Concomitant Tricuspid Regurgitation Severity and Its Secondary Reduction Determine Long-term Prognosis After Transcatheter Mitral Valve Edge-to-edge Repair

Overview

Journal Clin Res Cardiol

Specialty Cardiology & Vascular Diseases

Date 2021 Jan 12

PMID 33433670

Citations 13

Authors

Martin Geyer

Karsten Keller

Kevin Bachmann

Sonja Born

Alexander R Tamm

Tobias Friedrich Ruf

Felix Kreidel

Omar Hahad

Aniela Petrescu

Michaela Hell

Andres Beiras-Fernandez

Angela Kornberger

Eberhard Schulz

Thomas Munzel

Ralph Stephan von Bardeleben

Affiliations

Soon will be listed here.

Abstract

Background: Concomitant tricuspid regurgitation (TR) is a common finding in mitral regurgitation (MR). Transcatheter repair (TMVR) is a favorable treatment option in patients at elevated surgical risk. To date, evidence on long-term prognosis and the prognostic impact of TR after TMVR is limited.

Methods: Long-term survival data of patients undergoing isolated edge-to-edge repair from June 2010 to March 2018 (combinations with other forms of TMVR or tricuspid valve therapy excluded) were analyzed in a retrospective monocentric study. TR severity was categorized and the impact of TR on survival was analysed.

Results: Overall, 606 patients [46.5% female, 56.4% functional MR (FMR)] were enrolled in this study. TR at baseline was categorized severe/medium/mild/no or trace in 23.2/34.3/36.3/6.3% of the cases. At 30-day follow-up, improvement of at least one TR-grade was documented in 34.9%. Severe TR at baseline was identified as predictor of 1-year survival [65.2% vs. 77.0%, p = 0.030; HR for death 1.68 (95% CI 1.12-2.54), p = 0.013] and in FMR-patients also regarding long-term prognosis [adjusted HR for long-term mortality 1.57 (95% CI 1.00-2.45), p = 0.049]. Missing post-interventional reduction of TR severity was predictive for poor prognosis, especially in the FMR-subgroup [1-year survival: 92.9% vs. 78.3%, p = 0.025; HR for death at 1-year follow-up 3.31 (95% CI 1.15-9.58), p = 0.027]. While BNP levels decreased in both subgroups, TR reduction was associated with improved symptomatic benefit (NYHA-class-reduction 78.6 vs. 65.9%, p = 0.021).

Conclusion: In this large study, both, severe TR at baseline as well as missing secondary reduction were predictive for impaired long-term prognosis, especially in patients with FMR etiology. TR reduction was associated with increased symptomatic benefit.

Citing Articles

Prediction of tricuspid regurgitation regression after mitral valve transcatheter edge-to-edge repair using three-dimensional transoesophageal echocardiography.

Takeuchi M, Utsunomiya H, Tohgi K, Hamada A, Hyodo Y, Tsuchiya A Eur Heart J Imaging Methods Pract. 2025; 3(1):qyaf016.

PMID: 39935630 PMC: 11811635. DOI: 10.1093/ehjimp/qyaf016.

Insulin-Like Growth Factor Binding Protein 2 Predicts Right Ventricular Reverse Remodeling and Improvement of Concomitant Tricuspid Regurgitation After Transcatheter Edge-to-Edge Mitral Valve Repair.

Groger M, Felbel D, Paukovitsch M, Schneider L, Markovic S, Rottbauer W Clin Cardiol. 2024; 47(12):e70048.

PMID: 39600082 PMC: 11599423. DOI: 10.1002/clc.70048.

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

Shechter A, Taheri H, Nagasaka T, Gupta A, Kaewkes D, Patel V J Am Heart Assoc. 2024; 13(23):e037635.

PMID: 39575719 PMC: 11681571. DOI: 10.1161/JAHA.124.037635.

Predictors of Residual Severe Tricuspid Regurgitation After Transcatheter Mitral Valve Repair.

Basman C, Kodra A, Pirelli L, Mustafa A, Mehla P, Trost B J Soc Cardiovasc Angiogr Interv. 2024; 2(4):100612.

PMID: 39131656 PMC: 11307626. DOI: 10.1016/j.jscai.2023.100612.

Residual Tricuspid Regurgitation After Mitral Transcatheter Edge-to-Edge Repair: Accomplice or Bystander?.

Jagadeesan V, Blair J J Soc Cardiovasc Angiogr Interv. 2024; 2(4):100999.

PMID: 39131641 PMC: 11308409. DOI: 10.1016/j.jscai.2023.100999.

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