseline 42.2% ± 8.9%, discharge 31.1% ± 9.4%, 2-year follow-up 41.6% ± 8.9%). The 3D RV longitudinal strain of the septum and 3D RV longitudinal strain of the free wall developed analogously.

Conclusions: RVRR following T-TEER occurs in 2 stages and involves early RV unloading (reduction in RVEDV^3D) and later structural RVRR (reduction in RVESV^3D) with an improvement in RVEF.