Outcomes of TTVI in Patients With Pacemaker or Defibrillator Leads: Data From the TriValve Registry

Maurizio Taramasso, Mara Gavazzoni, Alberto Pozzoli, Hannes Alessandrini, Azeem Latib, Adrian Attinger-Toller, Luigi Biasco, Daniel Braun, Eric Brochet, Kim A. Connelly, Sabine de Bruijn, Paolo Denti, Florian Deuschl, Rodrigo Estevez-Louriero, Neil Fam, Christian Frerker, Edwin Ho, Jean Michel Juliard, Ryan Kaple, Susheel KodaliFelix Kreidel, Karl Heinz Kuck, Alexander Lauten, Julia Lurz, Vanessa Monivas, Michael Mehr, Tamin Nazif, Georg Nickening, Giovanni Pedrazzini, Fabien Praz, Rishi Puri, Josep Rodés-Cabau, Ulrich Schäfer, Joachim Schofer, Horst Sievert, Gilbert H.L. Tang, Ahmed A. Khattab, Holger Thiele, Matthias Unterhuber, Alec Vahanian, Ralph Stephan Von Bardeleben, John G. Webb, Marcel Weber, Stephan Windecker, Mirjam Winkel, Michel Zuber, Jörg Hausleiter, Philipp Lurz, Francesco Maisano, Martin B. Leon, Rebecca T. Hahn

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)554-564
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume13
Issue number5
DOIs
Publication statusPublished - Mar 9 2020

Keywords

  • transcatheter tricuspid intervention
  • tricuspid regurgitation
  • tricuspid valve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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