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 benef...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-04-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.14262 |
| _version_ | 1797857588779417600 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Isabel A. Hoerbrand |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-09T21:00:16Z |
| format | Article |
| id | doaj.art-f267aa9dd30b4efcb8e82ab9d2a74404 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-04-09T21:00:16Z |
| publishDate | 2023-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-f267aa9dd30b4efcb8e82ab9d2a744042023-03-29T11:45:21ZengWileyESC Heart Failure2055-58222023-04-011021003101210.1002/ehf2.14262Initial experience with transcatheter tricuspid valve repair in patients with cardiac amyloidosisIsabel A. Hoerbrand0Martin J. Volz1Fabian Aus dem Siepen2Matthias Aurich3Philipp Schlegel4Nicolas A. Geis5Ute Hegenbart6Mathias H. Konstandin7Norbert Frey8Philip W. Raake9Department of Internal Medicine III, Division of Cardiology University Hospital Heidelberg, Ruprecht‐Karl University Heidelberg 69120 Heidelberg GermanyDepartment of Internal Medicine III, Division of Cardiology University Hospital Heidelberg, Ruprecht‐Karl University Heidelberg 69120 Heidelberg GermanyDepartment of Internal Medicine III, Division of Cardiology University Hospital Heidelberg, Ruprecht‐Karl University Heidelberg 69120 Heidelberg GermanyDepartment of Internal Medicine III, Division of Cardiology University Hospital Heidelberg, Ruprecht‐Karl University Heidelberg 69120 Heidelberg GermanyDepartment of Internal Medicine III, Division of Cardiology University Hospital Heidelberg, Ruprecht‐Karl University Heidelberg 69120 Heidelberg GermanyDepartment of Internal Medicine III, Division of Cardiology University Hospital Heidelberg, Ruprecht‐Karl University Heidelberg 69120 Heidelberg GermanyDepartment of Internal Medicine V, Division of Hematology and Oncology, Amyloidosis Center University Hospital Heidelberg, Ruprecht‐Karl University Heidelberg Heidelberg GermanyDepartment of Internal Medicine III, Division of Cardiology University Hospital Heidelberg, Ruprecht‐Karl University Heidelberg 69120 Heidelberg GermanyDepartment of Internal Medicine III, Division of Cardiology University Hospital Heidelberg, Ruprecht‐Karl University Heidelberg 69120 Heidelberg GermanyDepartment of Internal Medicine III, Division of Cardiology University Hospital Heidelberg, Ruprecht‐Karl University Heidelberg 69120 Heidelberg GermanyAbstract 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.https://doi.org/10.1002/ehf2.14262Transcatheter tricuspid valve repairTricuspid regurgitationCardiac amyloidosisAmyloid cardiomyopathy |
| spellingShingle | 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 Initial experience with transcatheter tricuspid valve repair in patients with cardiac amyloidosis ESC Heart Failure Transcatheter tricuspid valve repair Tricuspid regurgitation Cardiac amyloidosis Amyloid cardiomyopathy |
| title | Initial experience with transcatheter tricuspid valve repair in patients with cardiac amyloidosis |
| title_full | Initial experience with transcatheter tricuspid valve repair in patients with cardiac amyloidosis |
| title_fullStr | Initial experience with transcatheter tricuspid valve repair in patients with cardiac amyloidosis |
| title_full_unstemmed | Initial experience with transcatheter tricuspid valve repair in patients with cardiac amyloidosis |
| title_short | Initial experience with transcatheter tricuspid valve repair in patients with cardiac amyloidosis |
| title_sort | initial experience with transcatheter tricuspid valve repair in patients with cardiac amyloidosis |
| topic | Transcatheter tricuspid valve repair Tricuspid regurgitation Cardiac amyloidosis Amyloid cardiomyopathy |
| url | https://doi.org/10.1002/ehf2.14262 |
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