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Tricuspid intervention for severe tricuspid regurgitation in patients with cardiac implantable electronic devices - management, fate of leads and outcomes
Session:
Sessão de Posters 52 - Intervenção na doença valvular
Speaker:
Ana Raquel Carvalho Santos
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Ana Raquel Carvalho Santos; Francisco Albuquerque; Alexandra Castelo; Vera Ferreira; Ana Galrinho; Pedro Rio; Ana Teresa Timoteo; Luisa Branco; António Fiarresga; Duarte Cacela; Rui Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">Prevalence of lead induced tricuspid regurgitation (LITR) is 7-45%. The most frequent mechanism is lead impingement. However, RV remodelling, pacing-induced cardiomyopathy and tricuspid annular dilatation also can contribute. Only a subset of patients (pts) are candidate to surgical treatment due to high operative risk. Percutaneous treatments have emerged as alternatives, even in pts with preexisting CIED leads. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Aim: </span></strong><span style="font-size:12.0pt">Despite its importance, there is a scarcity of data concerning the impact of the CIED-associated TR in terms of management, fate of leads and pts outcome. The purpose of the current work is to improve some of the gaps in evidence identified above. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Methods</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">A retrospective, single centre analysis was made including pts with CIEDs referred to study of eligibility for tricuspid percutaneous intervention. All CIED lead–related TR were evaluated using both transthoracic echocardiography (TTE) and transoesophageal echocardiography (TEE). Data were collected regarding pts evaluation, management and follow-up. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Results</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">From 2020 to 2023, of the 97 pts referred for study of tricuspid percutaneous intervention eligibility, 37% had a CIED, with 39% presenting lead impingement as TR mechanism. The majority of pts were female (58%), median age of 78 (72-83) years. Median Euroscore II was 6 % (3-9), with 51% of pts having a previous heart surgery. Prior to CIED implantation, 14% already presented severe TR. When analysing post CIED TR, 30% increased 1 grade of TR at 1 year follow up (FU) and 68% increased 1 grade of TR at 5 years FU. Desynchrony was present in 30% of pts. At time of referral for eligibility for percutaneous intervention all pts presented severe TR and 30% underwent intervention (22% percutaneous and 8% surgical). All pts remained with previous electrodes, without need for intervention for dysfunction during FU. When analysing LITR pts, 29% were submitted to intervention. Of those, 7% had edge to edge therapy, 7% heterotopic bicaval device implantation and 15% surgical correction. Subgroups analysis of desynchrony, LITR or type of intervention had no statistically significant differences in outcome, probably due to the small cohort.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Conclusions</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">On our study population more than one third presented lead impingement as TR mechanism and one third presented with desynchrony at 5 years post CIED implantation. There were no statistically significant differences in mortality when evaluating desynchrony, LITR or type of intervention. </span></span></span></p>
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