Impact of concomitant left sided valve disease on outcomes following tricuspid valve transcatheter edge-to-edge repair: Insights from EuroTR

Q: What are the key findings of this study?

Concomitant moderate or greater left-sided valvular heart disease in patients undergoing T-TEER was an independent predictor of mortality (HR 1.54; 95% CI 1.21-1.96; p<0.001).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Tricuspid regurgitation (n=1647). Intervention: Concomitant left-sided valvular heart disease (≥ moderate) vs. No or mild concomitant left-sided valvular heart disease. Primary outcome: Mortality (HR 1.54, 95% CI 1.21-1.96, p=<0.001).

Q: What does this research mean for the field?

Concomitant moderate or greater left-sided valvular heart disease in patients undergoing tricuspid valve transcatheter edge-to-edge repair (T-TEER) is an independent predictor of mortality, although the procedure still provides significant symptomatic benefit and tricuspid regurgitation reduction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

The study aims to assess how concomitant left-sided valvular heart disease affects outcomes after tricuspid valve edge-to-edge repair.

Jonas Gmeiner; Lukas Stolz; Karl‐Patrik Kresoja; Jennifer von Stein; Vera Fortmeier; Christoph Pauschinger; Wolfgang Rottbauer; Mohammad Kassar; Bjoern Goebel; Paolo Denti; Paul Achouh; Tienush Rassaf; Manuel Barreiro-Perez; Peter Boekstegers; Andreas Rück; Monika Zdanyte; M Adamo; Flavien Vincent; Philipp Schlegel; Sebastian Rosch; Mirjam G Wild; Christian Besler; Stefan Toggweiler; Stephanie Brunner; Julia Grapsa; Tiffany Patterson; H Thiele; Tobias Kister; Giuseppe Tarantini; Giulia Masiero; Marco De Carlo; Alessandro Sticchi; Fabian Voss; Amin Polzin; Antonio Popolo Rubbio; Francesco Bedogni; Thorald Stolte; T Nestelberger; Thomas Benito-Gonzales; Enrique Sánchez-Muñóz; Mathias H. Konstandin; Eric Van Belle; Marco Metra; Tobias Geisler; Rodrigo Estévez-Loureiro; Amir Abbas Mahabadi; Nicole Karam; Francesco Maisano; Philipp Lauten; F Praz; Mirjam Kessler; Daniel Kalbacher; Volker Rudolph; Christos Iliadis; P Lurz; Jörg Hausleiter; EuroTR Investigators; Julia Novotny; Ludwig T Weckbach; Thomas J Stocker; Kaspar Volz; Katalin Berschiminski; Philipp Doldi; Hannah Kempton; Dario Grassini; Clemens Scherer; Karl-Philip Rommel; Ralph Stephan von Bardeleben; Roman Pfister; Stephan Baldus; Philipp von Stein; Muhammed Gerçek; Felix Rudolph; Sebastian Ludwig; Benedikt Koell; Leonhard‐Moritz Schneider; Dominik Felbel; Carsten Salomon; Harald Lapp; Quentin de Baynast; Alain Berrebi; Florian Schindhelm; Berenice Caneiro-Queija; Julio Echarte-Morales; Andreas Goldschmied; Edoardo Pancaldi; Elisa Pezzola; Mauro Massussi; Laura Lupi; Natacha Rousse; Samy Aghezzaf; Norbert Frey; Martin Kraus; Dirk Westermann; Federico Arturi; Anke von Peter

doi:10.1093/eschf/xvag103

April 18, 2026ESC Heart FailureOpen Access

Impact of concomitant left sided valve disease on outcomes following tricuspid valve transcatheter edge-to-edge repair: Insights from EuroTR

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Key result

Concomitant moderate or greater left-sided valve disease during T-TEER is linked to ~54% higher mortality.

HR 1.54
95% CI 1.21-1.96
P<0.001
n=1,647

Figures

Why the study?

The prognostic impact of coexisting left-sided valvular heart disease on clinical outcomes after tricuspid valve edge-to-edge repair remains unclear under real-world conditions.

Does concomitant left-sided valvular heart disease worsen survival and heart failure hospitalizations in patients undergoing tricuspid valve transcatheter edge-to-edge repair?

Key Points

The study aims to assess how concomitant left-sided valvular heart disease affects outcomes after tricuspid valve edge-to-edge repair.
Included patients undergoing T-TEER from the EuroTR registry (NCT06307262) with complete echocardiographic data.
Endpoints included 2-year survival, heart failure hospitalizations, NYHA functional class, and TR reduction.
95.8% had ≥ mild, 35.6% had moderate, and 3.8% had severe concomitant left-sided valvular heart disease.
Moderate or higher valvular disease was linked to reduced 2-year survival (p<0.001) and higher rates of heart failure hospitalizations (p=0.005).
≥ Moderate VHD was an independent mortality predictor (Hazard ratio 1.54, 95% CI 1.21-1.96, p<0.001).

Study Design

Type

Observational (n=1,647)

Multicenter

Yes

Structured PICO

Does concomitant left-sided valvular heart disease worsen survival and heart failure hospitalizations in patients undergoing tricuspid valve transcatheter edge-to-edge repair?

P

Population

1,647 patients undergoing tricuspid valve transcatheter edge-to-edge repair (T-TEER) for tricuspid regurgitation (TR) from the EuroTR registry with complete echocardiographic data on left-sided valve disease.

I

Intervention

Tricuspid valve transcatheter edge-to-edge repair (T-TEER) in patients with ≥ moderate concomitant left-sided valvular heart disease

C

Comparator

Tricuspid valve transcatheter edge-to-edge repair (T-TEER) in patients with < moderate concomitant left-sided valvular heart disease

O

Outcome

Survival and heart failure hospitalizations (HFH) at 2 yearshard clinical

Main Result

Effect estimate: HR 1.54 (95% CI 1.21-1.96)

p-value: p=<0.001

Concomitant left-sided valvular heart disease is common in patients undergoing T-TEER and independently predicts worse survival and higher heart failure hospitalization rates, though T-TEER still provides symptomatic benefit and TR reduction.

Implication

≥ moderate VHD independently predicts mortality; leaves open whether targeted valvular intervention improves outcomes in this population.

Graphical abstract published by ESC Heart Failure — Graphical abstract · Published by ESC Heart Failure · CC BY

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Cite This Study

Gmeiner et al. (2026) conducted an observational in Tricuspid regurgitation (n=1,647). Concomitant left-sided valvular heart disease (≥ moderate) vs. No or mild concomitant left-sided valvular heart disease was evaluated on Mortality (HR 1.54, 95% CI 1.21-1.96, p=<0.001). Concomitant moderate or greater left-sided valvular heart disease in patients undergoing T-TEER was an independent predictor of mortality (HR 1.54; 95% CI 1.21-1.96; p<0.001).

synapsesocial.com/papers/6a0ff3ecd674f7c03778cebb https://doi.org/10.1093/eschf/xvag103