TY - JOUR
T1 - Comparison of Transcatheter Versus Surgical Tricuspid Repair Among Patients With Tricuspid Regurgitation
T2 - Two-Year Results
AU - Shimoda, Tomonari M.
AU - Ueyama, Hiroki A.
AU - Miyamoto, Yoshihisa
AU - Watanabe, Atsuyuki
AU - Gotanda, Hiroshi
AU - Kolte, Dhaval
AU - Latib, Azeem
AU - Kaneko, Tsuyoshi
AU - Zajarias, Alan
AU - Elmariah, Sammy
AU - Takayama, Hiroo
AU - Tsugawa, Yusuke
AU - Kuno, Toshiki
N1 - Publisher Copyright:
© 2024 American Heart Association, Inc.
PY - 2025/1/1
Y1 - 2025/1/1
N2 - BACKGROUND: Evidence is limited as to whether outcomes differ between patients with tricuspid regurgitation (TR) treated with tricuspid transcatheter edge-to-edge repair (T-TEER) versus surgical tricuspid valve repair. We aimed to compare outcomes between these 2 approaches. METHODS: We analyzed the data on Medicare fee-for-service beneficiaries aged 65 to 99 years with TR who underwent T-TEER or isolated surgical repair between July 2016 and December 2020. The primary outcome was 2-year all-cause mortality. Other outcomes included in-hospital mortality and permanent pacemaker implantation as well as 2-year heart failure hospitalization and tricuspid valve reintervention. A propensity score matching weight analysis was used to adjust for potential confounders. RESULTS: A total of 1143 patients were included (409 T-TEER versus 734 surgery). The proportion of T-TEER cases increased from 2% in the third quarter of 2016 to 67% in the last quarter of 2020 among all isolated TR procedures. After adjustment for potential confounders, we found no evidence that 2-year all-cause mortality differs between patients treated with T-TEER versus surgical repair (adjusted hazard ratio, 0.84 [95% CI, 0.63-1.13]). Patients treated with T-TEER experienced lower in-hospital mortality (2.5% versus 12.5%, P<0.001) and permanent pacemaker implantation rates (0.0% versus 12.7%, P<0.001) than those treated by surgical repair. At 2 years, we found no differences in heart failure hospitalizations, but tricuspid valve reinterventions were more frequent in the T-TEER group (subdistribution hazard ratio, 8.03 [95% CI, 2.87-22.48]). CONCLUSIONS: Among Medicare beneficiaries with TR, the 2-year mortality rate was comparable between T-TEER and surgical repair. T-TEER showed advantages in perioperative outcomes, including lower in-hospital mortality and pacemaker implantation rates, whereas tricuspid valve reinterventions were more frequent in the T-TEER group. Further studies are necessary to refine indications, patient selections, and optimal timing for intervention with either treatment strategy.
AB - BACKGROUND: Evidence is limited as to whether outcomes differ between patients with tricuspid regurgitation (TR) treated with tricuspid transcatheter edge-to-edge repair (T-TEER) versus surgical tricuspid valve repair. We aimed to compare outcomes between these 2 approaches. METHODS: We analyzed the data on Medicare fee-for-service beneficiaries aged 65 to 99 years with TR who underwent T-TEER or isolated surgical repair between July 2016 and December 2020. The primary outcome was 2-year all-cause mortality. Other outcomes included in-hospital mortality and permanent pacemaker implantation as well as 2-year heart failure hospitalization and tricuspid valve reintervention. A propensity score matching weight analysis was used to adjust for potential confounders. RESULTS: A total of 1143 patients were included (409 T-TEER versus 734 surgery). The proportion of T-TEER cases increased from 2% in the third quarter of 2016 to 67% in the last quarter of 2020 among all isolated TR procedures. After adjustment for potential confounders, we found no evidence that 2-year all-cause mortality differs between patients treated with T-TEER versus surgical repair (adjusted hazard ratio, 0.84 [95% CI, 0.63-1.13]). Patients treated with T-TEER experienced lower in-hospital mortality (2.5% versus 12.5%, P<0.001) and permanent pacemaker implantation rates (0.0% versus 12.7%, P<0.001) than those treated by surgical repair. At 2 years, we found no differences in heart failure hospitalizations, but tricuspid valve reinterventions were more frequent in the T-TEER group (subdistribution hazard ratio, 8.03 [95% CI, 2.87-22.48]). CONCLUSIONS: Among Medicare beneficiaries with TR, the 2-year mortality rate was comparable between T-TEER and surgical repair. T-TEER showed advantages in perioperative outcomes, including lower in-hospital mortality and pacemaker implantation rates, whereas tricuspid valve reinterventions were more frequent in the T-TEER group. Further studies are necessary to refine indications, patient selections, and optimal timing for intervention with either treatment strategy.
KW - Medicare
KW - catheters
KW - heart failure
KW - mortality
KW - tricuspid valve
UR - http://www.scopus.com/inward/record.url?scp=85214388234&partnerID=8YFLogxK
U2 - 10.1161/CIRCINTERVENTIONS.124.014825
DO - 10.1161/CIRCINTERVENTIONS.124.014825
M3 - Article
C2 - 39556351
AN - SCOPUS:85214388234
SN - 1941-7640
VL - 18
SP - e014825
JO - Circulation: Cardiovascular Interventions
JF - Circulation: Cardiovascular Interventions
IS - 1
ER -