Background:

Despite tricuspid regurgitation (TR) being associated with dismal outcomes, a non-negligible number of patients are conservatively managed due to right ventricular (RV) dysfunction.

Objectives:

We assessed the safety and feasibility of tricuspid transcatheter edge-to-edge repair (TEER) in patients with TR and RV dysfunction.

Methods:

In this retrospective analysis using a single-center prospective registry, we reviewed patients undergoing TEER to treat TR from June 2015 to October 2021. RV dysfunction was defined as tricuspid annular plane systolic excursion (TAPSE) <17 mm and RV fractional area change (RVFAC) <35%. The primary endpoint was 30-day mortality after TEER.

Results:

The study participants (n=262) were at high surgical risk (EuroSCORE II: 6.2% [IQR 4.0 – 10.3%]). Among them, 44 patients (16.8%) met the criteria of RV dysfunction. Thirty-day mortality after TEER was 3.2% in patients with normal RV function and 2.3% in patients with RV dysfunction (p=0.99). TR reduction to ≤2+ upon discharge was consistently achieved irrespective of RV dysfunction (76.5% vs. 70.5%, p=0.44). A significant increase in TAPSE and RVFAC was observed at discharge in patients with RV dysfunction, which was, however, not associated with clinical outcomes. Instead, baseline RV dysfunction was associated with an increased risk of two-year mortality (HR 2.22, 95%CI 1.24–3.97), cardiovascular death (HR 2.44, 95%CI 1.14–5.24), and heart failure rehospitalization (HR 1.79, 95%CI 1.00–3.22).

Conclusion:

TEER was safe and feasible to treat TR in patients with RV dysfunction. Nonetheless, baseline RV dysfunction is associated with an increased risk of adverse outcomes within two years.