Trends in Isolated Tricuspid Edge to edge Repair: Insights from the Sheba Experience

Reimbursement of transcatheter Tricuspid edge-to-edge repair (TEER) was approved in Israel at the beginning of 2024. The purpose of this study was to compare patient characteristics and procedural success in the early and late times.

Methods

All patients that underwent tricuspid TEER were included (N=57). Patients were dichotomized into two mutually exclusive groups: before 2024 (N=27) and during 2024 (N=30). T-test and chi square were used to compare characteristics of the two groups.

Results

Mean age of the study population was 78 (IQR 74-85), 41 (71%) were women and the average TR severity grade was 3.8 at baseline. Overall, 51 (89%) of patients achieved ≤moderate TR (FIGURE). Compared to the early experience, patients in the later time were similar with respect to age, sex, BMI and GFR. However, in 2024, patients presented with better LVEF (48% vs. 42%, p=0.39), and with better baseline hemodynamics during right heart study (mean RA,V-wave and mean PA were 13, 16 , and 28 mmHg respectively compared with 9, 11 and 24 mmHg; p<.05 for all ). Baseline PVR was also better in 2024 (2.86 vs. 2.3, p = 0.05). Baseline glide score was lower in 2024 (2.55 vs. 2.3) and severe glide score group (4+) was smaller in 2024 (2 vs.8 , p= 0.02) . With respect to TEER procedure, skin to skin time was significantly reduced from 106 to 81 minutes (p = 0.04) while number of clips implanted was increased from 1.28 to 1.57 clips per case (p=0.04). Procedural success rates were similar, with non-significant improvement from 85% to 93% (p = 0.33).

Conclusion

Our experience is consistent with the results of the TEER pivotal trials and real world registries with high success rates and a rapid learning curve.