Short-term impact of percutaneous tricuspid valve repair on right ventricular remodeling

Abstract Introduction and Objectives Percutaneous edge-to-edge repair (TEER) has demonstrated safety and efficacy in patients with symptomatic severe tricuspid regurgitation (TR). However, data on its impact on right ventricular (RV) remodeling are scarce. Our objective was to evaluate the short-term effects of TEER on TR reduction and RV remodeling. Methods We conducted a prospective, single-center observational study including symptomatic severe TR patients undergoing TEER at our institution from December 1, 2021, to January 31, 2025. Baseline clinical and echocardiographic parameters were recorded and reassessed at 3 months post-procedure. Results Forty-four patients (59% female; mean age 73 ± 11 years) were included. At baseline, TR severity was severe in 17 (39%), massive in 16 (37%), and torrential in 11 (25%) patients. The procedure was successful in 42 patients (96%). At 3 months, TR grade significantly decreased, with mild TR increasing from 0% to 59%, severe TR decreasing from 39% to 3%, and torrential TR remaining at 3% (Figure). Significant reductions were observed in RV basal diameter (48 ± 10 mm to 44 ± 6 mm; p=0.007) and tricuspid annulus diameter (44 ± 7 mm to 38 ± 6 mm; p0.001). No significant changes were noted in RV area or fractional area change (FAC). Echocardiographically estimated central venous pressure (CVP) and pulmonary artery systolic pressure (PASP) decreased significantly. TAPSE decreased from 20 ± 4 mm to 18 ± 4 mm (p=0.018). The TAPSE/PASP ratio showed a non-significant trend toward improvement (0.50 ± 0.14 vs. 0.59 ± 0.28; p=0.089) (Table). Conclusions In symptomatic severe TR, TEER was associated with significant TR reduction at 3 months. Favorable short-term remodeling of the tricuspid annulus and RV geometry was observed, despite a decrease in longitudinal RV function measured by TAPSE.Figure Table