Percutaneous Tricuspid Research Articles

Association of TRI-SCORE with clinical outcomes after percutaneous tricuspid annuloplasty

Abstract Background Significant tricuspid regurgitation (TR) has been associated with excess mortality and heart failure. Functional TR is associated to progressive right ventricular remodeling and dysfunction, leading to comorbidities which elevate the perioperative mortality of isolated tricuspid regurgitation surgery, with an in-hospital mortality between 6-10% according to series. Transcatheter tricuspid annuloplasty is a promising therapeutic alternative in patients with high surgical risk. Appropriate risk stratification and patient selection is essential to ensure benefits of this intervention. European System for Cardiac Operative Risk Evaluation (EUROSCORE) II and the Society of Thoracic Surgeons (STS) score are widely spread in-hospital mortality risk scores in valvular surgery. TRI-SCORE is focused on isolated TR surgery; nevertheless, application of these scores to transcatheter annuloplasty has not been specifically studied yet. Purpose To analyze the utility of surgical scores (EUROSCORE-II, STS and TRISCORE) to predict all-cause mortality in patients undergoing transcatheter tricuspid annuloplasty. Methods A cohort of 49 patients with significant TR was followed up prospectively after the transcatheter tricuspid annuloplasty with Cardioband between 2019 and January 2024 (mean follow-up 18,43 ± 10,95 months). Every score was evaluated in all patients. According to the TRI-SCORE –– 6 points was the 75-percentile and taken as cutoff value –– we divided the cohort in two groups: a low score group (≤6 points) and a high score group (>6 points). Survival was analyzed in the whole cohort and in both subgroups. The curves are depicted using Kaplan-Meier method and were compared using log rank test. Results The study included 49 patients, with mean age of 77,6 ± 7,67 years, 77,6% being women. All the patients had a secondary etiology of TR and 46,9% massive or torrential TR before the intervention. 49% had previous left heart surgery. The median surgical risk values are represented in Table 1. All-cause mortality during follow-up occurred in 9 patients (18,3%). Survival analysis based on EUROSCORE II and STS did not find statically significant association (Table 1). TRI-SCORE had a hazard ratio (HR) of 1,59, also without statically significant association (CI 0.93 – 2.71; p 0.089). Survival analysis in high score group found an increased risk of all-cause mortality (HR 8.5; p 0.025). According to our findings TRI-SCORE > 6 before the procedure confers significant risk of all-cause death (log rank p = 0.009). Figure 1. Conclusions Transcatheter tricuspid annuloplasty is a promising therapy for patients with significant TR regurgitation who are at high surgical risk. According to our findings, TRI-SCORE is an appropriate scoring model to predict all-cause mortality after percutaneous annuloplasty with band. It is not so for other surgical risk scores. Extended follow-up and broader experienced are needed to corroborate these results.Surgical scores: median and mortalitySurvival curves TRI-SCORE

Predictors of residual tricuspid regurgitation after interventional therapy: an automated deep-learning CT analysis

Computed tomography (CT) is used as a valuable tool for device selection for interventional therapy in tricuspid regurgitation (TR). We aimed to evaluate predictors of TR reduction using CT and automated deep learning algorithms. Patients with severe to torrential TR and CTs prior to either percutaneous annuloplasty (PA) or tricuspid transcatheter edge-to-edge repair (T-TEER) were enrolled. CTs were analyzed using automated deep learning algorithms to assess tricuspid valve anatomy, right heart morphology, and function. Outcome parameters comprised post-interventional TR ≤ 1 and all-cause mortality. 84 patients with T-TEER (n = 32) or PA treatment (n = 52) were enrolled. Patients with a post-interventional TR ≤ 1 presented lower tenting heights and smaller tenting angles compared to patients with a TR > 1. Tenting height showed the best accuracy for post-interventional TR > 1 with an AUC of 0.756 (95% CI 0.560–0.951) in the T-TEER and 0.658 (95% CI 0.501–0.815) in the PA group, consistent with a suggested threshold of 6.8 mm and 9.2 mm, respectively. Patients with a post-interventional TR ≤ 1 exhibited a mortality of 4% and those with a TR > 1 of 12% during a follow-up of 331 ± 300 and 370 ± 265 days, respectively (p = 0.124). To conclude, tenting is associated with procedural outcomes and should be considered during screening for interventional TR therapy.

Multimodality Imaging for Right Ventricular Function Assessment in Severe Tricuspid Regurgitation.

Severe tricuspid regurgitation (TR) is a pathological condition associated with worse cardiovascular outcomes. In the vicious cycle of right ventricular compensation and maladaptation to TR, the development of right ventricle (RV) dysfunction has significant prognostic implications, especially in patients undergoing surgical or percutaneous treatments. Indeed, RV dysfunction is associated with increased operative morbidity and mortality in both surgical and percutaneously treated patients. In this context, the identification of clinical or subtle right ventricle dysfunction plays a critical role inpatient selection and timing of surgical or percutaneous tricuspid valve intervention. However, in the presence of severe TR, evaluation of RV function is challenging, given the increase in preload that may lead to an overestimation of systolic function for the Frank-Starling law, reduced reliability of pulmonary artery pressure estimation, the sensitivity of RV to afterload that may result in afterload mismatch after treatment. Consequently, conventional echocardiographic indices have some limitations, and the use of speckle tracking for right ventricular free wall longitudinal strain (RV-FWLS) analysis and the use of 3D echocardiography for RV volumes and ejection fraction estimation are showing promising data. Cardiac magnetic resonance (CMR) represents the gold standards for volumes and ejection fraction evaluation and may add further prognostic information. Finally, cardiac computer tomography (CCT) provides measurements of RV and annulus dimensions that are particularly useful in the transcatheter field. Identification of subtle RV dysfunction may need, therefore, more than one imaging technique, which will lead to tip the balance between medical therapy and early intervention towards the latter before disease progression. Therefore, the aim of this review is to describe the main imaging techniques, providing a comprehensive assessment of their role in RV function evaluation in the presence of severe TR.

Severe lead induced tricuspid regurgitation - clinical impact of repair or replacement of tricuspid valve

Abstract The prevalence of lead-induced tricuspid regurgitation (LITR) ranges between 7 to 45%. The most frequent mechanism of LITR is the impingement of the leaflets, but right ventricle remodelling, pacing-induced cardiomyopathy and tricuspid annular dilatation also can contribute to the severity of tricuspid regurgitation (TR). Different studies concluded that LITR was associated with an increased risk of all-cause mortality and heart failure hospitalizations. Beyond diuretics, patients (P) may be candidates for interventional treatment, including lead extraction, surgery, or percutaneous tricuspid trans-catheter ‘edge-to-edge’ repair (TEER) and heterotopic bicaval devices (HBD). Despite its importance, there is a scarcity of data concerning the management and clinical impact of severe LITR. The purpose of the current analysis is to improve the knowledge regarding the impact of interventional treatment on the outcomes in this population. Methods A retrospective, single-centre analysis was made including P with severe LITR referred to evaluation regarding eligibility for tricuspid percutaneous intervention in a tertiary hospital. All P were evaluated using both transthoracic echocardiography (TTE) and transoesophageal echocardiography (TEE). Data were collected regarding clinical characterization, management, intervention and follow-up. Results From January 2020 to September 2023, of the 97 P referred for tricuspid intervention eligibility, 36 (37%) had LITR, with 14 cases (39%) presenting lead impingement as the TR mechanism. The majority of P were female (58%), with a median age of 78 [IQR 72-83] years. Median Euroscore II was 6 % [IQR 3-9]), with 51% of the P having a previous heart surgery, and 97% presenting atrial fibrillation. Prior to cardiac electronic device (CIED) implantation, 14% already presented TR. When analysing post-CIED TR, 30% increased 1 grade of TR at 1-year follow-up, and 68% increased 2 grades of TR at 5 years. According to TTE, ventricular desynchrony was present in 30% of the P. After evaluation of TR, 30% underwent intervention (22% percutaneous - TEER or HBD - and 8% surgical). All P remained with the previous electrodes. Mortality was 21.1% in the intervention population and 78.9% on the remaining pts (p=0.027). The type of intervention had no statistically significant differences in outcome. Conclusions In our study, more than 1/3 of the cases referred due to severe TR presented lead impingement as the mechanism underlying TR. As previously reported, the intervened population had better outcomes than the remaining pts.

Morbidity and mortality outcomes of patients requiring isolated tricuspid valve surgery: a retrospective cohort study of 537 patients in New South Wales between 2002 and 2018

ObjectivesThe aim of the study was to evaluate mortality and morbidity outcomes following open-heart isolated tricuspid valve surgery (TVSx) with medium to long-term follow-up.DesignRetrospective cohort study.SettingNew South Wales public and...

Frailty, periinterventional complications and outcome in patients undergoing percutaneous mitral and tricuspid valve repair.

Frailty is common in elderly and multimorbid patients and associated with increased vulnerability to stressors. In a single centre study frailty according to Fried criteria was assessed in consecutive patients before transcatheter mitral and tricuspid valve repair. Postprocedural infections, blood transfusion and bleeding and renal failure were retrospectively assessed from records. Median follow-up time for survival was 560 days (IQR: 363 to 730 days). 90% of 626 patients underwent mitral valve repair, 5% tricuspid valve repair, and 5% simultaneous mitral and tricuspid valve repair. 47% were classified as frail. Frailty was associated with a significantly increased frequency of bleeding (16 vs 10%; p = 0.016), blood transfusions (9 vs 3%; p = < 0.001) and infections (18 vs 10%; p = 0.006), but not with acute kidney injury (20 vs 20%; p = 1.00). Bleeding and infections were associated with longer hospital stays, with a more pronounced effect in frail patients (interaction test p < 0.05, additional 3.2 and 4.1 days in frail patients, respectively). Adjustment for the occurrence of complications did not attenuate the increased risk of mortality associated with frailty (HR 2.24 [95% CI 1.62-3.10]; p < 0.001). Bleeding complications and infections were more frequent in frail patients undergoing transcatheter mitral and tricuspid valve repair and partly explained the longer hospital stay. Albeit some of the complications were associated with higher long-term mortality, this did not explain the strong association between frailty and mortality. Further research is warranted to explore interventions targeting periprocedural complications to improve outcomes in this vulnerable population.

Incidence and clinical impact of renal failure and bleeding following transcatheter tricuspid valve annuloplasty.

Bleeding is the most common complication after percutaneous leaflet-based tricuspid valve repair and associated with acute kidney injury (AKI) and adverse outcome. TTVA with the Cardioband system is a technically more complex procedure; however, frequency and prognostic impact of postinterventional bleeding and renal complications have not been thoroughly examined. This study was performed to determine the incidence and clinical impact of bleeding complications (MVARC criteria) and acute kidney injury (KDIGO criteria) following transcatheter tricuspid valve annuloplasty (TTVA). In a bi-center retrospective analysis of patients undergoing TTVA between 2018 and 2022, we examined frequency, predictors, and clinical impact of bleeding and renal failure. In 145 consecutive patients, the incidence of any MVARC bleeding was 20.7% (n = 30), whereas major MVARC bleeding occurred in 6.9% (n = 10). The incidence of AKI was 18.6% (n = 27). Risk factors for bleeding events included low baseline hemoglobin and elevated baseline creatinine levels. Risk factors for AKI included diabetes mellitus, arterial hypertension, high body mass index, and elevated baseline creatinine levels. Neither procedure duration nor amount of contrast media was associated with AKI or bleeding. Both bleeding and AKI led to a longer hospital stay. At 3months, 10.0% (n = 3) of patients with bleeding and 7.8% (n = 9) of patients without bleeding complications died (p = 0.70). Additionally, mortality rate was 7.4% (n = 2) in patients with AKI compared to 8.5% (n = 10) without AKI (p = 0.83). While about a fifth of patients undergoing TTVA suffered from postinterventional AKI or bleeding, none of these complications was associated with higher mortality at short-term follow-up. One important risk factor for both complications was chronic renal dysfunction, indicating a high-risk patient population. The most frequent bleeding localizations were the femoral access site, pericardial hemorrhage, and the esophagus, which need explicit attention in periprocedural management.

Management of isolated native tricuspid valve infective endocarditis by a multidisciplinary program: a single-center retrospective cohort study.

Isolated native tricuspid valve infective endocarditis remains a challenging disease to treat given the large number of patients with substance use disorder. There is limited data on the optimal treatment strategy and the impact of a multidisciplinary endocarditis program on outcomes for this population. To assess the clinical outcomes associated with management of native tricuspid valve infective endocarditis by a multidisciplinary team. Single-center, retrospective cohort study. Patient cases were identified from the registry of the institutional multidisciplinary endocarditis team. Patients with left-sided endocarditis, multivalvular endocarditis, prosthetic tricuspid valves and cardiac implantable electronic devices were excluded. Between September 7th, 2021 and February 1st, 2024 72 consecutive patients with isolated native tricuspid valve infective endocarditis were identified. Sixty-six (91.7%) patients were managed medically. Five patients underwent percutaneous mechanical aspiration of tricuspid valve vegetations and one patient underwent tricuspid valve replacement during the index hospitalization. In-hospital mortality was 1.4% and 90-day mortality was 2.8%. Nineteen (26.4%) patients discharged before medically advised and 25% were re-admitted within 30 days. Ten (13.9%) patients underwent elective tricuspid valve replacements after outpatient follow-up. Among 72 patients with isolated native tricuspid valve infective endocarditis managed by a multidisciplinary endocarditis program over a 2.5-year period, in-hospital, 90-day mortality and 1-year mortality were very low despite low rates of percutaneous mechanical aspiration and tricuspid valve surgery. Multidisciplinary follow-up can lead to elective tricuspid valve surgery in a delayed fashion.

TCT-646 Percutaneous Tricuspid Valve-in-Valve Implantation in Failed Surgical Bioprosthetic Valves: Brazilian Single Center Registry

TCT-646 Percutaneous Tricuspid Valve-in-Valve Implantation in Failed Surgical Bioprosthetic Valves: Brazilian Single Center Registry

Lead management in patients undergoing percutaneous tricuspid valve replacement or repair: a 'heart team' approach.

Clinically significant tricuspid regurgitation (TR) has historically been managed with either medical therapy or surgical interventions. More recently, percutaneous trans-catheter tricuspid valve (TV) replacement and tricuspid trans-catheter edge-to-edge repair have emerged as alternative treatment modalities. Patients with cardiac implantable electronic devices (CIEDs) have an increased incidence of TR. Severe TR in this population can occur for multiple reasons but most often results from the interactions between the CIED lead and the TV apparatus. Management decisions in patients with CIED leads and clinically significant TR, who are undergoing evaluation for a percutaneous TV intervention, need careful consideration as a trans-venous lead extraction (TLE) may both worsen and improve TR severity. Furthermore, given the potential risks of 'jailing' a CIED lead at the time of a percutaneous TV intervention (lead fracture and risk of subsequent infections), consideration should be given to performing a TLE prior to a percutaneous TV intervention. The purpose of this 'state-of-the-art' review is to provide an overview of the causes of TR in patients with CIEDs, discuss the available therapeutic options for patients with TR and CIED leads, and advocate for including a lead management specialist as a member of the 'heart team' when making treatment decisions in patients TR and CIED leads.

Technical Considerations for Percutaneous Tricuspid Paravalvular Leak Closure

Tricuspid paravalvular leaks are uncommon and experience with tackling such cases is limited. There are few case reports in the literature and multiple variations in the techniques used. We highlight the step-by-step methods for performing percutaneous closure of tricuspid paravalvular leaks and discuss the important technical considerations for this complex procedure. A case is used as a practical illustration.

PO-04-016 FIRST REPORT OF LEADLESS PACEMAKER IMPLANTATION IN A PATIENT WITH BOTH A TRANSCATHETER TRICUPID VALVE REPAIR (TRICLIP) AND SURGICAL TRICUSPID VALVE ANNULOPLASTY

An increasing number of patients with valvular heart disease are undergoing novel structural valve interventions with subsequent need for pacemaker implantation. Leadless cardiac pacemakers (LCP) may be particularly suitable in patients with prior tricuspid valve interventions. However, the process of navigating previously repaired tricuspid valves (surgical or percutaneous) can be challenging. To our knowledge, implantation of an LCP in a patient with both surgical TV repair (annuloplasty) and transcatheter TV repair (TriClip, TTVr) has not been reported. In this case, intracardiac echocardiography (ICE) was used to navigate the LCP to its final implant position. To describe the feasibility of implanting an LCP in a patient with surgical and percutaneous tricuspid valve repairs, and the utility of ICE-guided implantation. N/A A 69 year old female with prior inferior vena cava (IVC) filter, percutaneous mitral valve repair (MitraClip) and transcatheter tricuspid valve repair (TriClip) underwent a BioBentall procedure with tricuspid valve repair (annuloplasty band). The existing clips were not removed at the time of surgery. She ultimately developed an indication for back-up ventricular pacing (intermittent high-degree AV block) and an LCP was recommended (Micra, Medtronic Inc., Minneapolis, MN). Under fluoroscopic guidance, the LCP introducer sheath (27 French outer diameter) was first traversed through the IVC filter into the right atrium. Then, using ICE to visualize the tricuspid valve and taking note of the clip position, the deflectable delivery system was maneuvered through the residual tricuspid valve orifice into the right ventricle while avoiding the clips via a superior and anterior approach. Positioning of the delivery system in the apical right ventricular septum in respect to the annuloplasty band and clips was confirmed on ICE imaging and fluoroscopy before and after deployment. LCP sensing, pacing threshold and impedance values were within normal limits. The severity of pre-existing moderate residual tricuspid regurgitation remained unchanged on follow up transthoracic echocardiography. Implantation of a leadless pacemaker after both transcatheter tricuspid valve repair and surgical tricuspid valve annuloplasty band is feasible. Steering through an anatomically challenging tricuspid valve neo-orifices can be performed safely and effectively under intracardiac echocardiography guidance.

PO-02-081 PERCUTANEOUS REMOVAL OF LARGE VEGETATION FACILITATES SAFE TRANSCUTANEOUS LEAD EXTRACTION: A SINGLE CENTER EXPERIENCE

Infective endocarditis (IE) is the most common indication for transvenous lead extraction (TLE), and it is associated with significant morbidity and mortality. Complete removal of the device in addition to antibiotics is required, however large vegetations (>2-3cm) on either the lead or the tricuspid valve confer a high risk of vegetation embolization with standard lead extraction. Vegetation size larger than 2cm appear to have higher incidence of intraprocedural clinically significant pulmonary embolism. An open surgical approach is usually recommended in this situation to mitigate the risk of embolization, however, surgical extraction is associated with increased morbidity/mortality and in some patients the risk is prohibitive. Percutaneous approach to remove large vegetations from tricuspid valve has been reported to be safe in several recent case reports The purpose of our study is to describe our single-center experience of the management of patients with a large vegetation involving the leads and/or the tricuspid valve. The use of percutaneous tricuspid valve/lead vegetation removal permitted or facilitated successful TLE avoiding cardiothoracic surgery We reviewed the perioperative course of 5 consecutive patients with large tricuspid valve and/or lead vegetation referred for device/lead extraction due to endocarditis. Patients with large vegetations considered at increased risk of embolization with transcutaneous extraction were referred for percutaneous vegectomy prior to TLE. Vegectomy procedure is done at our institution using the percutaneous catheter-based system FlowTriever aspiration catheter with FLEX technology (Inari Medical, Irvine, CA USA) with the guidance of intracardiac echocardiogram through femoral vein access (Figure 1). Over a 15-month period, 5 patients presented with large vegetations that precluded TLE due to embolization risk. Four patients (80%) were male, with an average age of 60 years, and the average vegetation size was 2.7 cm (2.4-3.2 cm). All patients underwent vegectomy followed by lead extraction as a staged procedure without complication. All patients survived the index hospitalization (see Table 1 for details) Percutaneous removal of large tricuspid valve/lead vegetations prior to lead extraction is a safe and effective way to manage patient with endocarditis and large vegetations thereby avoiding the morbidity and mortality associated with open heart surgeryTabled 1Table 1Patient #Age (years)Device Type# of LeadsOrganismVegetation Size (cm)Vegetation LocationComplications166CRT-D3MSSA2.5RV LeadNone263DC PPM2No growth2.4RA/RV LeadNone368CRT-D (HIS Lead)3Streptococcus2.5RA LeadNone456ICD (Dual Coil)1Corynebacterium3.0RV Lead/TVNone548DC PPM2MRSA3.2RA LeadNoneCRT-D: Cardiac resynchronization therapy – defibrillator; MSSA: Methicillin sensitive staph aureus; RV: right ventricular; DC PPM: Dual chamber permanent pacemaker; RA: right atrial; ICD: implantable cardioverter defibrillator; MRSA: Methicillin resistant staph aureus; TV: Tricuspid valve Open table in a new tab

(462) 'Tri'Ing to Clip the Gap: Percutaneous Tricuspid Intervention in a Heart Transplant

(462) 'Tri'Ing to Clip the Gap: Percutaneous Tricuspid Intervention in a Heart Transplant

Transcatheter Repair for Patients with Tricuspid Regurgitation

BackgroundSevere tricuspid regurgitation is a debilitating condition that is associated with substantial morbidity and often with poor quality of life. Decreasing tricuspid regurgitation may reduce symptoms and improve clinical outcomes in patients with this disease.MethodsWe conducted a prospective randomized trial of percutaneous tricuspid transcatheter edge-to-edge repair (TEER) for severe tricuspid regurgitation. Patients with symptomatic severe tricuspid regurgitation were enrolled at 65 centers in the United States, Canada, and Europe and were randomly assigned in a 1:1 ratio to receive either TEER or medical therapy (control). The primary end point was a hierarchical composite that included death from any cause or tricuspid-valve surgery; hospitalization for heart failure; and an improvement in quality of life as measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ), with an improvement defined as an increase of at least 15 points in the KCCQ score (range, 0 to 100, with higher scores indicating better quality of life) at the 1-year follow-up. The severity of tricuspid regurgitation and safety were also assessed.ResultsA total of 350 patients were enrolled; 175 were assigned to each group. The mean age of the patients was 78 years, and 54.9% were women. The results for the primary end point favored the TEER group (win ratio, 1.48; 95% confidence interval, 1.06 to 2.13; P=0.02). The incidence of death or tricuspid-valve surgery and the rate of hospitalization for heart failure did not appear to differ between the groups. The KCCQ quality-of-life score changed by a mean (±SD) of 12.3±1.8 points in the TEER group, as compared with 0.6±1.8 points in the control group (P<0.001). At 30 days, 87.0% of the patients in the TEER group and 4.8% of those in the control group had tricuspid regurgitation of no greater than moderate severity (P<0.001). TEER was found to be safe; 98.3% of the patients who underwent the procedure were free from major adverse events at 30 days.ConclusionsTricuspid TEER was safe for patients with severe tricuspid regurgitation, reduced the severity of tricuspid regurgitation, and was associated with an improvement in quality of life. (Funded by Abbott; TRILUMINATE Pivotal ClinicalTrials.gov number, NCT03904147.)

Percutaneous tricuspid valve repair: A safer alternative to traditional approaches?

Key Points The use of the PASCAL transcatheter valve repair system is a safe and feasible approach for treating patients with severe, symptomatic tricuspid regurgitation and is associated with improved quality‐of‐life outcomes at 30 days. The TriCLASP study adds to the growing body of evidence supporting the use of transcatheter tricuspid valve interventions for treating severe tricuspid regurgitation in high‐risk surgical patients. In the highly anticipated CLASP II TR pivotal trial (NCT04097145), patients will be randomized to receive treatment with the PASCAL system and optimal medical therapy or optimal medical therapy alone.

Erythromelalgia improvement after percutaneous tricuspid regurgitation repairment in a patient with polycythemia vera

Erythromelalgia improvement after percutaneous tricuspid regurgitation repairment in a patient with polycythemia vera

Sequential percutaneous tricuspid and pulmonary valve implantation in a young child operated previously for Ebstein Anomaly.

We report a successful percutaneous tricuspid valve implantation followed by a percutaneous pulmonary valve implantation in a young child with Ebstein's anomaly of tricuspid valve and pulmonary stenosis who was previously treated surgically at 1 year of age with tricuspid ring annuloplasty and a transannular outflow patch. This article shows the feasibility of sequential implantation of two valves in young patients with severe tricuspid and pulmonary valve insufficiency.

The evolving role of multi-modality imaging in transcatheter tricuspid valve interventions

Tricuspid valve pathophysiology is not well-understood. Emergence of novel transcatheter tricuspid therapies has fueled the requirements for improved imaging visualization techniques and interventional imaging physician skillsets in guiding these complex transcatheter procedures. There is growing understanding on the clinical significance of tricuspid regurgitation which expanded the interest for percutaneous tricuspid valve interventions. The present review concentrates on three essential aspects of tricuspid valve pathophysiology: anatomical considerations for tricuspid interventions, optimal timing of tricuspid interventions by imaging guidance, and the role of interventional imaging physicians' skillset and knowledge in this field.

Tricuspid regurgitation severity and transcatheter tricuspid annuloplasty

Abstract Introduction Transcatheter tricuspid annuloplasty is a promising therapeutic alternative for the treatment of tricuspid regurgitation (TR) in patients with a high surgical risk. To date, the published experience with percutaneous tricuspid devices is quite limited. The objective of this study is to present the impact of the transcatheter tricuspid annuloplasty with band implantation on the degree of TR and on several echocardiographic parameters in a series of 27 patients. Methods A single-center cohort of 27 patients was followed up prospectively after the transcatheter tricuspid annuloplasty with band implantation (mean follow-up: 10,39 months) (Figure 1). The degree of tricuspid regurgitation (mild, moderate, severe, massive, torrential) was measured before and after the procedure, as well as at 6 months and one year of follow-up. Other parameters have also been considered, such as the septal-lateral end-diastolic diameter of the tricuspid annulus, the vena contracta (VC), regurgitant orifice area (ROA) 2D, tricuspid annular plane systolic excursion (TAPSE), right ventricular ejection fraction (RVEF) and fractional area change (FAC). Results Initially, there were 22.3% of patients with torrential TR, 29.6% massive and 48% severe. After the procedure, these percentages were reduced to 3.8%, 7.7% and 23.1% respectively, leading to an amount of 65% of patients with mild or moderate TR. With respect to the the diameter of the lateral septum ring, the mean was initially 44.74 mm. After the procedure, it decreased to 34.5 mm (22% of reduction) and, as can be seen during follow-up, it remains stable over time. The ROA and VC were also significantly reduced while TAPSE, CAF and RVEF do not show significant changes (Figure 2). Percutaneous tricuspid annuloplasty demonstrated a notable impact on the degree of tricuspid regurgitation reduction in the patients in our study. The differences are already noticeable from the moment of the procedure and are maintained throughout the follow-up, where the stability of the diameter of the septolateral ring, the ERO and the vena contracta is observed. Funding Acknowledgement Type of funding sources: None.