Prognosis and evolution of tricuspid regurgitation in patients undergoing percutaneous mitral repair for severe mitral regurgitation

Abstract Introduction Tricuspid regurgitation (TR) is a common encounter in patients with severe mitral regurgitation. With the advent of percutaneous treatment, discussions have been ongoing regarding the indication for combined mitral and tricuspid repair vs. staged treatment in case of TR persistence after mitral treatment. Purpose To assess the evolution and impact of TR on patient’s outcome after mitral edge-to-edge repair. Methods This retrospective, observational study included 98 patients who underwent mitral edge-to-edge repair using the MitraClip® device between 2016 and 2022 at a French Hospital. Patients’s prognosis according to the presence or absence of TR grade ≥3, and the evolution of TR was assessed in the global population, with a comparison according to baseline TR severity. Results Patients with severe pre-procedural TR were more symptomatic at 6-mths follow-up (NYHA III or. IV in 27.3% vs. 6.1% in patients with TR grade 3); the also demonstrated significantly lower 2-year survival rates (p = 0.02). TR severity initially improved in the overall population, with the proportion of patients with TR grade 3 increasing from 88.3% at baseline to 93.1% after the procedure and 95.2% at 6-month follow-up. However, TR severity appeared similar to baseline at long-term follow-up. In patients with baseline TR grade ≥ 3, TR severity showed early improvement following mTEER (63.6% at baseline, 30.0% at 6-mths follow-up, with an increase at long-term follow-up to 40%). Conclusion The presence of severe TR is associated with worse prognosis in patients undergoing mitral edge-to-edge repair for severe MR. Although there is an initial improvement in TR severity following the procedure, this benefit appears to diminish by 6 months. These findings raise important considerations regarding the potential need for concomitant or early staged management of severe TR alongside mitral valve intervention.For image description, please refer to the figure legend and surrounding text. Evolution of TR gradeFor image description, please refer to the figure legend and surrounding text.