Transcatheter repair for tricuspid regurgitation is safe and effective

Transcatheter tricuspid valve repair (TTVr) appears to be both feasible and effective for patients with tricuspid regurgitation (TR), according to a new systematic review published in JACC: Cardiovascular Interventions.

“TR is a prevalent valvular disease, associated with increased mortality and morbidity and worsening of symptoms over time,” wrote first author Claudio Montalto, MD, a cardiologist at the University of Pavia in Italy, and colleagues. “In most cases, TR is secondary to left-sided heart disease and is often left untreated at the time of surgical correction of the primary valve disease. At present, many patients with symptomatic severe TR are at high or prohibitive surgical risk, and pharmacological therapy, often ineffective, remains the only management option available.”

TTVr, the authors added, has come a long way in recent years. To learn more about its effectiveness as an alternative treatment option, Montalto et al. explored data from seven different interventional studies published from Jan. 1, 2000, to Sept. 1, 2019.

Overall, 454 patients were included in the analysis. All patients had at least moderate TR and underwent TTVr. Ninety-five percent of those patients had at least severe TR. The follow-up times ranged from 30 days to a full year.

There was a successful implantation in 86% of patients, the team observed, and 9% died. Looking at other specific outcomes, the researchers noted that fewer patients had severe TR or were categorized as New York Heart Association functional class III or IV after the procedure.

Also, patients were able to walk a further distance in six minutes and showed “significant reductions” in tricuspid valve annular diameter after TTVr.

“Our pooled analysis revealed that TTVr with current devices is feasible and effective at reducing TR in high-risk patients with severe symptomatic TR,” the authors wrote. “Moreover, patients treated with TTVr exhibit favorable outcomes with improved functional capacities. Further studies are required to confirm the positive effects of transcatheter therapies on patient prognosis and functional status at long term follow-up.”

There were certain limitations to the team’s research. The results may not necessarily be applicable to patients with “less severe clinical conditions,” for instance, and “definitions of procedural success were different among the studies analyzed.”

Looking forward, Montalto and colleagues wrote that a larger randomized clinical trial is needed that focuses on the different TTVr solutions individually.