Hemodynamic Changes After Transcatheter Valve Repair and Replacement for Tricuspid Regurgitation.
MitraClip G4 vs PASCAL is a coin flip in functional MR.
The Leipzig propensity-matched cohort (116 pairs, single-center, non-randomized) found identical procedural success (98.1% vs 97.3%), 1-year survival (86.7% vs 87.8%), and freedom from HF rehospitalization.
BACKGROUND: Transcatheter edge-to-edge repair (TEER) and replacement (TTVR) have emerged as new modalities to treat patients with symptomatic significant tricuspid regurgitation. This study aimed to compare invasive hemodynamic and right ventricular (RV) changes and symptom improvement over 1 year. METHODS: Patients who underwent TEER/TTVR at Mayo Clinic (Rochester, MN, 2017-2024) were included. Hemodynamic profiles were described before and immediately after intervention, in addition to RV enlargement/dysfunction ≥moderate at 30 days and change in symptoms over time. RESULTS: Of 100 patients included (50 per group, median age 81 versus 80 years and female 62% versus 42%, in TTVR and TEER, respectively), all had ≥ moderate-severe symptomatic tricuspid regurgitation. Post intervention, mean right atrial pressure decreased in TEER (16 to 14 mm Hg, P<0.001), V wave decreased in both groups (to 16 mm Hg, P<0.001). RV enlargement was less prevalent in both cohorts at 30 days (60%-40% in TEER, P=0.01, and 72 to 58% in TTVR, P=0.07), yet prevalence of RV dysfunction decreased only in TEER (26 to 15%, P=0.17) as opposed to TTVR (31 to 44%, P=0.13). TTVR resulted in a higher stroke volume index and more complete tricuspid regurgitation elimination at 30 days. Both groups resulted in similar improvements in New York Heart Association class, with overall similar survival. CONCLUSIONS: TEER was associated with a greater reduction in right atrial pressure and more favorable RV remodeling at 30 days, as opposed to TTVR, which achieved more complete and sustained elimination of tricuspid regurgitation with higher forward stroke volume.
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