Impact of tricuspid regurgitation disease stage on short-term outcome in a real-world population after tricuspid transcatheter edge-to-edge repair

Background Transcatheter edge-to-edge repair (T-TEER) of severe tricuspid regurgitation (TR) is emerging as a lower-risk alternative to surgery, but futility remains a major concern. Currently, it is unclear at what stage of the disease patients would benefit from this therapy. Purpose Our aim was to analyze the association between disease stage and early outcomes following T-TEER. Methods Observational study in a prospective cohort of patients from a third level referral university hospital, which included all cases of severe or massive TR and persistent symptoms treated with TEER with the Pascal device from December 2021 to February 2025. The cohort was divided into two groups: early-stage disease (score 4 to 6 points)and intermediate-advanced disease (score 7 to 12 points) according to a multiparameter score based on left and right ventricular function, renal function, and natriuretic peptide levels. Baseline clinical and echocardiographic characteristics, as well as 18-month all-cause mortality and event- free survival (hospitalization for heart failure, Tricuspid Valve re-intervention or surgery), were analyzed. Results 44 patients were included: 12 (27%) were classified as early-stage and 32 (73%) as intermediate-advanced stage. Twenty-six patients (59%) were women, and the mean age of the overall cohort was 73 ± 11 years. Baseline characteristics are shown in Picture 1: no significant differences were found in baseline characteristics between the two groups, except for two of the score criteria (eGFR and NT-proBNP) and NYHA class, with a higher prevalence of NYHA III-IV in the intermediate-advanced group. The global median TRI-SCORE was 3.2 ± 1.5, with no significant difference between groups. In terms of echocardiographic parameters, neither LVEF (p = 0.270) nor TAPSE (p = 0.410) differed significantly, however, left ventricular end-diastolic diameter was larger in the intermediate-advanced stage. Systolic pulmonary artery pressure and effective regurgitant orifice area were also similar between the two groups. Procedural success was achieved in 95.5% (91.7% early vs 96.9% intermediate-advanced, p = 0.460) and 42 patients (95.5%) achieved moderate or lower TR (91.7% versus 96.6% for both groups, p = 0.460, respectively). Mortality at 18-month follow-up did not differ between patients with early and intermediate-advanced disease treated with T-TEER (p = 0.23), however, event-free survival was significantly lower in the early-stage group (p = 0.04) (Picture 2). Conclusions In patients with TR in early stages of the disease treated with T-TEER with the Pascal system, short-term event-free survival results are significantly better compared to those in an intermediate-advanced stage. Longer follow-up and a larger population are needed to better assess the potential impact of disease stage, especially with regard to mortality in patients with severe TR treated with T-TEER.