Written by Peter Liu
Spoon Feed
Transcatheter replacement of tricuspid valve (TTVR) and mitral valve (TMVR) procedures are emerging as options to treat valvular disease in heart failure (HF).
Synopsis
Today, we’re covering two articles in one post.
The TRISCEND II trial investigated whether TTVR improves health-related quality of life in patients with symptomatic, severe tricuspid regurgitation (TR). A total of 400 patients were randomized to TTVR with optimal medical therapy (OMT) or OMT alone. Health status was assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and SF-36 survey. At 1 year, TTVR patients demonstrated a 17.8-point higher KCCQ score (95%CI 13.0-22.5) compared to OMT alone, with greater improvements observed in those with massive/torrential TR. Limitations include an open-label design and subgroup effect variability. TTVR provides sustained quality-of-life improvements in severe TR.
The RESHAPE-HF2 trial examined whether TMVR improves outcomes in HF patients with moderate to severe functional mitral regurgitation (FMR). This randomized trial enrolled 505 patients assigned to TMVR with medical therapy or medical therapy alone. Key outcomes included HF hospitalization, cardiovascular death, and Kansas City Cardiomyopathy Questionnaire–Overall Summary (KCCQ-OS) score. TMVR reduced HF hospitalization/cardiovascular death (rate ratio 0.64, 95%CI 0.48-0.85; P=0.002) and improved KCCQ-OS by 10.9 points (95%CI 6.8-15.0; P<0.001). Limited generalizability due to patient selection was noted. TMVR reduces HF events and enhances quality of life in FMR. (AI-assisted)
Step aside, TAVR. Here comes TMVR and TTVR!
The success of transcatheter aortic valve replacement (TAVR) in treating severe aortic stenosis appears to have led to transcatheter valve replacement procedures for the other 3 valves. Two of these procedures, TMVR and TTVR, now have strong evidence to support their use.
For patients with symptomatic, severe tricuspid regurgitation (TR), the TRISCEND II RCT showed significant improvements in heart failure symptoms and quality of life (QOL), but no clear improvement in mortality or hospitalization rate with TTVR.
For patients with symptomatic, moderate-to-severe mitral regurgitation (MR), the RESHAPE-HF2 trial showed improvements not only in symptoms and QOL, but also reductions in composite hospitalization and mortality for TMVR. These benefits were at the cost of 4 patients (1.6%) with peri-procedural complications. These complications are clearly less severe than those that would occur from open valve replacement surgery,and put trancatheter procedures on the map for treatment of MR and TR in HF patients.
Predating the TMVR and TTVR are the less-invasive transcatheter edge-to-edge repairs (M-TEER and T-TEER). It will be interesting to see whether head-to-head comparisons of transcatheter valve replacements and TEER will be made.
Source
Quality of Life After Transcatheter Tricuspid Valve Replacement: 1-Year Results From TRISCEND II Pivotal Trial. J Am Coll Cardiol. 2024 Oct 22:S0735-1097(24)09954-6. doi: 10.1016/j.jacc.2024.10.067. Epub ahead of print. PMID: 39480380
Transcatheter Valve Repair in Heart Failure with Moderate to Severe Mitral Regurgitation. N Engl J Med. 2024 Nov 14;391(19):1799-1809. doi: 10.1056/NEJMoa2314328. Epub 2024 Aug 31. PMID: 39216092
