https://doi.org/10.1007/s00392-025-02625-4
1Bremer Institut für Herz- und Kreislaufforschung (BIHKF) Bremen, Deutschland; 2Universitätsklinikum Schleswig-Holstein Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin Lübeck, Deutschland
Background: Knowledge regarding gender-specific results of transcatheter edge-to-edge tricuspid valve repair (T-TEER) is scarce and gender-specific risk factors for mortality are rarely available.
Objective: The study sought to investigate gender-related differences in outcome and to evaluate gender-specific risk factors for all-cause mortality in patients undergoing T-TEER.
Methods: Consecutive patients with severe tricuspid regurgitation (TR) treated with T-TEER were included and followed prospectively. A propensity score match analysis was applied to evaluate gender-related differences in short and long-term outcome.
Primary endpoint was all-cause mortality during a follow-up period of 12±9 months. A multivariate Cox proportional-hazards regressions analysis was performed to identify gender-specific predictors for all-cause mortality.
Results: 157 patients (80.9 ± 6.3 years; 85 females, 72 male) underwent T-TEER. Propensity-matched women and men achieved comparable significant rates of successful TR reduction (71.4 % vs. 76.0 % TR ≤ 2+ at discharge) with low and similar in-hospital major adverse event rates. After propensity score matching women and men experienced similar rates of heart failure hospitalization (20 % vs. 11 %; log-rank p = 0.2) and all-cause mortality (23 % vs. 33 %; log-rank p = 0.2) at long-term follow-up.
In Cox regression analysis women and men showed similar risk-factors for all-cause mortality. Risk factors for women were failed clip (hazard ratio (HR) 25.4; 95% confidence interval (CI) 2.56-249; p = 0.006), NT-proBNP (HR 4.83; 95% CI 2.52-9.27; p < 0.001) and right ventricular cardiac power index (RVCPI; HR 3.38; 95% CI 1.33-8.62; p = 0.011). Risk factors for men were NT-proBNP (HR 3.15; 95% CI 1.47-6.74; p = 0.003) and RVCPI (HR 2.71; 95 CI 1.20-6.11; p = 0.0016).
Conclusions: Regardless of gender T-TEER is associated with immediate success and low in-hospital major adverse event rates. After propensity score matching women and men show similar survival rates at long-term follow-up. Both, RVCPI and NT-proBNP were independent risk factors for all-cause mortality in women and men, which might be of added value in patient selection for T-TEER.