Impact of Preprocedural Anemia on Outcomes in Patients With Tricuspid Regurgitation Undergoing Transcatheter Edge‐to‐Edge Repair: Insights From the TRISPA Registry

BACKGROUND: Tricuspid transcatheter edge-to-edge repair (T-TEER) is an established treatment for tricuspid regurgitation (TR) in patients at high surgical risk. Although anemia is a well-established predictor of poor outcomes in other transcatheter valvular interventions, its role in the tricuspid field remains poorly characterized. AIMS: To evaluate the clinical impact of anemia in a cohort of patients undergoing T-TEER. METHODS: A total of 487 patients undergoing T-TEER at 15 centers between 2020 and 2025 were included. Anemia was defined as a hemoglobin level < 13 g/dL in men and < 12 g/dL in women. The primary outcome was the composite of all-cause mortality and heart failure hospitalization (HFH) at 2-year follow-up, with each component also evaluated separately as secondary outcomes. RESULTS: Anemia was present in 174 patients (35.7%). Compared to those without anemia, patients with baseline anemia had a higher burden of baseline comorbidities, as well as more frequent right ventricular remodeling and tricuspid annular dilatation. Rates of in-hospital clinical complications were similar between groups (p = 0.696), but patients with anemia had higher rates of residual TR ≥ 3+ (p = 0.038). The composite endpoint at 2 years (49% vs. 12%, p < 0.001), as well as all-cause mortality (26% vs. 9%) and HFH (31% vs. 13%), were significantly higher in anemic patients. In the multivariate analysis, anemia was an independent predictor of all-cause mortality at follow-up (hazard ratio 3.03 [1.30-7.96]; p = 0.01). CONCLUSIONS: Baseline anemia is common among patients undergoing T-TEER and is associated with increased mortality and higher TR residual degree.