Introduction: Tricuspid regurgitation (TR) is a common valvular heart disease in elderly patients. As medical treatment and surgical tricuspid valve therapy is associated with a high mortality in multimorbid patients, new interventional therapies were developed and facilitated efficient TR reduction and symptom improvement. The present study aims to identify predictors of TR and symptom improvement after percutaneous annuloplasty and edge-to-edge repair (T-TEER). 

Methods: The ongoing Berlin registry of right heart interventions was started in 2020 and designed to enroll patients with severe to torrential TR undergoing interventional therapy. Treatment includes percutaneous annuloplasty (Cardioband, Edwards Lifesciences, Irvine, CA, USA) and T-TEER (TriClip, Abbott, Chicago, Illinois, USA, or PASCAL, Edwards Lifesciences, Irvine, Kalifornien, USA) according to the recommendation of our local heart team. Diagnostic evaluation of TR comprises medical history, laboratory measurements, electrocardiograms, echocardiography, computed tomography and right and left heart catheterization. Follow-up visits are performed after the procedure, at discharge and after two months.

Results: To date, the registry has enrolled 73 TR patients treated with Cardioband (n=34) or T-TEER (n=38). We observed a TR reduction immediately after the procedure and at discharge of 2.4±0.6 and 2.2±0.8 grades in the T-TEER group as well as 2.3±0.6 and 1.9±0.9 grades in the Cardioband group. A discrepant grading of TR severity immediately after implantation and before discharge was found in 26% of patients after T-TEER and 41% of patients after Cardioband, most likely due to volume status, sedation, and ventilation during the procedure. To identify predictors of stable TR improvement, we analysed parameters from the clinical routine, including quantitative parameters of TR severity, cardiac morphology, and function, laboratory measurements, and cumulative diuretic dose per day. In the T-TEER group, only right ventricular diameter (RVD mid) at baseline predicted a discrepant grading of TR severity (odds ratio [OR] 1.118 [95% confidence interval {CI} 1.011-1.236]) and a TR grade improvement of at least two grades (OR 0.898 [95% CI 0.808-0.999]). In the Cardioband group, none of the parameters assessed differed significantly between patients with and without a discrepant grading of TR severity and an improvement of at least two TR grades at discharge. After two months, 89% of patients after T-TEER (n=28) and 91% of patients after Cardioband (n=21) reported stable or improved symptoms as assessed with New York Heart Association (NYHA) class (p=0.892 for comparison of T-TEER and Cardioband). However, none of the parameters of the clinical routine predicted improvement of NYHA class at two months.

Conclusion: Both interventional therapies showed comparable TR reduction. Only RVD mid predicted post-procedural outcome in the T-TEER group, with RVD mid possibly being a marker of a more advanced disease with right ventricular dilatation and/ or predominantly ventricular TR.