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Background: It remains unclear what proportion of patients with tricuspid regurgitation (TR) are suitable candidates for transcatheter tricuspid valve intervention (TTVI) in clinical practice., Objectives: The aim of this study was to ascertain the prevalence of eligibility for tricuspid transcatheter edge-to-edge repair (T-TEER) and transcatheter tricuspid valve replacement (TTVR) devices among patients with TR., Methods: The tricuspid valve anatomy of all consecutive patients with TR who were considered for TTVI in local heart team conferences was retrospectively reviewed. According to current expert consensus, the anatomical feasibility for T-TEER was classified into 3 groups: favorable, feasible, and unfavorable anatomy. Clinical and anatomical eligibility for TTVR was evaluated in patients with cardiac computed tomographic (CCT) images., Results: Among 491 patients, 99 (20.2%) and 235 (47.9%) were considered to have favorable and feasible anatomy for T-TEER, respectively. In contrast, 157 patients (32.0%) had unfavorable anatomy for T-TEER. The most common reason for unfavorable anatomy for T-TEER was large coaptation gap width (66.2%), followed by anteroposterior TR jet location (62.4%). Among 327 patients with CCT images, 205 (62.7%) were judged to be clinically or anatomically ineligible for TTVR, mainly because of tricuspid annuli larger than commercially available prosthesis sizes (65.4%). Combined echocardiographic and CCT assessment showed that 23.2% of the patients with TR were ineligible for both T-TEER and TTVR., Conclusions: Of 491 patients requiring TTVI, 32.0% had unfavorable anatomy for T-TEER, and 37.3% of patients with CCT images were eligible for TTVR. Despite the emergence of TTVR devices, 23.2% of patients with TR remained ineligible for both T-TEER and TTVR., Competing Interests: Funding Support and Author Disclosures Dr Tanaka has received grants from the Japanese College of Cardiology and the Uehara Memorial Foundation; and has received honoraria from Canon Medical Systems. Dr Sugiura has received honoraria for lectures and proctoring from Edwards Lifesciences. Dr Nickenig has received research funding from Deutsche Forschungsgemeinschaft, the German Federal Ministry of Education and Research, the European Union, Abbott, Edwards Lifesciences, Medtronic, and St. Jude Medical; and has received honoraria for lectures or advisory board membership from Abbott, Edwards Lifesciences, Medtronic, and St. Jude Medical. Dr Weber has received lecture or proctoring fees from Abbott and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: We assessed the safety profile of tricuspid transcatheter edge-to-edge repair (TEER) in patients with right ventricular (RV) dysfunction., Methods: We identified patients undergoing TEER to treat tricuspid regurgitation from June 2015 to October 2021 and assessed tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (RVFAC). RV dysfunction was defined as TAPSE <17 mm and RVFAC <35%. The primary end point was 30-day mortality after TEER. We also investigated the change in the RV function in the early phase and clinical outcomes at 2 years., Results: The study participants (n=262) were at high surgical risk (EuroSCORE II, 6.2% [interquartile range, 4.0%-10.3%]). Among them, 44 patients met the criteria of RV dysfunction. Thirty-day mortality was 3.2% in patients with normal RV function and 2.3% in patients with RV dysfunction ( P =0.99). Tricuspid regurgitation reduction to ≤2+ was consistently achieved irrespective of RV dysfunction (76.5% versus 70.5%; P =0.44). TAPSE and RVFAC declined after TEER in patients with normal RV function (TAPSE, 19.0±4.7 to 17.9±4.5 mm; P =0.001; RVFAC, 46.2%±8.1% to 40.3%±9.7%; P <0.001). In contrast, those parameters were unchanged or tended to increase in patients with RV dysfunction (TAPSE, 13.2±2.3 to 15.3±4.7 mm; P =0.011; RVFAC, 29.6%±4.1% to 31.6%±8.3%; P =0.14). Two years after TEER, compared with patients with normal RV function, patients with RV dysfunction had significantly higher mortality (27.0% versus 56.3%; P <0.001)., Conclusions: TEER was safe and feasible to treat tricuspid regurgitation in patients with RV dysfunction. The decline in the RV function was observed in patients with normal RV function but not in patients with RV dysfunction., Competing Interests: Disclosures Dr Tanaka received a grant from the Japanese College of Cardiology and the Uehara Memorial Foundation and honoraria from Canon Medical Systems. Dr Nickenig received research funding from the Deutsche Forschungsgemeinschaft, the German Federal Ministry of Education and Research, Abbott, Edwards Lifesciences, Medtronic, and St. Jude Medical and honoraria for lectures or advisory boards from Abbott, Edwards Lifesciences, Medtronic, and St. Jude Medical. Dr Weber received lecture or proctoring fees from Abbott and Edwards Lifesciences. Dr Sugiura received honoraria for lectures from Abbott and Edwards Lifesciences. The other authors report no conflicts.

Aims: The role of right ventricular function in patients undergoing transcatheter tricuspid valve repair (TTVR) is poorly understood. This study investigated the association of right ventricular ejection fraction (RVEF) assessed by cardiac computed tomography (CCT) with clinical outcomes in patients undergoing TTVR., Methods and Results: We retrospectively assessed three-dimensional (3D) RVEF by using pre-procedural CCT images in patients undergoing TTVR. RV dysfunction was defined as a CT-RVEF of <45%. The primary outcome was a composite outcome, consisting of all-cause mortality and hospitalization due to heart failure, within 1 year after TTVR. Of 157 patients, 58 (36.9%) presented with CT-RVEF <45%. Procedural success and in-hospital mortality were comparable between patients with CT-RVEF <45% and ≥45%. However, CT-RVEF of <45% was associated with a higher risk of the composite outcome (hazard ratio: 2.99; 95% confidence interval: 1.65-5.41; P = 0.001), which had an additional value beyond two-dimensional echocardiographic assessments of RV function to stratify the risk of the composite outcome. In addition, patients with CT-RVEF ≥45% exhibited the association of procedural success (i.e. residual tricuspid regurgitation of ≤2+ at discharge) with a decreased risk of the composite outcome, while this association was attenuated in those with CT-RVEF <45% (P for interaction = 0.035)., Conclusion: CT-RVEF is associated with the risk of the composite outcome after TTVR, and a reduced CT-RVEF might attenuate the prognostic benefit of TR reduction. The assessment of 3D-RVEF by using CCT may refine the patient selection for TTVR., Competing Interests: Conflict of interest: T.T. has been financially supported in part by a Fellowship from the Japanese College of Cardiology and the Uehara Memorial Foundation. A.S. has received honoraria for lectures from Edwards Lifesciences. G.N. has received research funding from the Deutsche Forschungsgemeinschaft, the German Federal Ministry of Education and Research, the EU, Abbott, Edwards Lifesciences, Medtronic, and St. Jude Medical and has received honoraria for lectures or advisory boards from Abbott, Edwards Lifesciences, Medtronic, and St. Jude Medical. M.W. has received lecture or proctoring fees from Abbott and Edwards. The other authors have no conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Hepatorenal dysfunction is a strong risk factor in patients with heart failure (HF). We investigated the prognostic significance of hepatorenal dysfunction in 172 consecutive patients undergoing transcatheter tricuspid valve repair (TTVR). The model for end-stage liver disease excluding international normalized ratio (MELD-XI) score was calculated as 5.11 × ln(serum total bilirubin [mg/dl]) + 11.76 × ln(serum creatinine [mg/dl]) + 9.44. Patients were stratified into two groups: high (≥ 14) or low (< 14) MELD-XI score, according to the best cut-off value to predict a one-year composite outcome consisting of all-cause mortality and HF hospitalization. Compared to patients with low MELD-XI score (n = 121), patients with high MELD-XI score (n = 51) had a higher incidence of the composite outcome (47.1% vs. 17.4%; p < 0.0001). In the multivariable analysis, the MELD-XI score was an independent predictor of the composite outcome (adjusted hazard ratio: 1.12; 95% confidence interval [CI] 1.05-1.19; p = 0.0003). In addition, post-procedural TR < 3 + after TTVR was independently associated with a reduction in MELD-XI score six months after TTVR (adjusted odds ratio: 3.37; 95% CI 1.09-10.40; p = 0.03). Thus, the MELD-XI score was associated with the risk of one-year composite outcome, consisting of mortality and HF hospitalization, after TTVR and may help the risk stratification in patients undergoing TTVR., (© 2021. The Author(s).)

We aimed to comprehensively assess tricuspid valve anatomy and to determine factors associated with the more advanced stages beyond severe TR (i.e., massive to torrential). We retrospectively analyzed the pre-procedural cardiac CT images in patients with ≥severe TR using 3mensio software. The tricuspid valve annulus size, right-atrial and right-ventricular dimensions, tenting height, and leaflet angles were measured. A total of 103 patients were analyzed. The mean effective regurgitant orifice area was 61.7 ​± ​31.5 ​mm2, vena contracta was 13.1 ​± ​4.6 ​mm, and massive/torrential TR was observed in 62 patients. Compared to patients with severe TR, patients with massive/torrential TR had a larger tricuspid annulus area (18.6 ​± ​3.4 ​cm2 vs. 20.6 ​± ​5.3 ​cm2, p ​= ​0.037), right atrial short-axis diameter (66.1 ​± ​9.1 ​mm vs. 70.6 ​± ​9.9 ​mm, p ​= ​0.022), increased tenting height (8.8 ​± ​3.6 ​mm vs. 10.7 ​± ​3.7 ​mm, p ​= ​0.014), and greater leaflet angles (anterior leaflet: 22 ​± ​9° vs. 32 ​± ​13°, p ​< ​0.001; posterior leaflet: 22 ​± ​11° vs. 30 ​± ​11°, p ​= ​0.003). In the multivariable logistic regression model, the angle of anterior leaflet (OR 1.08, 95%CI 1.03–1.14, p ​= ​0.004) and posterior leaflet (OR 1.07, 95%CI 1.02–1.13, p ​= ​0.007) were associated with massive/torrential TR. Additionally, patients with massive/torrential TR more often had TR jets from non-central/non-anteroseptal commissure (34% vs. 76%, p ​< ​0.001). In the multivariable model, a greater angle of the leaflets and a more elliptical annulus were associated with non-central/non-anteroseptal TR jets. Anterior and posterior leaflet angles are significant factors associated with massive/torrential TR. Furthermore, leaflet angles and ellipticity of the tricuspid valve are associated with the location of TR jets. Tricuspid valve anatomy of massive to torrential TR. We assessed CT images in 103 patients with TR and investigated anatomical features of massive to torrential TR. Compared to patients with severe TR, patients with massive/torrential TR had a larger tricuspid annulus area, right atrial short-axis diameter, increased tenting height, and greater leaflet angles. In the multivariable logistic regression model, the angle of anterior leaflet (OR 1.08, 95%CI 1.03–1.14) and posterior leaflet (OR 1.07, 95%CI 1.02–1.13) were associated with massive/torrential TR. Additionally, the greater angle of the leaflets and more elliptical annulus were associated with non-central/non-anteroseptal TR jets. [Display omitted] [ABSTRACT FROM AUTHOR]

Since the recognition of the impact of significant tricuspid regurgitation on the clinical course and mortality, intensive efforts have been made in identifying and developing individually suitable and catheter-based therapy strategies to offer those often older and multimorbid patients at high surgical risk safe, feasible, and efficacious treatment options with justifiable risk. Up to now, transcatheter edge-to-edge repair with leaflet approximation devices such as TriClip (Abbott, Santa Clara, CA, USA) and PASCAL Implant System (Edwards Lifesciences, Irvine, CA, USA) have been evaluated best and several clinical trials could prove safety, feasibility, and efficacy of said devices leading to their recent CE mark. However, further randomized controlled trial are pending and necessary to evaluate their impact on clinical course and outcome in comparison to established treatment recommendations. [ABSTRACT FROM AUTHOR]