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Tricuspid regurgitation – patients characteristics, treatment and outcomes
Session:
Posters (Sessão 1 - Écran 8) - Doença Valvular 1 - Vários
Speaker:
Alexandra Castelo
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.2 Valvular Heart Disease – Epidemiology, Prognosis, Outcome
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Alexandra Castelo; Duarte Cacela; António Fiarresga; Ruben Ramos; Luísa Branco; Ana Galrinho; Pedro Brás; Vera Ferreira; Bárbara Teixeira; Rui Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Background</u>: Tricuspid valve has been neglected for a long time, but there is increasing evidence of its importance in patients’ morbidity and mortality, with increasing interest on its treatment.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Purpose</u>: To describe a cohort of patients with tricuspid regurgitation, concerning comorbidities, treatment options and clinical outcomes.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Methods</u>: Retrospective analysis of patients (P) with tricuspid regurgitation between 2018 and 2021 in a tertiary center. Baseline characteristics, treatment decisions and outcomes were collected. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Results</u>: 67P were included (73.1% female), with a mean age 76 ±12 years. P had several associated comorbidities (hypertension 80.6%, coronary artery disease 14.9%, previous stroke 13.4%, atrial fibrillation 88.1%, chronic kidney disease 52.2%, previous bleeding 17.9%). 27P had previous cardiac surgery (34.3% valvular surgery). A device was implanted in 43.3% (90% pacemaker and 10% defibrillator). All P were taking diuretics (100% furosemide, mean dose 56mg, 35.8% spironolactone, mean dose 27mg, 11.9% metolazone, mean dose 4mg) and 76.1% were under oral anticoagulation (45% vitamin K antagonists, 55% direct oral anticoagulants). 65P were in NYHA class 2 or 3, 55P had peripheral edema, 17P had ascites and 25P had previous hospital admissions for heart failure (1-6 admissions). On echocardiography 59.7% had right ventricle dilation, mean TAPSE was 19.5mm and PASP 44mmHg. Tricuspid regurgitation was classified into severe in 68.7%, massive in 4.5% and torrential in 26.9%, and was caused by annulus dilation in 65.7%, leaflet restriction in 6% and prolapse in 4.5% and lead induced in 16.4%. Mean euroscore II was 5.34 ± 4.24%. 7P were accepted for surgery (4P were effectively operated), 4P for clip implantation (3P submitted to the procedure), 8P for TricValve implantation (4P with implantation done), 19P are still being study and 29P were considered for clinical surveillance only (17P with few symptoms, 7P with contraindication for intervention and 5P with frailty). During the follow up 15P (22.4%) died, 3 of them related to heart failure. The majority (12P) died without any tricuspid intervention (5P were accepted for a procedure but died before it could be done), 1P died after surgery (cardiogenic shock) and 2P died after TricValve implantation (1P in the same hospital admission, 1P 4 months later with a septic shock). All the other treated patients had a significant clinical improvement (NYHA class I or II on follow up, no edema and no ascites), without new heart failure hospital admissions and with diuretic doses reductions.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Conclusion</u>: Tricuspid regurgitation is associated with increased morbidity and mortality when a timely treatment is not achieved. Besides frailty, most of these patients have several comorbidities, which makes the percutaneous interventions an attractive new treatment option.</span></span></p>
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