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Background <p>Success of tricuspid transcatheter edge-to-edge repair (T-TEER) was defined in feasibility studies for specific devices by ≥ one-grade tricuspid regurgitation (TR) reduction (1 + to 5 + classification). However, the Clinical Trial to Evaluate Cardiovascular Outcomes in Patients Treated With the Tricuspid Valve Repair System (TRILUMINATE) randomized controlled trial (RCT) showed significant quality of life (QoL) improvement only in patients with residual moderate-or-less TR (MTR). We sought to validate this finding in a real-world cohort by comparing long-term T-TEER clinical outcomes between patients with residual severe TR (STR; 3 +) and those with MTR (≤ 2).</p> Methods <p>Eligible inoperable patients had symptomatic functional TR despite medical therapy. The primary efficacy endpoint was ≥ one-grade TR reduction, coupled with severe-or-less residual TR (≤ 3), by 30-day follow-up.</p> Results <p>Sixty-four patients (mean-age 81.8 ± 4.9&#xa0;years; STS Score 10 ± 5.1%; 92% NYHA III–IV) with ≥ 3 TR underwent T-TEER at our institution. The primary efficacy endpoint was 94% (60/64) (37 MTR vs 23 STR patients), with 100% technical success. Both MTR (<i>n</i> = 32) and STR (<i>n</i> = 21) 1-year survivors improved their QoL, e.g., KCCQ Score increased by 33.7 ± 15.5 pts. (<i>p</i> &lt; 0.001) vs 23 ± 16.1 pts. (<i>p</i> = 0.001) (between-group <i>p</i> = 0.166), with no significant difference in NYHA class reduction (one-grade 56% vs 62%, <i>p</i> = 1.000; two-grade 31% vs 19%, <i>p</i> = 0.544). Predictors of STR on multivariate analysis were periprocedural image quality (OR 1.90,<i> p</i> = 0.003) and main TR jet position (OR 1.55, <i>p</i> = 0.036).</p> Conclusions <p>Although T-TEER should instinctively aim for MTR, considerable reduction is not always possible in multimorbid patients with advanced right heart remodeling. This study indicates that even moderate TR reduction and residual STR can improve QoL. Therefore, echocardiography should not be the only indicator of success.</p> Graphical Abstract <p></p>

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The impact of residual tricuspid regurgitation on long-term clinical outcomes, following tricuspid transcatheter edge-to-edge repair

  • 期刊论文

  • 发表日期：

    2026年5月11日

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  • Alexandru Patrascu,
  • Donat Binder,
  • Ibrahim Alashkar,
  • Hannah In der Wische,
  • Peter Schnabel,
  • Feraas Al Farwan,
  • Kai Weinmann,
  • Ilka Ott

摘要

Background

Success of tricuspid transcatheter edge-to-edge repair (T-TEER) was defined in feasibility studies for specific devices by ≥ one-grade tricuspid regurgitation (TR) reduction (1 + to 5 + classification). However, the Clinical Trial to Evaluate Cardiovascular Outcomes in Patients Treated With the Tricuspid Valve Repair System (TRILUMINATE) randomized controlled trial (RCT) showed significant quality of life (QoL) improvement only in patients with residual moderate-or-less TR (MTR). We sought to validate this finding in a real-world cohort by comparing long-term T-TEER clinical outcomes between patients with residual severe TR (STR; 3 +) and those with MTR (≤ 2).

Methods

Eligible inoperable patients had symptomatic functional TR despite medical therapy. The primary efficacy endpoint was ≥ one-grade TR reduction, coupled with severe-or-less residual TR (≤ 3), by 30-day follow-up.

Results

Sixty-four patients (mean-age 81.8 ± 4.9 years; STS Score 10 ± 5.1%; 92% NYHA III–IV) with ≥ 3 TR underwent T-TEER at our institution. The primary efficacy endpoint was 94% (60/64) (37 MTR vs 23 STR patients), with 100% technical success. Both MTR (n = 32) and STR (n = 21) 1-year survivors improved their QoL, e.g., KCCQ Score increased by 33.7 ± 15.5 pts. (p < 0.001) vs 23 ± 16.1 pts. (p = 0.001) (between-group p = 0.166), with no significant difference in NYHA class reduction (one-grade 56% vs 62%, p = 1.000; two-grade 31% vs 19%, p = 0.544). Predictors of STR on multivariate analysis were periprocedural image quality (OR 1.90, p = 0.003) and main TR jet position (OR 1.55, p = 0.036).

Conclusions

Although T-TEER should instinctively aim for MTR, considerable reduction is not always possible in multimorbid patients with advanced right heart remodeling. This study indicates that even moderate TR reduction and residual STR can improve QoL. Therefore, echocardiography should not be the only indicator of success.

Graphical Abstract