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.
