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Outcomes of TTVI in Patients With Pacemaker or Defibrillator Leads: Data From the TriValve Registry |
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| Institution: | 1. Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland;2. Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany;3. Cardiology Department, Montefiore Medical Center, New York, New York;4. Cardiology Department, St. Paul Hospital, Vancouver, Canada;5. Cardiology Department, Cardiocentro, Lugano, Switzerland;6. Cardiology Department, Klinikum der Universität München, Munich, Germany;7. Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France;8. Cardiology Department, Toronto Heart Center, St. Michael’s Hospital, Toronto, Canada;9. Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany;10. Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy;11. Cardiology Department, University Heart Center Hamburg, Hamburg, Germany;12. Cardiology Department, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain;13. Cardiology Department, Westchester Medical Center, Valhalla, New York;14. Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York;15. Cardiology Department, Department of Cardiology, University Medical Center Mainz, Mainz, Germany;p. Cardiology Department, Charité University Hospital, Berlin, Germany;q. Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany;r. Cardiology Department, Universitatsklinikum Bonn, Bonn, Germany;s. Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland;t. Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada;u. Cardiology Department, Albertinen Heart Center, Hamburg, Germany;v. Cardiac Surgery Department, Mount Sinai Hospital, New York, New York;w. Cardiology Department, Cardiance Clinic, Pfäffikon, Switzerland;x. Cardiology Department, University of Bern, Bern, Switzerland |
| Abstract: | ObjectivesThe interference of a transtricuspid cardiac implantable electronic device (CIED) lead with tricuspid valve function may contribute to the mechanism of tricuspid regurgitation (TR) and poses specific therapeutic challenges during transcatheter tricuspid valve intervention (TTVI). Feasibility and efficacy of TTVI in presence of a CIED is unclear.BackgroundFeasibility of TTVI in presence of a CIED lead has never been proven on a large basis.MethodsThe study population consisted of 470 patients with severe symptomatic TR from the TriValve (Transcatheter Tricuspid Valve Therapies) registry who underwent TTVI at 21 centers between 2015 and 2018. The association of CIED and outcomes were assessed.ResultsPre-procedural CIED was present in 121 of 470 (25.7%) patients. The most frequent location of the CIED lead was the posteroseptal commissure (44.0%). As compared with patients without a transvalvular lead (no-CIED group), patients having a tricuspid lead (CIED group) were more symptomatic (New York Heart Association functional class III to IV in 95.9% vs. 92.3%; p = 0.02) and more frequently had previous episodes of right heart failure (87.8% vs. 69.0%; p = 0.002). No-CIED patients had more severe TR (effective regurgitant orifice area 0.7 ± 0.6 cm2 vs. 0.6 ± 0.3 cm2; p = 0.02), but significantly better right ventricular function (tricuspid annular plane systolic excursion = 16.7 ± 5.0 mm vs. 15.9 ± 4.0 mm; p = 0.04). Overall, 373 patients (79%) were treated with the MitraClip (Abbott Vascular, Santa Clara, California) (106 87.0%] in the CIED group). Among them, 154 (33%) patients had concomitant transcatheter mitral repair (55 46.0%] in the CIED group, all MitraClip). Procedural success was achieved in 80.0% of no-CIED patients and in 78.6% of CIED patients (p = 0.74), with an in-hospital mortality of 2.9% and 3.7%, respectively (p = 0.70). At 30 days, residual TR ≤2+ was observed in 70.8% of no-CIED and in 73.7% of CIED patients (p = 0.6). Symptomatic improvement was observed in both groups (NYHA functional class I to II at 30 days: 66.0% vs. 65.0%; p = 0.30). Survival at 12 months was 80.7 ± 3.0% in the no-CIED patients and 73.6 ± 5.0% in the CIED patients (p = 0.30).ConclusionsTTVI is feasible in selected patients with CIED leads and acute procedural success and short-term clinical outcomes are comparable to those observed in patients without a transtricuspid lead. |
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