Clinical Pearls & Morning Reports
Published May 17, 2023
Sorajja et al. conducted a randomized clinical trial to evaluate the safety and effectiveness of percutaneous tricuspid transcath¬eter edge-to-edge repair (TEER) in symptom¬atic patients with severe tricuspid regurgitation. Read the NEJM Original Article here.
Q: What medical therapies are used to treat tricuspid regurgitation?
A: Recent recognition that tricuspid regurgitation has independent prognostic implications for clin¬ical outcomes has refocused attention on treat¬ment options, including medical therapies and surgery. Medical therapy for tricuspid regurgita¬tion is largely limited to diuretic agents, which can lead to abatement of symptoms in some patients. Many patients have progression to the point that they are periodically hospitalized or attend clinic visits to receive intravenous diuret¬ics when their fluid status is not well-managed.
Q: Does tricuspid TEER involve deployment of a clip?
A: Treatment of tricuspid regurgitation with trans¬catheter edge-to-edge repair (TEER) has emerged as a safe and potentially effective therapy for patients with tricuspid regurgitation. This percutaneous procedure involves a transvenous approach and approximates the tricuspid-valve leaflets by deploying a clip to hold the leaflets together and reduce tricuspid regurgitation without the need for cardiopulmonary bypass or cardiac surgery.
A: The authors found that tricuspid TEER reduced severe tricuspid regurgitation and was associated with improvements in quality of life at 1 year. The primary end point of the trial was a hierarchical com¬posite that included death from any cause or tricuspid-valve surgery; hospitalization for heart failure; and an improvement in quality of life as measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ), with an improvement defined as an increase of at least 15 points as¬sessed at the 1-year follow-up. Death from any cause or tricuspid-valve sur¬gery occurred in 16 patients (9.4% by Kaplan–Meier analysis) in the TEER group and 18 patients (10.6% by Kaplan–Meier analysis) in the control group. The annualized rate of hospitalization for heart failure was 0.21 events per patient-year in the TEER group and 0.17 events per patient-year in the control group. The reduction in tricuspid regurgitation was correlated with improvements in quality-of-life scores in the TEER group, with a mean increase in the KCCQ score of approximately 12 points at 1 year, as compared with a mean increase of approximately 1 point in the control group. Almost twice as many patients in the TEER group as in the control group had an improve-ment of 15 points or greater in their KCCQ score at 1 year.
A: TEER was found to be safe; 98.3% of the patients who underwent the procedure were free from major adverse events at 30 days. Given the importance of symp¬toms and the degree of valve regurgitation for long-term event-free survival and the differences between the two groups at 1 year, longitudinal follow-up for survival and hospitalizations for heart failure will be important. The patients enrolled in this trial will be followed for 5 years.