1Herzzentrum Leipzig - Universität Leipzig Klinik für Innere Medizin/Kardiologie Leipzig, Deutschland; 2LMU Klinikum der Universität München Medizinische Klinik und Poliklinik I München, Deutschland; 3Inselspital, University of Bern Department of Cardiology Bern, Schweiz; 4University Hospital Alvaro Cunqueiro Interventional Cardiology Clinic Vigo, Spanien; 5San Raffaele Division of Cardiology and Department of Cardiac Surgery Milano, Italien; 6Institut Cœur Poumon, Inserm U1011, Institut Pasteur de Lille, France Département de Cardiologie Lille, Frankreich; 7Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland; 8Herzzentrum der Universität zu Köln Klinik III für Innere Medizin Köln, Deutschland; 9European Hospital, Georges Pompidou, Paris, France; and the eUniversity of Paris, PARCC, INSERM, Paris, France Advanced Heart Failure Unit Paris, Frankreich; 10Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; 11University of Brescia Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Brescia, Italien; 12Universitätsmedizin der Johannes Gutenberg-Universität Mainz Zentrum für Kardiologie im Herz- und Gefäßzentrum Mainz, Deutschland; 13Zentralklinik Bad Berka GmbH Klinik für Kardiologie und Internistische Intensivmedizin Bad Berka, Deutschland; 14Universitätsklinikum Essen Klinik für Kardiologie und Angiologie Essen, Deutschland; 15Universitätsklinikum Augsburg I. Medizinische Klinik Augsburg, Deutschland; 16Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland. Luzern, Schweiz; 17HELIOS Klinikum Siegburg Siegburg, Deutschland; 18Karolinska University Hospital, SE-171 76 Stockholm, Sweden. Department of Cardiology Stockholm, Schweden; 19Universitätsklinikum Tübingen Innere Medizin III, Kardiologie und Kreislauferkrankungen Tübingen, Deutschland; 20Universitätsklinikum Ulm Klinik für Innere Medizin II Ulm, Deutschland; 21Helios-Klinikum Erfurt 3. Medizinische Klinik – Kardiologie Erfurt, Deutschland; 22Universitätsmedizin der Johannes Gutenberg-Universität Mainz Kardiologie 1, Zentrum für Kardiologie Mainz, 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.