https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Ulm Klinik für Innere Medizin II Ulm, Deutschland
Background: Transcatheter tricuspid edge-to-edge repair (T-TEER) is widely used to treat severe atrial (aFTR) and ventricular (vFTR) functional tricuspid regurgitation (FTR).
Methods: Outcome of 130 consecutive patients treated with T-TEER for severe, symptomatic vFTR or aFTR was analyzed using a composite endpoint of one-year death and rehospitalization for decompensated heart failure. AFTR was defined as left-ventricular ejection fraction ≥50%, right ventricular fractional area change (RVFAC) ≥35% and sPAP≤50mmHg.
Results: Patients with vFTR (N=105) and aFTR (N=25, 19.2%) were both elderly (82.0 years {interquartile range: 74.5-84.5} vs. 82.0 {IQR: 75.0-84.0}, p=0.81) and had similar interventional risk according to the EuroScoreII (6.2 {4.0-10.0} vs. 4.7 {3.6-9.6}, p=0.39). Atrial fibrillation was equally frequent in both groups (89.5 vs. 88.0%, p=0.73). aFTR patients tended to be female more often (57.1 vs. 76.0%, p=0.08) and had lower Nt-proBNP (3513.0 {1744.0-7487.5}vs. 2097 {1744.0-2531.0} pg/ml, p=0.03).
While RVFAC (29.5±8.6 vs. 41.9±4.4%, p<0.01) and LVEF (48.5±12.4 vs. 58.4±8.3%, p<0.01) were expectedly lower in patients with vFTR, right atrial dilation (RA volume: 126.7±56.5 vs. 129.4±76.2ml, p=0.84) was similar in both patient groups.
Successful T-TEER with TR reduction ≥2 degrees (92.2 vs. 92.0, p=0.33) was observed in both groups and residual TR≤II (94.3 vs. 96.0, p=1.0) was achieved equally frequent with a comparable number of devices (≥2 devices: 65.7 vs. 56.0%, p=0.36).
The cumulative incidence of the one-year composite endpoint was significantly higher (34.3 vs. 12.0%) in patients with vFTR (log-rank p=0.046).
Conclusion: Despite equally effective TR reduction through T-TEER, better outcome was observed in patients with aFTR regarding the one-year composite endpoint of death and rehospitalization for heart failure.