Faculty Collaboration Database

Mid-Term Valve-Related Outcomes After Transcatheter Tricuspid Valve-in-Valve or Valve-in-Ring Replacement. J Am Coll Cardiol 2019 Jan 22;73(2):148-157

Date

01/19/2019

Pubmed ID

30654886

DOI

10.1016/j.jacc.2018.10.051

Scopus ID

2-s2.0-85059349346 (requires institutional sign-in at Scopus site)   78 Citations

Abstract

BACKGROUND: Transcatheter aortic and pulmonary valves have been used to treat stenosis or regurgitation after prior surgical tricuspid valve (TV) replacement or repair. Little is known about intermediate-term valve-related outcomes after transcatheter tricuspid valve replacement (TTVR), including valve function, thrombus, and endocarditis.

OBJECTIVES: The authors sought to evaluate mid-term outcomes in a large cohort of patients who underwent TTVR after surgical TV repair or replacement, with a focus on valve-related outcomes.

METHODS: Patients who underwent TTVR after prior surgical TV replacement or repair were collected through an international registry. Time-related outcomes were modeled and risk factors assessed.

RESULTS: Data were collected for 306 patients who underwent TTVR from 2008 through 2017 at 80 centers; 52 patients (17%) had a prior history of endocarditis. Patients were followed for a median of 15.9 months after implantation (0.1 to 90 months), with 64% of patients estimated to be alive without TV reintervention or a valve-related event at 3 years. The cumulative 3-year incidence of death, reintervention, and valve-related adverse outcomes (endocarditis, thrombosis, or significant dysfunction) were 17%, 12%, and 8%, respectively. Endocarditis was diagnosed in 8 patients 2 to 29 months after TTVR, for an annualized incidence rate of 1.5% per patient-year (95% confidence interval: 0.45% to 2.5%). An additional 8 patients were diagnosed with clinically relevant valve thrombosis, 3 in the short term, 2 within 2 months, and 3 beyond 6 months. Only 2 of these 8 patients received anticoagulant therapy before thrombus detection (p = 0.13 vs. patients without thrombus). Prior endocarditis was not a risk factor for reintervention, endocarditis, or valve thrombosis, and there was no difference in valve-related outcomes according to TTVR valve type.

CONCLUSIONS: TV dysfunction, endocarditis, and leaflet thrombosis were uncommon after TTVR. Patients with prior endocarditis were not at higher risk for endocarditis or other adverse outcomes after TTVR, and endocarditis occurred with similar frequency in different valve types. Though rare, leaflet thrombosis is an important adverse outcome, and further study is necessary to determine the appropriate level of prophylactic therapy after TTVR.

Author List

McElhinney DB, Aboulhosn JA, Dvir D, Whisenant B, Zhang Y, Eicken A, Ribichini F, Tzifa A, Hainstock MR, Martin MH, Kornowski R, Schubert S, Latib A, Thomson JDR, Torres AJ, Meadows J, Delaney JW, Guerrero ME, Salizzoni S, El-Said H, Finkelstein A, George I, Gewillig M, Alvarez-Fuente M, Lamers L, Cheema AN, Kreutzer JN, Rudolph T, Hildick-Smith D, Cabalka AK, VIVID Registry

Author

Susan Foerster MD Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Endocarditis
Endovascular Procedures
Heart Valve Prosthesis Implantation
Humans
Infant
Middle Aged
Postoperative Complications
Reoperation
Retrospective Studies
Thrombosis
Treatment Outcome
Tricuspid Valve
Young Adult