Reintervention for failed T-TEER achieved greater tricuspid regurgitation reduction than medical therapy, but the composite of death or heart failure rehospitalization (38.2%) did not differ.
Observational (n=2,278)
Yes
Does reintervention improve clinical outcomes compared to medical therapy in patients with failed transcatheter tricuspid edge-to-edge repair?
In patients with T-TEER device failure, reintervention improves echocardiographic parameters compared to medical therapy but does not significantly reduce the high rate of death or heart failure rehospitalization.
BACKGROUND: Tricuspid regurgitation (TR) is linked to significant morbidity and mortality. Tricuspid transcatheter edge-to-edge repair (T-TEER) provides a less invasive option for high-risk patients, but real-world data on device failure mechanisms and outcomes remain limited. OBJECTIVES: The aim of this study was to investigate the incidence, management, and outcomes of T-TEER device-related failures due to loss of leaflet insertion, single-leaflet device attachment, or device embolization, offering insights into these adverse events. METHODS: The retrospective, multicenter FATE (Failed Tricuspid Transcatheter Edge-to-Edge) registry identified all device-related failures associated with moderate or greater residual or recurrent TR among 2,278 consecutive T-TEER procedures performed at 31 centers from 2017 to 2024. Failure mechanisms were classified by multiparametric echocardiography. Coprimary endpoints were the incidence and management of device-related failure and the composite of death or heart failure rehospitalization. RESULTS: Among 2,278 T-TEER procedures, 123 device-related failures (5.4%) were identified (loss of leaflet insertion, 24%; single-leaflet device attachment, 75%; embolization, 1%), mostly diagnosed early and associated with severe or greater TR in 73%. Management was medical therapy in 54% and reintervention in 46%. Reintervention achieved greater TR reduction and right atrial reverse remodeling than medical therapy, but over a median follow-up period of 255 days, the composite of death or heart failure rehospitalization remained frequent (38.2%) and did not differ between strategies. Higher TRI-SCORE, acute kidney injury, and greater discharge TR severity independently predicted adverse outcomes. CONCLUSIONS: Device-related failure after T-TEER is uncommon but clinically relevant. Reintervention achieves greater TR reduction and right atrial reverse remodeling than medical therapy, but events remain similar between both strategies.
Marco et al. (Sun,) conducted a observational in Tricuspid regurgitation with failed transcatheter edge-to-edge repair (n=2,278). Reintervention vs. Medical therapy was evaluated on Incidence and management of device-related failure and the composite of death or heart failure rehospitalization. Reintervention for failed T-TEER achieved greater tricuspid regurgitation reduction than medical therapy, but the composite of death or heart failure rehospitalization (38.2%) did not differ.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: