Tricuspid regurgitation disease stages predict treatment outcomes after transcatheter tricuspid valve repair

F. Schlotter (Leipzig)¹, L. Stolz (München)², K.-P. Kresoja (Mainz)³, F. Praz (Bern)⁴, R. Estévez-Loureiro (Vigo)⁵, F. Maisano (Milan)⁶, E. Van Belle (Lille)⁷, D. Kalbacher (Hamburg)⁸, C. Iliadis (Köln)⁹, N. Karam (Paris)¹⁰, V. Rudolph (Bad Oeynhausen)¹¹, M. Metra (Brescia)¹², R. S. von Bardeleben (Mainz)¹³, H. Lapp (Bad Berka)¹⁴, P. Lüdike (Osnabrück)¹⁵, P. Raake (Augsburg)¹⁶, S. Toggweiler (Luzern)¹⁷, P. Boekstegers (Siegburg)¹⁸, A. Rück (Stockholm)¹⁹, T. Geisler (Tübingen)²⁰, M. Keßler (Ulm)²¹, H. Thiele (Leipzig)¹, K.-P. Rommel (Mainz)³, A. Lauten (Erfurt)²², J. Hausleiter (München)², P. Lurz (Mainz)^3
1Herzzentrum Leipzig - Universität Leipzig Klinik für Innere Medizin/Kardiologie Leipzig, Deutschland; ²LMU Klinikum der Universität München Medizinische Klinik und Poliklinik I München, Deutschland; ³Universitätsmedizin der Johannes Gutenberg-Universität Mainz Kardiologie 1, Zentrum für Kardiologie Mainz, Deutschland; ⁴Inselspital - Universitätsspital Bern Universitätsklinik für Kardiologie Bern, Schweiz; ⁵University Hospital Alvaro Cunqueiro Vigo, Spanien; ⁶San Raffaele Hospital IRCCS Ospedale San Raffaele Milan, Italien; ⁷Centre Hospitalier Universitaire de Lille Cardiology Department Lille, Frankreich; ⁸Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland; ⁹Herzzentrum der Universität zu Köln Klinik III für Innere Medizin Köln, Deutschland; ¹⁰European Hospital, Georges Pompidou, Paris, France; and the eUniversity of Paris, PARCC, INSERM, Paris, France Advanced Heart Failure Unit Paris, Frankreich; ¹¹Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; ¹²University of Brescia Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health Brescia, Italien; ¹³Universitätsmedizin der Johannes Gutenberg-Universität Mainz Zentrum für Kardiologie im Herz- und Gefäßzentrum Mainz, Deutschland; ¹⁴Zentralklinik Bad Berka GmbH Klinik für Kardiologie und Internistische Intensivmedizin Bad Berka, Deutschland; ¹⁵Marienhospital Osnabrück Klinik für Innere Medizin / Kardiologie und Intensivmedizin Osnabrück, Deutschland; ¹⁶Universitätsklinikum Augsburg I. Medizinische Klinik Augsburg, Deutschland; ¹⁷Luzerner Kantonsspital Heart Center Lucerne Luzern, Schweiz; ¹⁸HELIOS Klinikum Siegburg Abteilung für Kardiologie und Angiologie Siegburg, Deutschland; ¹⁹Karolinska University Hospital Cardiology Stockholm, Schweden; ²⁰Universitätsklinikum Tübingen Innere Medizin III, Kardiologie und Kreislauferkrankungen Tübingen, Deutschland; ²¹Universitätsklinikum Ulm Klinik für Innere Medizin II Ulm, Deutschland; ²²Helios-Klinikum Erfurt 3. Medizinische Klinik – Kardiologie Erfurt, Deutschland

Background: Tricuspid valve edge-to-edge repair (T-TEER) emerged as a treatment option for patients with severe tricuspid regurgitation (TR), however, randomized trials have not shown a survival benefit, possibly due to inclusion of patients in early or advanced disease stages. We sought to investigate the association of TR disease stages with outcomes following TTVR.

Methods: In total, 1885 patients with significant TR were analyzed, including 585 conservatively treated individuals and 1300 patients who received T-TEER, and were evaluated as part of the prospective EURO-TR registry. Patients were grouped into early, intermediate and late disease stages based on left and right ventricular functional parameters as well as renal function and natriuretic peptide levels. One-year mortality was evaluated to reveal T-TEER treatment effects. Procedural success was defined as postprocedural TR <3°.

Results: Overall, 395 patients (21%) were categorized into early, 1173 patients (62%) as intermediate and 317 patients (17%) as late stage TR. Event rates were lowest in the early stage and highest in late stage. While, survival was not affected by T-TEER in the early and late stage, in the intermediate stage, T-TEER was associated with a survival benefit (p=0.04). T-TEER benefit showed a u-shaped relationship with TR disease stage, with the highest treatment effect in patients in intermediate disease stages.

Conclusion: In a large cohort study, T-TEER was associated with a survival benefit as compared to medical therapy in patients in an intermediate diseases stage, while outcomes were neither affected in early nor late stages. Timing of T-TEER with regard to disease stages might be crucial to optimize treatment benefits.