Background:
There is limited evidence on the impact of postprocedural transvalvular gradients on clinical outcomes following tricuspid valve transcatheter edge-to-edge repair (T-TEER). This study aims to assess the association between postprocedural gradients and outcomes, including mortality and heart failure-related hospitalizations, in a large cohort of patients treated with T-TEER within the real-world PASTE (PASCAL for Tricuspid Regurgitation—a European registry, NCT05328284) registry.
Methods:
We retrospectively analyzed data from 903 patients with severe tricuspid regurgitation (TR) who underwent T-TEER in 16 European centers. The primary outcome was a composite of all-cause mortality or hospitalization for heart failure (HFH) during follow-up. We conducted image-based analyses on transvalvular gradients and TR reduction to moderate or less TR (procedural success) at discharge in all patients and evaluated their association with clinical outcomes, using Kaplan-Meier analyses, and Cox proportional hazard models.
Results:
Higher transvalvular gradients at discharge were associated with an increased risk of mortality and HFH. The impact was particularly evident for the composite endpoint of death or HFH (Hazard ratio [HR]: 2.58, 95%CI: 1.65-4.01, p<0.001). Notably, procedural success (TR≤2+) emerged as an additional significant predictor of improved outcomes. Patients with higher gradient at discharge (>3mmHg) but successful repair (TR ≤2+) demonstrated a lower rate of 1-year death or HFH compared to those with lower gradient but unsuccessful repair (23.7% vs. 34.2%, p=0.025). The subgroup of patients with both a high gradient and lack of procedural success showed the highest rate of death and HFH (HR: 3.3, 95% CI: 2.0–3.4, p<0.001).
Conclusions:
This study identifies transvalvular gradient as an important factor influencing outcomes after T-TEER. While elevated gradients correlate with poor outcome, procedural success appears to mitigate this association, underscoring the clinical importance of achieving optimal TR reduction. Our findings support the use of the postprocedural gradient to identify patients at elevated risk, which may affect clinical decision-making and follow-up strategies.
