DOI: 10.1161/jaha.124.037635 ISSN: 2047-9980

Implications of Tricuspid Regurgitation Severity in Patients Undergoing Mitral Transcatheter Edge‐to‐Edge Repair

Alon Shechter, Homa Taheri, Takashi Nagasaka, Aakriti Gupta, Danon Kaewkes, Vivek Patel, Kazuki Suruga, Manvir Dhillon, Keita Koseki, Ofir Koren, Moody Makar, Sabah Skaf, Dhairya Patel, Tarun Chakravarty, Robert J. Siegel, Raj R. Makkar
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Background

Prognostically meaningful tricuspid regurgitation (TR) is not well‐defined in the mitral transcatheter edge‐to‐edge repair arena. We aimed to explore the prevalence, correlates, and consequences of TR grades and postprocedural trends in this setting.

Methods and Results

A single‐center registry of isolated, first‐time interventions was retrospectively assessed for pre‐, intra‐, and postprocedural aspects up to 1 year, of them the primary composite outcome of all‐cause deaths or heart failure (HF) hospitalizations, all according to TR severity at baseline and at 1 month following mitral transcatheter edge‐to‐edge repair. Overall, 1287 individuals (60.3% men, age 78 [interquartile range, 69–85] years, 52.9% with functional mitral regurgitation) were included. Below‐moderate, moderate, and above‐moderate TR affected 48.4%, 29.5%, and 22.1% of patients, respectively. Increasing TR severity was accompanied by higher rates of functional, severe mitral regurgitation, greater comorbidity, and more advanced heart failure. Although not affecting technical and echocardiographic procedural success, moderate‐and‐above TR degrees were associated with higher incidence of mortality, heart failure admissions, and functional class III to IV postprocedure, with moderate‐to‐severe and greater TR independently conferring increased risk for the various outcomes (primary end point; HR, 1.36 [95% CI, 1.21–1.80]; P =0.027). One‐month postprocedural TR severity directly correlated with, and was mostly similar to or worse than, its baseline counterpart. Rather than the change between the two, moderate‐and‐above grade at 1 month, observed in 37.1% of eligible cases, emerged as predictive of the primary outcome's risk.

Conclusions

Among patients undergoing mitral transcatheter edge‐to‐edge repair, above‐moderate TR at baseline and the closely related moderate‐and‐above TR at 1 month postprocedure are highly prevalent and signal a suboptimal course.

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