Effect of interventional edge-to-edge repair in tricuspid regurgitation on ring dimensions. (14th October 2021)

• Record Type: Journal Article
• Authors: Goebel, B; Salomon, C; Abdulrahman, M; Richter, S; El Garhy, M; Costello-Boerrigter, L; Lapp, H; Lauten, P
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: Valvular Heart Disease; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.0111
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: The concept of percutaneous tricuspid valve edge-to-edge repair (pTVR) is based on the connection of leaflets in the area of insufficiency using a coaptation device. By closing the coaptation device a considerable tractive force is applied on the leaflets, which might have an effect on the valve ring. Aim of the study was to examine the impact of device implantation on tricuspid ring dimensions. Methods: During pTVR 3D zoom loops of tricuspid valve were acquired before and after clip placement using transoesophageal echocardiography. Measurements of TV ring dimensions included the following parameters: ring area (TV area), maximal diameter, minimal diameter, eccentricity index (Figure 1). Tenting area was derived from a four-chamber view of the valve. In addition, regurgitation severity was graded from 1+ to 5+ by measuring vena contracta area (VCA3D) in 3D full volume colour Doppler loop using multiplanar reconstruction. Right atrial (RA) and ventricular volumes (RVVd3D, RVVs3D) and function (RVEF3D) were assessed in a 3D full volume loop. Results: The study population comprised 97 patients (age 78±6 years, 47 male), who underwent pTVR at our hospital. As expected cavity dimension correlated with TV area size (for RVVd3D r=0.51, p<0.001 and for RA volume r=0.71, p<0.001). The mean TV ring area was significantly reduced (ring area 8.53±2.23 cm 2 /m 2 BSA vs. 7.55±2.18 cm 2 /m 2 BSA, p<0.001) and the ring shape became more oval (Eccentricity index 1.2±0.15 vs. 1.29±0.17, p<0.001) after pTVR. The reduction of ring area (12±7%, range 0.7–28%) showed an only modest correlation to the number of implanted coaptation devices (r=0.30, p<0.001) and percentage reduction of VCA3D (r=0.36, p<0.001). In the patient group with a ring area change ≥12% a reduction to TR grade ≤2+ by pTVR was achieved in 83% of cases, whereas only 62% of patients reached moderate TR when area change was below 12%. Conclusion: pTVR using coaptation devices reduces the ring area. This effect is related to the number of devices implanted. Funding Acknowledgement: Type of funding sources: None.