Background: Transcatheter edge-to-edge repair (TEER) for severe tricuspid regurgitation (TR) emerged as a novel treatment option for patients (pts.) not amenable for surgery. However, knowledge regarding independent risk factors for worse prognosis is rarely available.

Objective: The study sought to investigate the impact of right ventricular cardiac power index (RVCPi) on 1-year outcome in pts. with severe symptomatic TR undergoing TEER.

Methods: Consecutive pts. with severe TR who underwent TEER between 08/2020 to 11/2021 were included and followed prospectively. Baseline clinical and invasive hemodynamic variables, changes in echocardiographic parameters and New York Heart Association (NYHA) functional class, periprocedural and in-hospital major adverse events were assessed. Primary endpoint was defined as a composite of all-cause mortality and heart failure hospitalization at 1-year after TEER. A multivariable Cox proportional-hazards regression analysis was performed to identify independent risk factors for combined primary endpoint. RVCPi was calculated as: [Cardiac index * mean pulmonary pressure] * K (conversion factor 2.22 × 10^-3) = W/m². Receiver operator characteristic (ROC) analysis was used to determine discriminative capacity of RVCPi. The prognostic value of RVCPi threshold was tested using Kaplan-Meier analysis.

Results: 90 patients (median age 81±5.8 years, 51.1% women) at high operative risk (LogEuro-Score 18.4±13.1%) underwent TEER for severe TR. Primary endpoint occurred in 30 patients (33.3%). ROC curve analysis demonstrated that RVCPi was associated with an area under the curve of 0.70 (95% confidence interval (CI) 0.57-0.84; p=0.008). RVCPi threshold of 0.15 W/m² (simple nearest-to-median value) was associated with 64.3% sensitivity and 64.5% specificity for the combined primary endpoint. Event-free survival was significantly higher in the RVCPi < 0.15 W/m² group compared to those with RVCPi ≥ 0.15 W/m² (20.9% vs. 45.0%; log-rank p=0.04). In Cox regression analysis RVCPi was an independent predictor for the combined primary endpoint (Hazard ratio 6.9; 95% CI 1.4-33.9; p=0.017).

Conclusions: RVCPi is associated with outcome among pts. undergoing TEER for severe TR. 

Therefore, this hemodynamic predictor might be useful in risk stratification of TEER candidates with severe TR.