In-Hospital Outcomes of Transcatheter Tricuspid Valve Repair: An Analysis From the National Inpatient Sample

Overview

Journal J Soc Cardiovasc Angiogr Interv

Specialty Cardiology & Vascular Diseases

Date 2024 Aug 12

PMID 39131469

Authors

Christian Torres

Mathew R Lozier

Charles J Davidson

Gorav Ailawadi

Marissa Donatelle

Karthik Vedantam

Susheel K Kodali

Martin B Leon

Nirat Beohar

Affiliations

Soon will be listed here.

Abstract

Background: Patients with severe tricuspid regurgitation carry an elevated surgical risk resulting in increasing adoption of less invasive transcatheter therapies such as transcatheter tricuspid valve repair (TTVR); however, data are limited. This study aimed to describe patient characteristics and predictors of poor outcomes among those undergoing TTVR.

Methods: The National Inpatient Sample was queried (2016-2019) to identify all patients undergoing TTVR ( code 02UJ3JZ) alone or in combination with mitral transcatheter edge-to-edge repair (MTEER) (code 02UG3JZ). The primary aim was to define clinical characteristics, time trends, in-hospital outcomes, and predictors of all-cause in-hospital mortality (mortality). The secondary outcomes included predictors of increased hospitalization costs and length of stay (greater than the 75th percentile).

Results: We identified 925 patients who underwent TTVR (460 [49.7%] who underwent TTVR alone and 465 [50.3%] who underwent TTVR in combination with MTEER). There was a 6.5-fold increase in TTVR adoption ( < .001). Patients were older (78 ± 10 years), female (63.2%), and White (72.7%), with frequent comorbidities. Mortality occurred in 2.2%, vascular complications occurred in 10.3%, and major bleeding occurred in 3.3%. The predictors of mortality were acute kidney injury (odds ratio [OR], 5.25; 95% CI, 5.24-5.26; < .001), major bleeding (OR, 2.81; 95% CI, 2.80-2.83; < .001), pericardiocentesis (OR, 2.15; 95% CI, 2.11-2.18; < .001), and chronic liver disease (OR, 1.40; 95% CI, 1.39-1.40; < .001). The predictors of increased length of stay or hospitalization costs included coronary artery disease, atrial arrhythmias, pulmonary hypertension, chronic liver disease, and procedural complications.

Conclusions: TTVR showed increased adoption with elevated but acceptable mortality and complications considering this high-risk population. The results of randomized trials are awaited.

Citing Articles

Cost of illness of Heart Valve Diseases (HVDs): A real-world analysis in Italy.

Sciattella P, Scortichini M Glob Reg Health Technol Assess. 2025; 12:34-42.

PMID: 39996092 PMC: 11848861. DOI: 10.33393/grhta.2025.3243.

Comparison of Transcatheter Versus Surgical Tricuspid Repair Among Patients With Tricuspid Regurgitation: Two-Year Results.

Shimoda T, Shimoda T, Ueyama H, Ueyama H, Miyamoto Y, Watanabe A Circ Cardiovasc Interv. 2024; 18(1):e014825.

PMID: 39556351 PMC: 11748907. DOI: 10.1161/CIRCINTERVENTIONS.124.014825.

Enhancing Access to Transcatheter Tricuspid Interventions Amid Disparities.

Goel S, Khan S JACC Adv. 2024; 3(11):101341.

PMID: 39493315 PMC: 11530835. DOI: 10.1016/j.jacadv.2024.101341.

References

Sadeghpour A, Hassanzadeh M, Kyavar M, Bakhshandeh H, Naderi N, Ghadrdoost B . Impact of severe tricuspid regurgitation on long term survival. Res Cardiovasc Med. 2014; 2(3):121-6. PMC: 4253772. DOI: 10.5812/cardiovascmed.10686. View

Nath J, Foster E, Heidenreich P . Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol. 2004; 43(3):405-9. DOI: 10.1016/j.jacc.2003.09.036. View

Benfari G, Antoine C, Miller W, Thapa P, Topilsky Y, Rossi A . Excess Mortality Associated With Functional Tricuspid Regurgitation Complicating Heart Failure With Reduced Ejection Fraction. Circulation. 2019; 140(3):196-206. DOI: 10.1161/CIRCULATIONAHA.118.038946. View

Baumgartner H, Falk V, Bax J, De Bonis M, Hamm C, Holm P . 2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease. Rev Esp Cardiol (Engl Ed). 2018; 71(2):110. DOI: 10.1016/j.rec.2017.12.013. View

Chorin E, Rozenbaum Z, Topilsky Y, Konigstein M, Ziv-Baran T, Richert E . Tricuspid regurgitation and long-term clinical outcomes. Eur Heart J Cardiovasc Imaging. 2019; 21(2):157-165. DOI: 10.1093/ehjci/jez216. View

Wong W, Chen S, Chou A, Lee H, Cheng Y, Tsai F . Late Outcomes of Valve Repair Versus Replacement in Isolated and Concomitant Tricuspid Valve Surgery: A Nationwide Cohort Study. J Am Heart Assoc. 2020; 9(8):e015637. PMC: 7428522. DOI: 10.1161/JAHA.119.015637. View

Otto C, Nishimura R, Bonow R, Carabello B, Erwin 3rd J, Gentile F . 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2020; 143(5):e35-e71. DOI: 10.1161/CIR.0000000000000932. View

Fender E, Zack C, Nishimura R . Isolated tricuspid regurgitation: outcomes and therapeutic interventions. Heart. 2017; 104(10):798-806. PMC: 5931246. DOI: 10.1136/heartjnl-2017-311586. View

Elixhauser A, Steiner C, Harris D, Coffey R . Comorbidity measures for use with administrative data. Med Care. 1998; 36(1):8-27. DOI: 10.1097/00005650-199801000-00004. View

10.

Baron S, Wang K, Arnold S, Magnuson E, Whisenant B, Brieke A . Cost-Effectiveness of Transcatheter Mitral Valve Repair Versus Medical Therapy in Patients With Heart Failure and Secondary Mitral Regurgitation: Results From the COAPT Trial. Circulation. 2019; 140(23):1881-1891. DOI: 10.1161/CIRCULATIONAHA.119.043275. View

11.

Kodali S, Hahn R, Eleid M, Kipperman R, Smith R, Lim D . Feasibility Study of the Transcatheter Valve Repair System for Severe Tricuspid Regurgitation. J Am Coll Cardiol. 2021; 77(4):345-356. DOI: 10.1016/j.jacc.2020.11.047. View

12.

Taramasso M, Hahn R, Alessandrini H, Latib A, Attinger-Toller A, Braun D . The International Multicenter TriValve Registry: Which Patients Are Undergoing Transcatheter Tricuspid Repair?. JACC Cardiovasc Interv. 2017; 10(19):1982-1990. DOI: 10.1016/j.jcin.2017.08.011. View

13.

Singh J, Evans J, Levy D, Larson M, Freed L, FULLER D . Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol. 1999; 83(6):897-902. DOI: 10.1016/s0002-9149(98)01064-9. View

14.

Beckhoff F, Alushi B, Jung C, Navarese E, Franz M, Kretzschmar D . Tricuspid Regurgitation - Medical Management and Evolving Interventional Concepts. Front Cardiovasc Med. 2018; 5:49. PMC: 5985450. DOI: 10.3389/fcvm.2018.00049. View

15.

Taramasso M, Alessandrini H, Latib A, Asami M, Attinger-Toller A, Biasco L . Outcomes After Current Transcatheter Tricuspid Valve Intervention: Mid-Term Results From the International TriValve Registry. JACC Cardiovasc Interv. 2018; 12(2):155-165. DOI: 10.1016/j.jcin.2018.10.022. View

16.

Alkhouli M, Alqahtani F, Holmes D, Berzingi C . Racial Disparities in the Utilization and Outcomes of Structural Heart Disease Interventions in the United States. J Am Heart Assoc. 2019; 8(15):e012125. PMC: 6761641. DOI: 10.1161/JAHA.119.012125. View

17.

Case B, Yerasi C, Forrestal B, Wang Y, Musallam A, Hahm J . MitraClip 30-Day Readmissions and Impact of Early Discharge: An Analysis from the Nationwide Readmissions Database 2016. Cardiovasc Revasc Med. 2020; 21(8):954-958. DOI: 10.1016/j.carrev.2020.04.004. View

18.

Sorajja P, Mack M, Vemulapalli S, Holmes Jr D, Stebbins A, Kar S . Initial Experience With Commercial Transcatheter Mitral Valve Repair in the United States. J Am Coll Cardiol. 2016; 67(10):1129-1140. DOI: 10.1016/j.jacc.2015.12.054. View