Determinants of recovery from right ventricular dysfunction after transcatheter edge-to-edge tricuspid valve repair

BACKGROUND: Transcatheter edge-to-edge tricuspid valve repair (T-TEER) has emerged as a well tolerated and efficacious treatment modality among patients with tricuspid valve regurgitation. Right ventricular dysfunction (RVD) has been observed in up to 22% of patients undergoing T-TEER. Currently, the determinants of RVD recovery are not sufficiently understood. METHODS: All patients in four German tertiary cardiac centers scheduled for T-TEER were included for analysis. Patients were divided according to concomitant RVD at the time of T-TEER. RVD was defined as impairment of either tricuspid plane systolic excursion (TAPSE) or right ventricular fractional area change (RV-FAC). The primary endpoint of the study was recovery from RVD during follow-up 3 months after T-TEER. Predictors of RVD recovery were identified via univariable and multivariable logistic regression analyses. RESULTS: A total of 105 patients were included. Concomitant RVD was present in 43.8% of the patients (46/105). Recovery from RVD was observed in 47.8% (22/46) of patients, particularly in patients with mild RVD at baseline according to the TAPSE. A sufficient reduction in tricuspid valve regurgitation to mild severity likewise constituted a predictor of RVD recovery and emerged as a surrogate parameter of reduced right ventricular volume overload. CONCLUSION: Recovery from RVD was most likely in patients who presented with mild RVD and a sufficient reduction in tricuspid valve regurgitation to mild severity according to T-TEER. Early identification and interventional treatment of today's patients with high-grade tricuspid valve regurgitation and RVD represent key factors in providing relief for this particular cohort of patients.