Serial cardiac remodeling and organ function changes after transcatheter tricuspid valve repair in patients with severe tricuspid regurgitation: Importance of multimodal assessment post-TTVR

Background Transcatheter tricuspid valve repair (TTVR) improves severe tricuspid regurgitation (TR), but procedure-related changes of biventricular and systemic organ function remain poorly characterized. Purpose This study investigates serial biventricular and systemic organ function changes in severe TR patients post-TTVR. Methods Thirty-one patients (76±11 years, 41.9% male) with severe TR undergoing TTVR were prospectively enrolled. Echocardiographic assessments were performed at baseline (T0), post-procedure before discharge (T1, median 3 days), and one year post-procedure (T2, median 442 days). Concurrent serum cardiac, renal and hepatic biomarkers were also measured. Results Following TTVR, TR severity decreased significantly, with effective regurgitant orifice area declining from 0.53 cm² to 0.31 cm² (P=0.003) and regurgitant volume from 48.7 mL to 30.9 mL (P=0.002) at one year. Concurrently, right ventricular (RV) reverse remodeling was observed, characterized by reductions in basal RV diameter (51.3 mm to 48.0 mm, P=0.026), mid-diameter (40.3 mm to 36.0 mm, P=0.005), and end-diastolic area (26.9 cm² to 22.6 cm², P < 0.001). Right atrial size and function showed no improvement, with persistently increased end-systolic volume (129 mL to 135 mL) and reduced emptying fraction (14.7% to 15.2%). Systolic pulmonary artery pressure (sPAP) progressively reduced from 51.8 mmHg to 44.8 mmHg (P=0.002). RV fractional area change (RVFAC) transiently decreased post-procedure (42.2% to 37.4%, P=0.007) but returned to baseline by one year (42.2%), while RV free-wall longitudinal strain worsened acutely (-21.0% to -17.8%, P=0.011) and showed no recovery at one year follow-up. Left ventricular ejection fraction exhibited transient fluctuations post-TTVR but stabilized at one year, whereas left atrial volume index trended to increase post-TTVR (50.8 mL/m² to 55.7 mL/m², P=0.052). Diastolic dysfunction persisted, marked by declining septal e’ velocity (P=0.002) and rising E/e’ ratio (P=0.046) despite TTVR. Improved renal and hepatic function was evidenced by reduction of urea (18% decrease, P=0.022) and gamma-glutamyl transferase (25% decrease, P=0.022). Conclusions TTVR induces sustained TR reduction and right ventricle reverse remodeling, with favorable sPAP declines. TTVR also induce improvement of renal and hepatic function. These findings highlight the importance of multimodal post-TTVR assessment on the evaluation of the efficacy of this procedure.