Tricuspid Regurgitation and 3-Year Mortality After Transseptal Mitral Valve-in-Valve Replacement

BACKGROUND: There is a paucity of data on the impact of transcatheter mitral valve interventions on tricuspid regurgitation (TR). OBJECTIVES: This study aimed to assess the impact of preprocedural TR, residual TR at 30 days, and the associated change in TR severity after transseptal mitral valve-in-valve (MViV) replacement on 3-year mortality. METHODS: The Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry was used to extract data for all patients (n = 5,971) undergoing MViV from 2015 to 2024 at 513 sites. Propensity score matching was used to compare the impact of severe or greater TR on 3-year all-cause mortality. RESULTS: Of the 4,938 patients who met the inclusion criteria, 1,039 (21.0%) had severe or greater TR at baseline. Preprocedural severe or greater TR was associated with significantly higher 3-year mortality compared with moderate and mild or less TR (39.4% vs 31.3% vs 27.7%; P = 0.004). Among patients with severe or greater TR, at least 1-grade improvement was noted in 68.1% at 30 days after MViV. In the 30-day landmark analysis, 3-year mortality was significantly higher in the group with residual severe or greater TR compared with moderate or less TR (43.2% vs 30.7%; P = 0.04). Improvement in TR grade from baseline to 30 days was associated with lower mortality compared with unchanged or worsened TR. CONCLUSIONS: Preprocedural severe or greater TR, 30-day residual severe or greater TR, and unchanged or worsened TR after transseptal MViV were associated with a significantly increased risk for 3-year all-cause mortality. These findings underscore the negative impact of severe TR in multivalvular disease and identify a high-risk group for early intervention with transcatheter tricuspid therapies.