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September 14, 2026Circulation Cardiovascular Interventions

Impact of Tricuspid Regurgitation on Outcomes After Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation: The PRIME-MR Registry

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Why the study?

The presence of tricuspid regurgitation may affect prognosis in patients with primary mitral regurgitation, prompting investigation into its impact on outcomes after M-TEER.

Does baseline severe tricuspid regurgitation increase 2-year all-cause mortality in patients with primary mitral regurgitation undergoing successful M-TEER?

Population

2155 patients with severe primary mitral regurgitation and successful M-TEER at 25 international sites

Comparison

Baseline TR>=Sev vs TR<=Mod

Design

International registry-based observational study

Follow-up

2 years

Key result

Baseline severe tricuspid regurgitation independently predicted higher 2-year all-cause mortality compared to moderate or less severity (29.6% vs 19.6%; adjusted HR 2.01; 95% CI 1.35-3.00; P<0.001).

Authors

ASAndrea ScottiSLSebastian LudwigDFDaniel Feldman

Discussion

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Overview

Baseline severe TR doubles mortality risk after successful M-TEER; leaves open whether TR-directed intervention improves outcomes.

Key Points

  • To assess how concomitant tricuspid regurgitation affects 2-year clinical outcomes in patients with primary mitral regurgitation undergoing successful transcatheter edge-to-edge repair.
  • Analyzed 2,155 patients with successful mitral transcatheter edge-to-edge repair (post-procedural MR ≤ moderate) from the international PRIME-MR registry across 25 sites between 2008 and 2022.
  • Stratified patients by baseline tricuspid regurgitation severity into TR ≤ moderate (n=1,734) versus TR ≥ severe (n=421) and evaluated the primary endpoint of 2-year all-cause mortality.
  • Baseline TR ≥ severe was associated with significantly increased 2-year all-cause mortality compared to TR ≤ moderate (29.6% vs 19.6%; P < 0.0001) and higher heart failure hospitalizations (21.1% vs 16.8%; P = 0.018).
  • Baseline TR ≥ severe remained an independent predictor of 2-year mortality on multivariable analysis (adjusted HR, 2.01 [95% CI, 1.35–3.00]; P < 0.001).
  • Although severe TR improved in 30% of patients following successful repair, residual severe TR remained associated with elevated 2-year mortality compared to TR ≤ moderate (30.4% vs 19.9%; P = 0.0037).

Study Design

Type

Cohort (n=2,155)

Multicenter

Yes

Structured PICO

Does baseline severe tricuspid regurgitation increase 2-year all-cause mortality in patients with primary mitral regurgitation undergoing successful M-TEER?

P
Population
2,155 patients with severe primary mitral regurgitation and successful M-TEER procedures, stratified by baseline tricuspid regurgitation severity, followed for 2 years.
E
Exposure
Baseline severe tricuspid regurgitation (TR ≥ Severe)
C
Comparator
Baseline moderate or less tricuspid regurgitation (TR ≤ Moderate)
O
Outcome
2-year all-cause mortalityhard clinical

Main Result

Hazard Ratio: 2.01 (95% CI 1.35–3)

Absolute Event Rate: 29.6% vs 19.6%

p-value: p=<0.001

In patients undergoing successful M-TEER for primary mitral regurgitation, baseline severe tricuspid regurgitation is independently associated with a twofold increased risk of 2-year all-cause mortality.

Cite This Study

Scotti et al. (2026) conducted a cohort in Primary mitral regurgitation (n=2,155). Baseline tricuspid regurgitation ≥Severe vs. Baseline tricuspid regurgitation ≤Moderate was evaluated on 2-year all-cause mortality (adjusted HR 2.01, 95% CI 1.35-3.00, p=<0.001). Baseline severe tricuspid regurgitation independently predicted higher 2-year all-cause mortality compared to moderate or less severity (29.6% vs 19.6%; adjusted HR 2.01; 95% CI 1.35-3.00; P<0.001).

synapsesocial.com/papers/6aa7b32d0926e14a848b1e91https://doi.org/10.1161/circinterventions.126.016634
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