Initial experience with transcatheter tricuspid valve repair in patients with cardiac amyloidosis.

Abstract

AIMS:

Wildtype transthyretin amyloid cardiomyopathy is an under-recognized cause of heart failure in elderly patients. Transcatheter tricuspid valve repair is a newly emerging therapeutic option for severe tricuspid regurgitation (TR). We present first insights into safety and possible benefits of this procedure in patients with cardiac amyloidosis.

METHODS AND RESULTS:

Eight patients with cardiac non-hereditary (wildtype) transthyretin (ATTRwt) amyloidosis and severe to torrential TR, undergoing successful transcatheter tricuspid valve repair, were included in the analysis and compared to a control group of 21 patients without cardiac amyloidosis. All patients presented with an advanced stage of amyloid cardiomyopathy. Primary endpoint was reduction in TR at 3 months follow-up. Secondary endpoints were feasibility, safety, hospitalization or death, clinical improvement, cardiac biomarkers, and structural and functional right heart parameter obtained by echocardiography. Transcatheter tricuspid valve repair resulted in a significant reduction of TR (IV to II, P = 0.008) in all eight patients with cardiac amyloidosis (100%). Device success (amyloidosis 75% vs. control group 86%, P = 0.597) and overall probability of hospitalization or death (amyloidosis 13% vs. control group 25%, P = 0.646) were similar compared with those in the control group at 3 months follow-up. Transcatheter tricuspid valve repair led to an improvement of New York Heart Association functional class (P = 0.031) and 6 min walking distance (from 313 ± 118 to 337 ± 106, P = 0.012). TR reduction in amyloidosis patients was less extensive compared with that in control group (TR-reduction 1.6 ± 0.3, P = 0.008 vs. control group 2.3 ± 0.3, P < 0.0001). Furthermore, these patients showed no significant improvement of structural right heart parameters.

CONCLUSIONS:

Transcatheter tricuspid valve repair is a safe and feasible new treatment option in patients with amyloid cardiomyopathy and has the potential to improve TR-grade and clinical status. However, the benefit appears to be less pronounced compared with patients without cardiac amyloidosis.

• Authors: Isabel A Hoerbrand, Martin J Volz, Fabian Aus dem Siepen, Matthias Aurich, Philipp Schlegel, Nicolas A Geis, Ute Hegenbart, Mathias H Konstandin, Norbert Frey, Philip W Raake
• Journal: ESC heart failure (ESC Heart Fail) Vol. 10 Issue 2 Pg. 1003-1012 (04 2023) ISSN: 2055-5822 [Electronic] England
• PMID: 36514259 (Publication Type: Journal Article)
• Copyright: © 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Chemical References

• Prealbumin

Topics

• Aged
• Humans
• Amyloidosis (complications, diagnosis, surgery)
• Cardiac Catheterization (methods)
• Prealbumin
• Treatment Outcome
• Tricuspid Valve (surgery)
• Tricuspid Valve Insufficiency (complications, diagnosis, surgery)