Tricuspid regurgitation disease stages predict treatment outcomes after transcatheter tricuspid valve repair

Florian Schlotter (Leipzig)1, L. Stolz (München)2, K.-P. Kresoja (Leipzig)1, F. Praz (Bern)3, R. Estevez-Loureiro (Vigo)4, F. Maisano (Milano)5, E. van Belle (Lille)6, D. Kalbacher (Hamburg)7, C. Iliadis (Köln)8, N. Karam (Paris)9, V. Rudolph (Bad Oeynhausen)10, M. Metra (Brescia)11, R. S. von Bardeleben (Mainz)12, H. Lapp (Bad Berka)13, P. Lüdike (Essen)14, P. Raake (Augsburg)15, S. Toggweiler (Luzern)16, P. Boekstegers (Siegburg)17, A. Rück (Stockholm)18, T. Geisler (Tübingen)19, M. Keßler (Ulm)20, H. Thiele (Leipzig)1, K.-P. Rommel (Leipzig)1, A. Lauten (Erfurt)21, J. Hausleiter (München)2, P. Lurz (Mainz)22

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.

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