Cardiohepatic Syndrome Is Associated With Poor Prognosis in Patients Undergoing Tricuspid Transcatheter Edge-to-Edge Valve Repair

• DOI: 10.1016/j.jcin.2021.10.033
• Publication Date: 2022-01-17T20:02:07Z
• Authors: Lukas Stolz; Mathias Orban; Christian Besler; Karl-Patrik Kresoja; Daniel Braun; Philipp Doldi; Martin Orban; Christian Hagl; Karl-Philipp Rommel; Julia Mayerle; Sebastian Hausleiter; Kornelia Löw; Satoshi Higuchi; Mirjam Wild; Matthias Unterhuber; Steffen Massberg; Michael Näbauer; Holger Thiele; Philipp Lurz; Jörg Hausleiter
• Keywords: Heart Failure; Heart Valve Prosthesis Implantation; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Humans; Cardiac Surgical Procedures; Tricuspid Valve Insufficiency; 3. Good health

The aim of this study was to evaluate the prevalence and prognostic implications of cardiohepatic syndrome (CHS) in patients with tricuspid regurgitation (TR) treated with tricuspid transcatheter edge-to-edge valve repair (T-TEER).The role of CHS in patients undergoing T-TEER for severe TR has not been studied.This study included patients who underwent T-TEER for TR between 2016 and 2020 at 2 high-volume academic centers. CHS was defined as elevation of at least 2 of 3 cholestatic hepatic enzymes. The impact of CHS on 1-year all-cause mortality and clinical outcomes after T-TEER was investigated.T-TEER reduced TR severity to ≤2+ in 257 of 305 included patients (86.2%). CHS was present in 45.2% of patients and was associated with a higher rate of mortality and of first hospitalization for heart failure (HHF) (CHS vs no CHS: estimated 1-year mortality, 34.0% vs 15.9% [P < 0.01]; HHF, 23.0% vs 12.2% [P = 0.01]). CHS was identified as an independent predictor of 1-year all-cause mortality (HR: 1.86; 95% CI: 1.10-3.14; P < 0.05). Irrespective of CHS, T-TEER improved New York Heart Association functional class and 6-minute walk distance in the majority of patients. In patients with impaired baseline hepatic function, laboratory liver parameters improved after T-TEER.CHS is a strong predictor of mortality and HHF after T-TEER and should be evaluated in the process of procedural decision making for T-TEER. Nevertheless, T-TEER is associated with relevant symptomatic alleviation irrespective of CHS.