Tricuspid regurgitation (TR) is frequent structural heart disease and associated with high mortality and impaired quality of life. Functional etiology is the most frequent with annular dilation, leaflet tethering, and coaptation gap secondary to right atrial (RA) and/ or ventricular (RV) dilation.  The interventional tricuspid valve repair (ITVR) techniques are being increasingly and successfully performed.  In this study, we sought to compare the long-term outcomes of clipping and annuloplasty in our patient cohort and assess parameters for proper patient/technique selection and adequate interventional timing. 

We retrospectively included patients who underwent between January 2016 to March 2019 ITVR (edge-to-edge:E2E repair or annuloplasty) at our center. The mean follow-up (FU) duration was 15 months. Comprehensive echocardiography was performed before and at FU in all patients. Strain analysis was additionally performed to sufficiently evaluate the global function of left and right ventricles and atriums through a dedicated automated post-processing program (TomTec).

We retrospectively included 100 patients (76.3 ± 3.2 years, 46 % female) with symptomatic (30% ascites, 90% edema, 100% NYHA>II, 95% liver congestion) severe functional TR (TR≥severe) at surgical high risk (EuroSCORE II: 6.1 ± 1.4%).  80 patients underwent E2E ITVR (MitraClip, TriClip, PASCAL) and twenty patients were treated by interventional tricuspid valve annuloplasty (Cardioband). All interventions were successfully finalized with TR reduction to <severe or at least one grade reduction without any major periinterventional complication. All patients were on guidelines-directed optimized heart failure therapy before the procedure without any relevant differences between the groups. 

At baseline, patients in the E2E group showed higher EuroScore II and more decreased functional capacity. Patients in the annuloplasty group presented bigger coaptation gap with more impaired right ventricular function and more dilated RA. In contrast, the E2E group showed higher RV systolic pressure. Left ventricular dimensions and functions were comparable between the groups. Furthermore, TR defining parameter presented no relevant differences in both groups. Left atrial volume and RA pressure were found to be statistically significantly reduced in both groups at FU. RV and RA fractional area change were found to be relevantly improved solely after interventional annuloplasty at FU. Left ventricular end-diastolic pressure significantly increased in the E2E group with relevant reduction of outflow/inflow ratio. Moreover, interventional annuloplasty, as expected, reduces SL diameter more significantly.

Patients showed lower symptoms and better functional capacity 15 months after E2E ITVR. Of note, improvement in walk distance was found to be significantly higher in patients who underwent annuloplasty. However, patients were more frequently hospitalized after interventional annuloplasty.

Both interventional techniques are safe, feasible, and effective for the treatment of TR in patients at surgical high risk. Interventional annuloplasty shows significant implications for RV function and TV geometry and reduces SL diameter significantly. On the other hand, E2E ITVR leads to having a better functional capacity and a lower rate of rehospitalization within 15 months postinterventionally despite higher comorbidities at baseline.