Mid-Term Valve-Related Outcomes After Transcatheter Tricuspid Valve-in-Valve or Valve-in-Ring Replacement

VIVID Registry

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Transcatheter aortic and pulmonary valves have been used to treat stenosis or regurgitation after prior surgical tricuspid valve (TV) replacement or repair. Little is known about intermediate-term valve-related outcomes after transcatheter tricuspid valve replacement (TTVR), including valve function, thrombus, and endocarditis. Objectives: The authors sought to evaluate mid-term outcomes in a large cohort of patients who underwent TTVR after surgical TV repair or replacement, with a focus on valve-related outcomes. Methods: Patients who underwent TTVR after prior surgical TV replacement or repair were collected through an international registry. Time-related outcomes were modeled and risk factors assessed. Results: Data were collected for 306 patients who underwent TTVR from 2008 through 2017 at 80 centers; 52 patients (17%) had a prior history of endocarditis. Patients were followed for a median of 15.9 months after implantation (0.1 to 90 months), with 64% of patients estimated to be alive without TV reintervention or a valve-related event at 3 years. The cumulative 3-year incidence of death, reintervention, and valve-related adverse outcomes (endocarditis, thrombosis, or significant dysfunction) were 17%, 12%, and 8%, respectively. Endocarditis was diagnosed in 8 patients 2 to 29 months after TTVR, for an annualized incidence rate of 1.5% per patient-year (95% confidence interval: 0.45% to 2.5%). An additional 8 patients were diagnosed with clinically relevant valve thrombosis, 3 in the short term, 2 within 2 months, and 3 beyond 6 months. Only 2 of these 8 patients received anticoagulant therapy before thrombus detection (p = 0.13 vs. patients without thrombus). Prior endocarditis was not a risk factor for reintervention, endocarditis, or valve thrombosis, and there was no difference in valve-related outcomes according to TTVR valve type. Conclusions: TV dysfunction, endocarditis, and leaflet thrombosis were uncommon after TTVR. Patients with prior endocarditis were not at higher risk for endocarditis or other adverse outcomes after TTVR, and endocarditis occurred with similar frequency in different valve types. Though rare, leaflet thrombosis is an important adverse outcome, and further study is necessary to determine the appropriate level of prophylactic therapy after TTVR.

Original languageEnglish (US)
Pages (from-to)148-157
Number of pages10
JournalJournal of the American College of Cardiology
Volume73
Issue number2
DOIs
StatePublished - Jan 22 2019

Fingerprint

Tricuspid Valve
Endocarditis
Thrombosis
Surgical Instruments
Pulmonary Valve
Incidence
Aortic Valve
Anticoagulants
Registries

Keywords

  • endocarditis
  • percutaneous valve
  • stenosis
  • thrombus
  • transcatheter valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Mid-Term Valve-Related Outcomes After Transcatheter Tricuspid Valve-in-Valve or Valve-in-Ring Replacement. / VIVID Registry.

In: Journal of the American College of Cardiology, Vol. 73, No. 2, 22.01.2019, p. 148-157.

Research output: Contribution to journalArticle

@article{0f9051739bc2472a8ed686a3f311a6f1,
title = "Mid-Term Valve-Related Outcomes After Transcatheter Tricuspid Valve-in-Valve or Valve-in-Ring Replacement",
abstract = "Background: Transcatheter aortic and pulmonary valves have been used to treat stenosis or regurgitation after prior surgical tricuspid valve (TV) replacement or repair. Little is known about intermediate-term valve-related outcomes after transcatheter tricuspid valve replacement (TTVR), including valve function, thrombus, and endocarditis. Objectives: The authors sought to evaluate mid-term outcomes in a large cohort of patients who underwent TTVR after surgical TV repair or replacement, with a focus on valve-related outcomes. Methods: Patients who underwent TTVR after prior surgical TV replacement or repair were collected through an international registry. Time-related outcomes were modeled and risk factors assessed. Results: Data were collected for 306 patients who underwent TTVR from 2008 through 2017 at 80 centers; 52 patients (17{\%}) had a prior history of endocarditis. Patients were followed for a median of 15.9 months after implantation (0.1 to 90 months), with 64{\%} of patients estimated to be alive without TV reintervention or a valve-related event at 3 years. The cumulative 3-year incidence of death, reintervention, and valve-related adverse outcomes (endocarditis, thrombosis, or significant dysfunction) were 17{\%}, 12{\%}, and 8{\%}, respectively. Endocarditis was diagnosed in 8 patients 2 to 29 months after TTVR, for an annualized incidence rate of 1.5{\%} per patient-year (95{\%} confidence interval: 0.45{\%} to 2.5{\%}). An additional 8 patients were diagnosed with clinically relevant valve thrombosis, 3 in the short term, 2 within 2 months, and 3 beyond 6 months. Only 2 of these 8 patients received anticoagulant therapy before thrombus detection (p = 0.13 vs. patients without thrombus). Prior endocarditis was not a risk factor for reintervention, endocarditis, or valve thrombosis, and there was no difference in valve-related outcomes according to TTVR valve type. Conclusions: TV dysfunction, endocarditis, and leaflet thrombosis were uncommon after TTVR. Patients with prior endocarditis were not at higher risk for endocarditis or other adverse outcomes after TTVR, and endocarditis occurred with similar frequency in different valve types. Though rare, leaflet thrombosis is an important adverse outcome, and further study is necessary to determine the appropriate level of prophylactic therapy after TTVR.",
keywords = "endocarditis, percutaneous valve, stenosis, thrombus, transcatheter valve implantation",
author = "{VIVID Registry} and McElhinney, {Doff B.} and Aboulhosn, {Jamil A.} and Danny Dvir and Brian Whisenant and Yulin Zhang and Andreas Eicken and Flavio Ribichini and Aphrodite Tzifa and Hainstock, {Michael R.} and Martin, {Mary H.} and Ran Kornowski and Stephan Schubert and Azeem Latib and Thomson, {John D.R.} and Torres, {Alejandro J.} and Jeffery Meadows and Delaney, {Jeffrey W.} and Guerrero, {Mayra E.} and Stefano Salizzoni and Howaida El-Said and Ariel Finkelstein and Isaac George and Marc Gewillig and Maria Alvarez-Fuente and Luke Lamers and Cheema, {Asim N.} and Kreutzer, {Jacqueline N.} and Tanja Rudolph and David Hildick-Smith and Cabalka, {Allison K.} and Younes Boudjemline and Guiti Milani and Bocks, {Martin L.} and Asnes, {Jeremy D.} and Vaikom Mahadevan and Dominique Himbert and Goldstein, {Bryan H.} and Fagan, {Thomas E.} and Cheatham, {John P.} and Momenah, {Tarek S.} and Kim, {Dennis W.} and Antonio Colombo and Marco Ancona and Gianfranco Butera and Forbes, {Thomas J.} and Eric Horlick and Carlos Pedra and Jacopo Alfonsi and Jones, {Thomas K.} and Mark Hoyer",
year = "2019",
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language = "English (US)",
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TY - JOUR

T1 - Mid-Term Valve-Related Outcomes After Transcatheter Tricuspid Valve-in-Valve or Valve-in-Ring Replacement

AU - VIVID Registry

AU - McElhinney, Doff B.

AU - Aboulhosn, Jamil A.

AU - Dvir, Danny

AU - Whisenant, Brian

AU - Zhang, Yulin

AU - Eicken, Andreas

AU - Ribichini, Flavio

AU - Tzifa, Aphrodite

AU - Hainstock, Michael R.

AU - Martin, Mary H.

AU - Kornowski, Ran

AU - Schubert, Stephan

AU - Latib, Azeem

AU - Thomson, John D.R.

AU - Torres, Alejandro J.

AU - Meadows, Jeffery

AU - Delaney, Jeffrey W.

AU - Guerrero, Mayra E.

AU - Salizzoni, Stefano

AU - El-Said, Howaida

AU - Finkelstein, Ariel

AU - George, Isaac

AU - Gewillig, Marc

AU - Alvarez-Fuente, Maria

AU - Lamers, Luke

AU - Cheema, Asim N.

AU - Kreutzer, Jacqueline N.

AU - Rudolph, Tanja

AU - Hildick-Smith, David

AU - Cabalka, Allison K.

AU - Boudjemline, Younes

AU - Milani, Guiti

AU - Bocks, Martin L.

AU - Asnes, Jeremy D.

AU - Mahadevan, Vaikom

AU - Himbert, Dominique

AU - Goldstein, Bryan H.

AU - Fagan, Thomas E.

AU - Cheatham, John P.

AU - Momenah, Tarek S.

AU - Kim, Dennis W.

AU - Colombo, Antonio

AU - Ancona, Marco

AU - Butera, Gianfranco

AU - Forbes, Thomas J.

AU - Horlick, Eric

AU - Pedra, Carlos

AU - Alfonsi, Jacopo

AU - Jones, Thomas K.

AU - Hoyer, Mark

PY - 2019/1/22

Y1 - 2019/1/22

N2 - Background: Transcatheter aortic and pulmonary valves have been used to treat stenosis or regurgitation after prior surgical tricuspid valve (TV) replacement or repair. Little is known about intermediate-term valve-related outcomes after transcatheter tricuspid valve replacement (TTVR), including valve function, thrombus, and endocarditis. Objectives: The authors sought to evaluate mid-term outcomes in a large cohort of patients who underwent TTVR after surgical TV repair or replacement, with a focus on valve-related outcomes. Methods: Patients who underwent TTVR after prior surgical TV replacement or repair were collected through an international registry. Time-related outcomes were modeled and risk factors assessed. Results: Data were collected for 306 patients who underwent TTVR from 2008 through 2017 at 80 centers; 52 patients (17%) had a prior history of endocarditis. Patients were followed for a median of 15.9 months after implantation (0.1 to 90 months), with 64% of patients estimated to be alive without TV reintervention or a valve-related event at 3 years. The cumulative 3-year incidence of death, reintervention, and valve-related adverse outcomes (endocarditis, thrombosis, or significant dysfunction) were 17%, 12%, and 8%, respectively. Endocarditis was diagnosed in 8 patients 2 to 29 months after TTVR, for an annualized incidence rate of 1.5% per patient-year (95% confidence interval: 0.45% to 2.5%). An additional 8 patients were diagnosed with clinically relevant valve thrombosis, 3 in the short term, 2 within 2 months, and 3 beyond 6 months. Only 2 of these 8 patients received anticoagulant therapy before thrombus detection (p = 0.13 vs. patients without thrombus). Prior endocarditis was not a risk factor for reintervention, endocarditis, or valve thrombosis, and there was no difference in valve-related outcomes according to TTVR valve type. Conclusions: TV dysfunction, endocarditis, and leaflet thrombosis were uncommon after TTVR. Patients with prior endocarditis were not at higher risk for endocarditis or other adverse outcomes after TTVR, and endocarditis occurred with similar frequency in different valve types. Though rare, leaflet thrombosis is an important adverse outcome, and further study is necessary to determine the appropriate level of prophylactic therapy after TTVR.

AB - Background: Transcatheter aortic and pulmonary valves have been used to treat stenosis or regurgitation after prior surgical tricuspid valve (TV) replacement or repair. Little is known about intermediate-term valve-related outcomes after transcatheter tricuspid valve replacement (TTVR), including valve function, thrombus, and endocarditis. Objectives: The authors sought to evaluate mid-term outcomes in a large cohort of patients who underwent TTVR after surgical TV repair or replacement, with a focus on valve-related outcomes. Methods: Patients who underwent TTVR after prior surgical TV replacement or repair were collected through an international registry. Time-related outcomes were modeled and risk factors assessed. Results: Data were collected for 306 patients who underwent TTVR from 2008 through 2017 at 80 centers; 52 patients (17%) had a prior history of endocarditis. Patients were followed for a median of 15.9 months after implantation (0.1 to 90 months), with 64% of patients estimated to be alive without TV reintervention or a valve-related event at 3 years. The cumulative 3-year incidence of death, reintervention, and valve-related adverse outcomes (endocarditis, thrombosis, or significant dysfunction) were 17%, 12%, and 8%, respectively. Endocarditis was diagnosed in 8 patients 2 to 29 months after TTVR, for an annualized incidence rate of 1.5% per patient-year (95% confidence interval: 0.45% to 2.5%). An additional 8 patients were diagnosed with clinically relevant valve thrombosis, 3 in the short term, 2 within 2 months, and 3 beyond 6 months. Only 2 of these 8 patients received anticoagulant therapy before thrombus detection (p = 0.13 vs. patients without thrombus). Prior endocarditis was not a risk factor for reintervention, endocarditis, or valve thrombosis, and there was no difference in valve-related outcomes according to TTVR valve type. Conclusions: TV dysfunction, endocarditis, and leaflet thrombosis were uncommon after TTVR. Patients with prior endocarditis were not at higher risk for endocarditis or other adverse outcomes after TTVR, and endocarditis occurred with similar frequency in different valve types. Though rare, leaflet thrombosis is an important adverse outcome, and further study is necessary to determine the appropriate level of prophylactic therapy after TTVR.

KW - endocarditis

KW - percutaneous valve

KW - stenosis

KW - thrombus

KW - transcatheter valve implantation

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JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

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