Real-world outcomes of transcatheter tricuspid edge-to-edge repair: a single-center experience

Background

Severe tricuspid regurgitation (TR) is a challenging condition with high morbidity, and transcatheter tricuspid edge-to-edge repair (T-TEER) has emerged as a therapeutic option for patients at high surgical risk. We aimed to describe the baseline profile, procedural characteristics, safety, and mid-term clinical outcomes of patients undergoing T-TEER.

Methods

We conducted a single-center retrospective analysis of consecutive patients who underwent T-TEER between 2021 and 2025 at our center. Baseline clinical, echocardiographic, and procedural data were collected. Outcomes were assessed at discharge, 6 months and 1 year, including functional status, heart-failure rehospitalizations, and mortality.

Results

A total of 35 patients were included (mean age 80±4 years; 74.3% female). Most patients were highly symptomatic (NYHA class III–IV in 68.6%), and presented a high comorbidity burden, including atrial fibrillation (97.1%), hypertension (71.4%), dyslipidemia (51.4%), diabetes mellitus (37.1%) and chronic kidney disease (22.9%). Regarding prior cardiac interventions, 37.1% patients had a history of left-sided valve surgery. All patients were on chronic oral anticoagulation, and 91.4% on loop diuretics. Median NT-proBNP was 1877pg/mL [1177-2708], and the median TRI-SCORE was 4 (range 2–9).

TR was predominantly secondary (88.6%), mainly due to annular dilation (62.9%), and was classified as severe, massive or torrential in 40%, 20% and 40% of patients, respectively. Right ventricular (RV) dysfunction, by echocardiographic evaluation, was present in 28.6%, with atrial and ventricular dilation in 97.1% and 80% of patients, respectively. Right heart catheterization, performed in 45.7%, showed predominantly mild precapillary and combined pulmonary hypertension.

Most procedures were elective (80%), with a median hospital stay of 2 days [1-10]. The PASCAL system was used in 68.6% of procedures, with a median of 2 devices per patient. A reduction of at least two grades in TR severity was achieved in 57.2% of patients, with residual TR less than or equal to moderate in 68.5%. Partial device detachment occurred in 17.1%, and RV dysfunction was documented in 22.9%. Bleeding complications, for any cause, occurred in 8.6%.

At 6 months, 77.1% reported symptomatic improvement, with 71.4% in NYHA class I–II. Heart failure readmissions occurred in 17.1%. Overall mortality was 20%, with a 30-day mortality of 5.7% and 1-year mortality of 14.3%.

Conclusions

In this cohort, T-TEER was associated with symptomatic improvement and acceptable mid-term outcomes. These findings reinforce T-TEER as a feasible and effective therapeutic option in carefully selected patients, although larger studies with longer follow-up are needed.For image description, please refer to the figure legend and surrounding text.