Impact of Ventricular Stroke Work on Outcomes After Tricuspid Transcatheter Edge-to-Edge Repair

Background Tricuspid transcatheter edge-to-edge repair (T-TEER) is an effective treatment for severe tricuspid regurgitation (TR), but predictors of outcome and clinical benefit after T-TEER remain limited. Methods In 144 patients with severe symptomatic TR undergoing T-TEER, left and right ventricular stroke work indices (LVSWI, RVSWI) were calculated from invasive hemodynamics by right heart catheterization. Patients were stratified by median values (LVSWI 27 cJ/m 2 , RVSWI 6 cJ/m 2 ) into four subgroups. The primary endpoint was one-year all-cause mortality. Results After T-TEER, all-cause mortality was 28%. Outcomes differed significantly across subgroups: LVSWI high, RVSWI high: 15%, LVSWI high, RVSWI low: 15%, LVSWI low, RVSWI high: 55%, and LVSWI low, RVSWI low: 31% (Kaplan-Meier, log-rank p=0.00027). Patients with low LVSWI but high RVSWI had the poorest survival, characterized by elevated pulmonary artery pressures, pulmonary capillary wedge pressure, and left ventricular transmural pressure. In univariate Cox regression, LVSWI below the median predicted mortality (≤ 27 cJ/m 2 ; HR 4.73, 95% CI 2.07–10.8; p < 0.001), whereas RVSWI did not. LVSWI remained an independent predictor after adjusting in multivariate analysis (HR 0.44, 95% CI 0.27–0.71; p < 0.001). Conclusion LVSWI is a robust, independent prognostic marker after T-TEER, whereas RVSWI alone lacks predictive value. A discordant profile of low LVSWI with high RVSWI identifies a particularly high-risk subgroup with >50% mortality within one year. Incorporating stroke work indices into pre-procedural assessment may refine risk stratification and optimize management strategies in T-TEER candidates.