Outcomes of TTVI in Patients With Pacemaker or Defibrillator Leads: Data From the TriValve Registry.
Taramasso MCardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland. Electronic address: maurizio.taramasso@usz.ch.
Gavazzoni MCardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
Pozzoli ACardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
Alessandrini HCardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany.
Latib ACardiology Department, Montefiore Medical Center, New York, New York.
Attinger-Toller ACardiology Department, St. Paul Hospital, Vancouver, Canada.
Braun DCardiology Department, Klinikum der Universität München, Munich, Germany.
Brochet ECardiology Department, Hôpital Bichat, Université Paris VI, Paris, France.
Connelly KACardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada.
de Bruijn SCardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany.
Denti PCardiac Surgery Department, San Raffaele University Hospital, Milan, Italy.
Deuschl FCardiology Department, University Heart Center Hamburg, Hamburg, Germany.
Estevez-Louriero RCardiology Department, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain.
Fam NCardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada.
Frerker CCardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany.
Ho ECardiology Department, Montefiore Medical Center, New York, New York; Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada.
Juliard JMCardiology Department, Hôpital Bichat, Université Paris VI, Paris, France.
Kaple RCardiology Department, Westchester Medical Center, Valhalla, New York.
Kodali SCardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York.
Kreidel FCardiology Department, Department of Cardiology, University Medical Center Mainz, Mainz, Germany.
Kuck KHCardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany.
Lauten ACardiology Department, Charité University Hospital, Berlin, Germany.
Lurz JCardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany.
Monivas VCardiology Department, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain.
Mehr MCardiology Department, Klinikum der Universität München, Munich, Germany.
Nazif TCardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York.
Praz FCardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Puri RCardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada.
Rodés-Cabau JCardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada.
Schäfer UCardiology Department, University Heart Center Hamburg, Hamburg, Germany.
Schofer JCardiology Department, Albertinen Heart Center, Hamburg, Germany.
Sievert HCardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany.
Tang GHLCardiac Surgery Department, Mount Sinai Hospital, New York, New York.
Khattab AACardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland; Cardiology Department, Cardiance Clinic, Pfäffikon, Switzerland; Cardiology Department, University of Bern, Bern, Switzerland.
Thiele HCardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany.
Unterhuber MCardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany.
Vahanian ACardiology Department, Hôpital Bichat, Université Paris VI, Paris, France.
Von Bardeleben RSCardiology Department, Department of Cardiology, University Medical Center Mainz, Mainz, Germany.
Webb JGCardiology Department, St. Paul Hospital, Vancouver, Canada.
English
OBJECTIVES The 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.
BACKGROUND Feasibility of TTVI in presence of a CIED lead has never been proven on a large basis.
METHODS The 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.
RESULTS Pre-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).
CONCLUSIONS TTVI 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.