Implications of Tricuspid Regurgitation Severity in Patients Undergoing Mitral Transcatheter Edge-to-Edge Repair - The 72nd Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery

Alon Shechter ^1,2,3 Homa Taheri ¹ Takashi Nagasaka ^1,4 Aakriti Gupta ¹ Danon Kaewkes ^1,5 Vivek Patel ¹ Kazuki Suruga ¹ Keita Koseki ^1,6 Ofir Koren ¹ Tarun Chakravarty ¹ Robert J Siegel ^1,7 Raj R Makkar ¹

¹Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, USA
²Department of Cardiology, Rabin Medical Center, Israel
³Faculty of Medicine, Tel Aviv University, Israel
⁴Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Japan
⁵Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand
⁶Department of Cardiovascular Medicine, The University of Tokyo, Japan
⁷David Geffen School of Medicine, University of California Los Angeles, USA

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

Methods – A single-center registry of isolated, first-time interventions was retrospectively assessed for pre-, intra-, and post-procedural 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 TEER.

Results – Overall, 1,287 individuals (60.3% males, age 78 (IQR, 69-85) years, 52.9% with functional mitral regurgitation (MR)) 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 MR, greater comorbidity, and more advanced HF. Although not affecting technical and echocardiographic procedural success, moderate-and-above TR degrees were associated with higher incidence of mortality, HF admissions, and functional class III-IV post-procedure, with moderate-to-severe and greater TR independently conferring increased risk for the various outcomes (primary endpoint – 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.

Conclusion – Among mitral TEER patients, above-moderate TR at baseline and the closely-related moderate-and-above TR at 1-month post-procedure are highly prevalent and signal a suboptimal course.