SPC365

Tricuspid Transcatheter Edge-to-Edge Repair (TEER): Right Ventricle (RV) function and RV-Pulmonary Artery (RV-PA) coupling characterization in a real-world setting

Session: Comunicações Orais - Sessão 17 - Miscelânea
Speaker: Rita Amador

Congress: CPC 2024
Topic: P. Other
Theme: 37. Miscellanea
Subtheme: 15.4 Valvular Heart Disease – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Rita Amador; Mariana Sousa Paiva; Rui Campante Teles; Marisa Trabulo; Sérgio Maltês; Regina Ribeiras; Pedro Gonçalves; Pedro Freitas; Afonso Felix Oliveira; Sara Guerreiro; João Brito; Manuel Almeida

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Triscuspid Transcatheter Edge-to-Edge Repair (TEER) is a treatment option for high risk patients with tricuspid regurgitation (TR). Nonetheless, right ventricular (RV) dysfunction remains a critical prognosis predictor even in those ultimately undergoing TEER. The RV &ndash; Pulmonary Artery (RV-PA) coupling (TAPSE/PSAP on transthoracic echocardiogram) has been shown to independently predict mortality. However, both TAPSE and PSAP have limited value in patients with severe TR. Our aim was to characterize RV function and RV-PA before and after treatment in those undergoing TEER.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Retrospective, single centre study, including 14 consecutive patients (median age 79 (IQR 77 &ndash; 82) years, 14% male) who underwent TEER between May 2021 and October 2023. A total of 6 patients&nbsp;had undergone previous surgical valvular repair (5 aortic prosthesis and 1 mitral annuloplasty), and 6 patients underwent right heart catheterization prior to TEER.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">We evaluated symptoms, diuretics dose and multiparametric RV function pre- and post-TEER, including RV-PA coupling as calculated by different methods (TAPSE/PSAP; RVS/PSAP and FAC/PSAP).</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In the group that underwent right heart catheterization, mean PMAP, PASP and Cardiac Index were 31 &plusmn; 12 mmHg, 48 &plusmn; 16 mmHg and 2.0 &plusmn; 0.5 L/min/m<sup>2&nbsp;</sup>respectively. There was high concordance between invasive and echocardiographic measurements of PASP (&rho; = 0.926; 95%CI 0.460 &ndash; 0.992). Median Pulmonary Artery Pulsatility index (PAPi) was 3.3 (IQR 1.7 &ndash; 4.1).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In 14 TEER procedures, median procedure time was 124 (IQR 92 &ndash; 203) minutes and median radiation dose was 244 (152 &ndash; 793) mGy. Most patients (79%) implanted 2 devices (6 Clip Mitral XT, XTw, NT, NTW and 8 Pascal P10, PAScal ACE). No procedural complications ocurred. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">TR was reduced to mild-to-moderate in all but 1 patient. We observed a statistically significant reduction in both NYHA class (median 3 to 2 p &lt; 0.05) and furosemide dose (median 70 (IQR 75 &ndash; 120) mg vs. 40 (IQR 0 &ndash; 120 mg), p &lt; 0.05) after the procedure (see figure). There was no significant difference in RV function parameters or RV-PA coupling measures pre- and post-TEER (see figure). </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">At a median follow-up (FUP) of 28 (IQR 5 &ndash; 49) weeks, 2 deaths occurred (1 due to heart failure in a patient with no procedural success and 1 due to fatal ischemic stroke 2 days after the procedure) and 4 patients had heart failure re-admissions. </span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong></span></span></p>

<p><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Early experience indicates that TEER is a feasible and safe procedure, resulting in a significant improvement in tricuspid regurgitation grade and symptomatic relief. A multiparametric evaluation of RV function in patients undergoing tricuspid TEER is warranted to optimize patient selection and outcomes.</span></span></p>