Biphasic Right Ventricular Reverse Remodeling Following Tricuspid Valve Transcatheter Edge-to-Edge Repair

JACC Cardiovasc Interv. 2024 Dec 9;17(23):2811-2822. doi: 10.1016/j.jcin.2024.09.069.

Abstract

Background: Transcatheter tricuspid valve edge-to-edge repair (T-TEER) has been reported to be associated with right ventricular reverse remodeling (RVRR). Data on the temporal evolution of this phenomenon are scarce.

Objectives: The aim of this study was to evaluate RVRR over the course of 2-year follow-up after T-TEER using sequential 3-dimensional echocardiograms (3DE).

Methods: The study included T-TEER patients with available 3DE at baseline and discharge. Further follow-ups were scheduled at 1 month, 6 months, as well as 1 and 2 years. The 3DE evaluation included right ventricular volumes (right ventricular end-diastolic volume [RVEDV3D]; right ventricular end-systolic volume [RVESV3D]), right ventricular ejection fraction (RVEF3D), and RV longitudinal strain of the free wall and the septum.

Results: The study included 231 patients (median age 82 [IQR: 79-86] years, 48% women). We observed a biphasic pattern of RVRR following T-TEER consisting of early RV volume unloading (phase 1, reduced RVEDV3D) and later structural remodeling (phase 2, reduced RVESV3D). Whereas RVEDV3D was significantly reduced early after the procedure (-9.7% from baseline to discharge; P < 0.001), RVESV3D remained unchanged at 1-month follow-up. Reduction in RVESV3D was observed at 6-month follow-up for the first time (-5.4% from baseline to 6-month follow-up; P < 0.001). Reduction in both RVEDV3D and RVESV3D peaked at 1-year follow-up and remained stable until 2 years after T-TEER. RV function declined early after T-TEER and gradually increased over the course of follow-up (RVEF3D at baseline 42.2% ± 8.9%, discharge 31.1% ± 9.4%, 2-year follow-up 41.6% ± 8.9%). The 3D RV longitudinal strain of the septum and 3D RV longitudinal strain of the free wall developed analogously.

Conclusions: RVRR following T-TEER occurs in 2 stages and involves early RV unloading (reduction in RVEDV3D) and later structural RVRR (reduction in RVESV3D) with an improvement in RVEF.

Keywords: 3-dimensional echocardiography; remodeling; right ventricular function; tricuspid regurgitation.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cardiac Catheterization* / instrumentation
  • Echocardiography, Three-Dimensional*
  • Female
  • Heart Valve Prosthesis Implantation / adverse effects
  • Heart Valve Prosthesis Implantation / instrumentation
  • Humans
  • Male
  • Recovery of Function*
  • Time Factors
  • Treatment Outcome
  • Tricuspid Valve Insufficiency* / diagnostic imaging
  • Tricuspid Valve Insufficiency* / physiopathology
  • Tricuspid Valve Insufficiency* / surgery
  • Tricuspid Valve* / diagnostic imaging
  • Tricuspid Valve* / physiopathology
  • Tricuspid Valve* / surgery
  • Ventricular Function, Right*
  • Ventricular Remodeling*