BACKGROUND AND AIMS: For patients with symptomatic, severe tricuspid regurgitation (TR), early results of transcatheter tricuspid valve (TV) intervention studies have shown significant improvements in functional status and quality of life associated with right-heart reverse remodelling. Longer-term follow-up is needed to confirm sustained improvements in these outcomes. METHODS: The prospective, single-arm, multicentre TRISCEND study enrolled 176 patients to evaluate the safety and performance of transcatheter TV replacement in patients with ≥moderate, symptomatic TR despite medical therapy. Major adverse events, reduction in TR grade and haemodynamic outcomes by echocardiography, and clinical, functional, and quality-of-life parameters are reported to one year. RESULTS: Enrolled patients were 71.0% female, mean age 78.7 years, 88.0% ≥ severe TR, and 75.4% New York Heart Association classes III-IV. Tricuspid regurgitation was reduced to ≤mild in 97.6% (P < .001), with increases in stroke volume (10.5 ± 16.8â mL, P < .001) and cardiac output (0.6 ± 1.2â L/min, P < .001). New York Heart Association class I or II was achieved in 93.3% (P < .001), Kansas City Cardiomyopathy Questionnaire score increased by 25.7 points (P < .001), and six-minute walk distance increased by 56.2â m (P < .001). All-cause mortality was 9.1%, and 10.2% of patients were hospitalized for heart failure. CONCLUSIONS: In an elderly, highly comorbid population with ≥moderate TR, patients receiving transfemoral EVOQUE transcatheter TV replacement had sustained TR reduction, significant increases in stroke volume and cardiac output, and high survival and low hospitalization rates with improved clinical, functional, and quality-of-life outcomes to one year. Funded by Edwards Lifesciences, TRISCEND ClinicalTrials.gov number, NCT04221490.
Heart Valve Prosthesis Implantation , Tricuspid Valve Insufficiency , Humans , Female , Aged , Male , Tricuspid Valve Insufficiency/epidemiology , Tricuspid Valve Insufficiency/surgery , Tricuspid Valve/surgery , Heart Valve Prosthesis Implantation/methods , Prospective Studies , Quality of Life , Treatment Outcome , Cardiac Catheterization/methods , Severity of Illness Index
Angina Pectoris , Coronary Aneurysm , Coronary Vessels , Endovascular Procedures , Multidetector Computed Tomography/methods , Stents , Aged , Angina Pectoris/diagnosis , Angina Pectoris/etiology , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/etiology , Coronary Aneurysm/physiopathology , Coronary Angiography/methods , Coronary Vessels/diagnostic imaging , Coronary Vessels/pathology , Coronary Vessels/surgery , Endovascular Procedures/instrumentation , Endovascular Procedures/methods , Humans , Long Term Adverse Effects/diagnosis , Long Term Adverse Effects/physiopathology , Male , Myocardial Revascularization/adverse effects , Myocardial Revascularization/instrumentation , Myocardial Revascularization/methods , Reoperation/adverse effects , Reoperation/methods , Surgery, Computer-Assisted/methods , Treatment Outcome
Transcatheter aortic valve implantation (TAVI) is a recognized therapy for patients with symptomatic severe aortic stenosis (AS). TAVI is superior compared to medical therapy as for mortality in extreme-risk patients, is non-inferior or superior to surgery in high-risk patients and non-inferior to surgery in intermediate-risk patients. However, several limitations affect outcomes after TAVI. Adverse events related to this procedure, like vascular complications, need for pacemaker implantation, paravalvular regurgitation, can be factors limiting TAVI treatment in younger patients at lower risk, as well as uncertainties regarding valve durability. This review tries to figure out some of the main complications still unsolved after TAVI.
Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Postoperative Complications/etiology , Transcatheter Aortic Valve Replacement/adverse effects , Aortic Valve/diagnostic imaging , Aortic Valve/physiopathology , Aortic Valve Insufficiency/etiology , Aortic Valve Insufficiency/therapy , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/physiopathology , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/therapy , Cardiac Pacing, Artificial , Fibrinolytic Agents/therapeutic use , Heart Valve Prosthesis , Humans , Pacemaker, Artificial , Postoperative Complications/diagnosis , Postoperative Complications/therapy , Prosthesis Design , Prosthesis Failure , Risk Factors , Severity of Illness Index , Stroke/etiology , Stroke/therapy , Thrombosis/etiology , Thrombosis/therapy , Transcatheter Aortic Valve Replacement/instrumentation , Treatment Outcome , Vascular Diseases/etiology , Vascular Diseases/therapy
