Key result
Baseline moderate or severe TR does not compromise 30-day clinical and QoL gains after mitral TEER.
Why the study?
Significant tricuspid regurgitation is prevalent in patients undergoing M-TEER, is linked to poor prognosis, and impacts surgical decision-making, but its impact on quality of life improvements needed evaluation.
Does mitral transcatheter edge-to-edge repair improve quality of life similarly in patients with moderate/severe baseline tricuspid regurgitation compared to those with no/mild tricuspid regurgitation?
Observational (n=1,838)
Yes
Does mitral transcatheter edge-to-edge repair improve quality of life similarly in patients with moderate/severe baseline tricuspid regurgitation compared to those with no/mild tricuspid regurgitation?
Patients undergoing mitral transcatheter edge-to-edge repair experience similar and significant improvements in quality of life regardless of baseline tricuspid regurgitation severity, although moderate/severe TR is associated with worse 1-year survival.
Answers are grounded in this paper and cite their sources.
Moderate/severe baseline TR did not reduce 30-day survival with QoL gain after mitral TEER; leaves open effects on selection and durability.
Background There is a high prevalence of significant tricuspid regurgitation (TR) in patients undergoing mitral transcatheter edge-to-edge repair (M-TEER). Significant TR is associated with poor prognosis and affects decision-making between M-TEER and concomitant mitral and tricuspid valve surgery. Improved quality of life (QoL) is an important metric for patients. Methods We analyzed data from 1838 patients undergoing M-TEER included in a multicenter statewide registry from 2015 to 2023. QoL was assessed using baseline and 30-day Kansas City Cardiomyopathy Questionnaire (KCCQ) scores. Patients were classified as no/mild TR or moderate/severe TR, and changes in KCCQ scores were compared. The primary outcome was an adjusted analysis consisting of survival to 30 days with a ≥15-point improvement in KCCQ score. Results Complete endpoint data were available for 1421 patients (77.3%). On average, patients undergoing M-TEER experienced large improvements in QoL, regardless of baseline TR group. Thirty-day mortality for patients with moderate/severe TR was higher than for those with no/mild TR (42 [4.1%] vs. 16 [2.0%], respectively, p = 0.018). The majority of patients survived to 30 days with ΔKCCQ ≥15 (63.8% for no/mild TR vs. 59.6% for moderate/severe TR, p = 0.120). Patients with moderate/severe TR exhibited no difference in the primary adjusted outcome (adjusted odds ratio: 0.851, p = 0.177). Conclusions The majority of patients experience a large improvement in QoL after M-TEER, regardless of baseline TR severity. Further research should explore a staged approach of M-TEER followed by tricuspid valve intervention as needed compared to concomitant mitral/tricuspid valve surgery.
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Brooks et al. (2025) conducted an observational in Mitral regurgitation with concomitant tricuspid regurgitation (n=1,838). Moderate/severe tricuspid regurgitation vs. No/mild tricuspid regurgitation was evaluated on Composite of survival to 30 days and ≥15-point improvement in Kansas City Cardiomyopathy Questionnaire (KCCQ) score (adjusted OR 0.851, 95% CI 0.674-1.076, p=0.177). Moderate or severe baseline tricuspid regurgitation did not significantly reduce the likelihood of 30-day survival with ≥15-point quality of life improvement after mitral TEER compared to no/mild TR (adjusted OR 0.851).
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