Key result
Baseline tricuspid regurgitation in patients undergoing MitraClip implantation was associated with increased all-cause mortality (HR 2.34; 95% CI 1.36-4.03; p<0.01).
Why the study?
Patients undergoing mitral repair with MitraClip frequently have concomitant tricuspid regurgitation, but its impact on long-term clinical outcomes remains uncertain.
Does concomitant moderate or severe tricuspid regurgitation worsen long-term outcomes in patients undergoing percutaneous treatment of mitral regurgitation with MitraClip?
Cohort (n=177)
Does concomitant moderate or severe tricuspid regurgitation worsen long-term outcomes in patients undergoing percutaneous treatment of mitral regurgitation with MitraClip?
Hazard Ratio: 2.34 (95% CI 1.36–4.03)
p-value: p=<0.01
In patients undergoing percutaneous mitral valve repair, the presence of concomitant moderate or severe tricuspid regurgitation is associated with significantly higher long-term mortality and heart failure hospitalization.
Concomitant TR may identify higher-risk MitraClip patients; leaves open whether TR intervention improves outcomes.
OBJECTIVES: Investigate the impact of concomitant tricuspid regurgitation (TR) on clinical outcomes during long-term follow-up in patients undergoing percutaneous treatment of mitral regurgitation (MR) with the MitraClip system. BACKGROUND: Patients undergoing mitral repair using the MitraClip frequently present with concomitant TR. It is uncertain how the presence of TR impacts the long-term outcomes of such patients. METHODS: We analyzed consecutive patients with MitraClip implantation from the prospective MitraSwiss registry. Endpoints were all-cause mortality, hospitalization for heart failure, and the composite endpoint of the two. RESULTS: We enrolled 177 patients (mean age 76 ± 9 years, 37% female). Acute procedural success was achieved in 149 (84%). Concomitant moderate or severe TR was present in 31% at baseline and 32% before discharge. After a median follow-up of 1103 days (IQR: 555-1766 days), 70 (40%) of patients had died, and 34 (19%) were hospitalized for heart failure. In multivariable analysis, TR at baseline was associated with an increase in all-cause mortality (HR: 2.34, 95% CI: 1.36-4.03, p < 0.01), hospitalization for heart failure (HR: 3.19, 95% CI: 1.37-7.41, p = 0.01), and the composite endpoint (HR: 2.00, 95% CI: 1.19-3.36, p = 0.01). CONCLUSION: Despite treatment of MR, TR did not improve in most patients. The presence of relevant TR at baseline was associated with reduced survival and higher rates of hospitalization for heart failure. More research is needed to understand the causal role of TR in such patients and to investigate if simultaneous treatment of concomitant TR may improve prognosis in patients undergoing percutaneous treatment of MR.
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Brunner et al. (2022) conducted a cohort in Mitral regurgitation (n=177). Concomitant tricuspid regurgitation at baseline vs. No or non-relevant tricuspid regurgitation was evaluated on All-cause mortality (HR 2.34, 95% CI 1.36-4.03, p=<0.01). Baseline tricuspid regurgitation in patients undergoing MitraClip implantation was associated with increased all-cause mortality (HR 2.34; 95% CI 1.36-4.03; p<0.01).
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