Background:
Transcatheter edge-to-edge repair (T-TEER) has become an established therapy for severe tricuspid regurgitation (TR). The etiology of TR appears to influence prognosis, but data remain limited.
Methods:
This single-center retrospective study included 85 patients treated with T-TEER for severe TR between 2021 and 2024 at Asklepios Klinik St. Georg within the AVALoN registry. Baseline, procedural, and follow-up data, including echocardiographic parameters, were analyzed and stratified by atrial functional (AFTR), ventricular functional (VFTR), and cardiac implantable electronic device–associated (CIED) TR.
Results:
Among 85 patients, 24 (29%) had AFTR, 44 (52%) VFTR, and 8 (9%) CIED-TR. 9 patients (10%) could not be classified and were categorized as primary TR. CIED patients showed higher baseline TRI-SCORES compared to both AFTR (6 [5–7.25] vs. 3 [2–4], post hoc p<0.001) and VFTR (4 [2–5], post hoc p=0.003). The annular diameter was larger in VFTR and CIED-TR (43 ± 5 mm each) than in AFTR (42 ± 6 mm; global p=0.007). RV dilatation was most pronounced in VFTR and CIED-TR (RV basal 49 ± 7 mm and 51 ± 5 mm; global p< 0.001). RV–PA coupling (TAPSE/sPAP) was most favorable in AFTR (0.41 ± 0.14) and lowest in CIED-TR (0.35 ± 0.13; global P=0.007), reflecting better right ventricular function in AFTR. sPAP was higher in VFTR (45 ± 12 mmHg) and CIED-TR (49 ± 15 mmHg) than in AFTR (41 ± 11 mmHg; global p=0.043). After T-TEER, a significant reduction in TR severity was achieved across all groups (P<0.001). However, CIED-TR tended to show higher rates of residual regurgitation compared to AFTR and VFTR. Annular diameter showed a decrease after T-TEER compared with baseline (42.0 [38.0–47.0] mm vs. 37.0 [33.0–42.0] mm, p=0.007), indicating a trend toward structural reverse remodeling. Annular dimensions differed among etiologic subgroups (p=0.035), with the greatest reduction observed in atrial functional TR. RV function remained largely preserved, with TAPSE highest in AFTR (17.0 ± 4.0 mm) and lowest in CIED-TR (13.8 ± 3.5 mm; global p=0.33). sPAP showed a slight postprocedural decrease (AFTR 40 ± 8 mmHg, VFTR 39 ± 10 mmHg, CIED-TR 38 ± 16 mmHg; global p=0.61). Major complications, including major bleeding, dialysis, and in-hospital mortality, occurred in 7 % of AFTR, 5 % of VFTR, and 0 % of CIED-TR patients (p=0.62). Minor complications were comparable across all groups (21 %, 21 %, and 13 %; p=0.88). Clip detachment was analyzed separately and occurred in 12 % of AFTR, 9 % of VFTR, and 12 % of CIED-TR patients (p=0.84). Unplanned rehospitalizations occurred in 12.5 %, 11.4 %, and 25 % at 30 days (p=0.54) and in 33 %, 36 %, and 50 % at one year (p=0.67).
Conclusion:
T-TEER proved safe and effective, achieving a significant reduction of TR in all etiologies. TR etiology was a determinant of outcome: AFTR showed preserved RV function and favorable remodeling, VFTR demonstrated signs of RV reverse remodeling, whereas CIED-TR was associated with lower RV contractility and higher residual regurgitation. Etiology-based classification may improve patient selection and procedural strategy to maximize therapeutic success.
