Background

Tricuspid valve transcatheter edge-to-edge repair (T-TEER) is the most widely used transcatheter therapy to treat severe tricuspid regurgitation (TR).

Objectives

This study aimed to develop a simplified anatomical score model to predict procedural outcomes in T-TEER.

Methods

All T-TEER patients (n=189). between January 2017 and November 2022 from two centers were included in the derivation cohort Additionally, 126 patients from two separate institutions served for a validation cohort. T-TEER was performed using 2 commercially available technologies.

Procedural transesophageal echocardiograms (TEE) were used to determine: septolateral andanteroposterior coaptation gap, leaflet morphology, septal leaflet length and mobility/tethering (SLM), chordal structure density, en-face TR jet morphology and TR jet location, shadowing/image quality, and presence of intracardiac leads. A scoring-system was derived using univariate and multivariate logistic regression. Endpoints assessed were immediate post-procedural TR reduction ≥2 grades and TR grade ≤2+.

Results

Median age was 81 [79-84] years, 49% were female and TR was 3+ (severe) in 53%, 4+ (massive) in 39%, and 5+ (torrential) in 8%. Multivariate analysis determined four anatomic characteristics (T-TEER score range 0-7) were the best predictors of the endpoints septal leaflet gap, septal leaflet mobility/tethering, en-face TR jet morphology, and TR jet location (Figure 1). TR reduction ≥2 and TR ≤2+ were observed in >90% of the patients with a T-TEER-Score of 0-1, and in only 13% and 22% of the patients with a T-TEER-Score >4. Importantly, T-TEER-Score was externally validated (AUC: 0.80, 95% CI: 0.73-0.88).

Conclusion

This novel T-TEER-Score is a simple, four-component anatomic score that is readily obtained during patient imaging which can predict successful T-TEER.  

Figure 1: The Tricuspid TEER-Score