Home > Cardiology > QoL better in most patients after transcatheter tricuspid-valve repair

QoL better in most patients after transcatheter tricuspid-valve repair

Journal
JACC: Cardiovascular Interventions
Reuters Health - 31/12/2021 - In patients with clinically relevant tricuspid regurgitation, successful transcatheter tricuspid-valve repair (TTVR) appears to improve quality of life (QoL), according to researchers in Germany.

In a paper in JACC: Cardiovascular Interventions, they write that "although TTVR surely will not enable highly symptomatic patients to perform vigorous physical activities, improvement in their capability to perform daily work tasks . . . makes their lives more livable beyond mere prolongation of life expectancy."

In their single-center observational study, Dr. Philipp Lurz of Heart Center Leipzig and colleagues evaluated 115 consecutive patients (median age, 78; 50% women) who had undergone isolated edge-to-edge TTVR between 2016 and 2020.

All patients presented in New York Heart Association functional class II or higher, despite medical therapy, and were judged to be at prohibitively high surgical risk. All had at least severe TR, and nearly a third had TR graded as massive or torrential.

Health-related QoL was assessed with the 36-Item Short Form Health Survey (SF-36) and the Minnesota Living With Heart Failure Questionnaire (MLHFQ) at baseline and at one-month follow-up, as well as at six and 12 months if possible.

The TTVR device, predominantly the MitraClip NTR/XTR from Abbott Vascular, was successfully implanted in 110. Following surgery, TR was reduced to moderate or less in 95 patients.

At the one-month follow-up, the SF-36 physical component summary score had improved in 71 patients (62%), the SF-36 mental component summary score had improved in 60 patients (52%), and MLHFQ score had improved in 82 patients (71%).

Following TTVR, the mean SF-36 physical component summary score had increased by 3.0 points at one month and by 4.5 points at six months (P<0.001). The mean mental component summary score increased by 2.0 points and 3.6 points, respectively (P < 0.001), and the MLHFQ score by 8.2 points and 7.3 points (P < 0.001).

From TTVR till the final follow-up visit (a median of 365 days), 12 patients (10%) died, 29 (25%) were readmitted for decompensated heart failure, and one patient had to undergo repeat TTVR, because of residual severe TR.

An increase in the physical component summary score within one month after TTVR was associated with a lower occurrence of a composite endpoint of all-cause death, heart failure rehospitalization and repeat tricuspid valve intervention.

In an accompanying editorial, Dr. Georg Nickenig and Can Ozturk of the Heart Center, University Hospital Bonn, also in Germany, note that sustained improvement of QoL during follow-up was documented only in patients without recurrent or residual TR.

The editorial writers also observe, "The target patient population of TTVR consists predominantly of geriatric and frail patients with advanced comorbidities and decreased QoL."

"Therefore," they continue, "the main treatment goal is the improvement of patients' QoL by reduction in heart failure-related symptoms and morbidity. A mere prolongation of survival without concomitant improvement in QoL appears unrewarding."

Dr. Suzanne J. Baron, director of interventional cardiology at Lahey Hospital and Medical Center, in Boston, who was not involved in the study, told Reuters Health by email, "More and more, the medical community is focusing on better understanding the effects of a novel device not just on clinical outcomes, such as survival, but also on patient-reported outcomes. This is incredibly important since studies have shown that elderly patients, particularly those with multiple co-morbidities, have been shown to value quality of life as much as quantity of life."

She called these findings "consistent with prior data in other areas of cardiology research, which has shown that improved quality of life can serve as a positive prognostic sign in regards to other clinical outcomes, such as mortality or need for repeat hospitalization."

SOURCE: https://bit.ly/3F5k50i JACC: Cardiovascular Interventions, online December 13, 2021.

By Scott Baltic

 



Posted on