Patients undergoing transcatheter edge-to-edge mitral valve repair (M-TEER) for moderate-to-severe symptomatic mitral regurgitation (MR) often show concomitant tricuspid regurgitation (TR). It is known, that TR regression can be achieved by left-sided valve repair alone. However, patient characteristics leading to improvement of TR are not yet understood.

 

We retrospectively examined patients undergoing M-TEER at our center from 2018 to 2021 and stratified them with regard to grade of concomitant TR. Baseline clinical, echocardiographic and invasive hemodynamic parameters were assessed. Patients were then analyzed in two groups: patients with improvement of TR by at least 1 grade vs. patients with no TR improvement. Patients were followed up for 12 months and echocardiographic and clinical features as well as mortality and heart failure induced rehospitalisation were assessed. 

 

300 consecutive patients were included in this study. Concomitant TR grade I was present in 39 patients (13%), grade II in 123 patients (41%), grade III in 104 patients (34.7%), grade IV in 28 patients (9.3%) and grade V in 6 patients (2.0%). Patients with moderate to high-grade TR showed severe comorbidities leading to an increased EuroSCORE II. Combined clinical and echocardiographic follow-up was available in 199 patients. 3 months following M-TEER only 73.7% of high-grade TR patients still remained with TR-grade ≥III (p<0.001). 12 months after the procedure this number dropped further to 54.5% (p=0.016). Patients with improved TR were more often female (60 vs. 43.9%; p=0.037), had lower LV-EF (42.16±16.48 vs. 47.50±15.05%; p = 0.043) and higher baseline MR grade (3.77±0.38 vs. 3.62±0.53; p=0.026). Baseline high-grade TR was also significantly more frequent in these patients (60 vs. 39.86%; p<0.001). 12 months after M-TEER NYHA class was numerically lower in the improved TR group, however heart failure symptoms improved drastically in both cohorts (26.9% of patients with improved TR vs. 36.4% of patients without TR improvement remained with NYHA class ≥III; p=0.774). No difference was seen in the number of heart failure induced rehospitalisations (13.3% of patients with improved TR vs. 14.4% of patients with no TR improvement; p=0.874). Mortality was numerically, yet insignificantly lower in patients with TR regression (27.7 vs. 36.0%; p=0.167). TR improvement independently predicted lower mortality (Hazard Ratio 0.456 (95% CI 0.231-0.900; p=0.024).   

 

TR regression following M-TEER is frequent and further improves symptom level. TR improvement occured more often in females and in patients with initial high-grade TR and reduced LV-EF. TR improvement was an independent predictor of lower 12 month mortality.