Background and Aims: Treatment of severe tricuspid regurgitation (TR) is usually preceded by optimization of volume status through individual adjustment of diuretic medication. Patients presenting for tricuspid valve transcatheter edge-to-edge repair (T-TEER) often undergo prehabilitation during index hospitalization prior to the procedure. A structured assessment of this prehabilitation and its potential effects on coaptation gaps and treatment outcomes has not yet been systematically investigated. Therefore, the objective of this study was to address this knowledge gap.
Methods: The study included patients who underwent T-TEER at a high-volume heart valve center from April 2021 until June 2025. Prehabilitation and its effects were evaluated by assessing the following parameters at admission and day of intervention: loop diuretic dosage, thiazide diuretic dosage, body weight, coaptation gap size, blood pressure, heart rate, hemoglobin, hematocrit, serum osmolality, serum potassium level, serum sodium level and estimated glomerular filtration rate. The degree of TR reduction was assessed at the end of the T-TEER procedure.
Results: The study included a total of 229 patients (mean age 82.3±6.5 years, 57.6% women). TR was torrential in 14.4%, massive in 47.2% and severe in 36.7% of patients. The median time from hospital admission to treatment was 8.0±4.3 days. Prehabilitation included a significant increase in the dosage and a trend towards higher prescription rates of loop diuretics (80 [IQR 40-160] mg/d to 120 [IQR 60-190] mg/d, p<0.001; 94.8% to 96.9%, p=0.197). The percentage of patients receiving thiazide diuretics (21.0% to 24.9%, p=0.208) as well as the median dosage remained unchanged (25 [IQR 13-25]% to 25 [IQR 20-25]%).
Prehabilitation led to a significant reduction in body weight (71.1±14.3 kg to 68.7±13.7 kg, p<0.001) and coaptation gap size (4.5±2.0 mm to 3.3±1.8 mm, p<0.001). At the same time a significant reduction in blood pressure and heart rate was concurrently observed (systolic 121±20 mmHg to 116±19 mmHg; diastolic 71±11 mmHg to 68±11 mmHg; heart rate 75±17/min to 71±13/min, all p<0.001). Hemoglobin, hematocrit and serum sodium levels significantly increased (11.9±2.2 to 12.3±2.0 g/dl; 36.0±6.4 to 37.2±6.0%; 139±3.9 mmol/l to 139.7±3.6 mmol/l, all p<0.001), whereas serum potassium levels decreased (4.4±0.7 mmol/l to 4.2±0.5 mmol/l, p<0.001). By eGFR, there was a non-statistically significant reduction in renal function (41.4±17.0 ml/min to 39.9±17.9 ml/min, p=0.053).
T-TEER reduced TR to ≤ 1+ in 81.7% and ≤ 2+ in 99.1% of patients. A one-, two-, three- and four grade TR reduction was observed in 2.6%, 46.3%, 44.5% and 6.6% of patients, respectively. The reduction in gap size significantly correlated with the degree of TR reduction (𝜌=0.234, p=0.004).
Conclusions: Prehabilitation, defined as the reduction in systemic venous congestion and optimization of volume status, was primarily driven by an increase in loop diuretic dosage. It was associated with reduced body weight as well as improved coaptation gaps, which was correlated with the degree of TR reduction.
