Combined transcatheter mitral and tricuspid edge-to-edge repair or tricuspid edge-to-edge repair alone in moderate mitral regurgitation: a propensity-matched analysis

Abstract Background and Aims The coexistence of moderate mitral regurgitation (MR) and severe tricuspid regurgitation (TR) is common, yet evidence guiding optimal management remains limited. Transcatheter edge-to-edge repair (TEER) of both valves—performed either sequentially or in combination—has emerged as a potential therapeutic strategy. This study aimed to assess the prognostic impact of moderate MR in patients undergoing tricuspid TEER (T-TEER) for severe TR and to evaluate whether concomitant mitral TEER (M-TEER) improves clinical outcomes. Methods Data from the EuroTR registry (2016–25) were analysed, including patients with severe TR treated with T-TEER. Outcomes were compared between patients with untreated moderate MR and those who underwent concomitant M-TEER using propensity score matching (PSM). The primary endpoint was all-cause mortality at 2 years. Secondary endpoints included New York Heart Association (NYHA) class, 6 min walk distance (6MWD), TR severity, and heart failure rehospitalizations. Results Among 3100 patients, 30% had moderate MR, which was associated with higher 2-year mortality (23% vs 37%, p0.0001). After PSM, 217 matched patients treated with concomitant M-TEER had greater TR reduction (−1.9 vs −1.6 grades, P = .001), better NYHA improvement, and increased 6MWD at follow-up. Survival was higher in the combined treatment group (87% vs 76% at 1 year; 81% vs 70% at 2 years, P = .005). In a multivariable analysis, moderate MR predicted increased mortality [hazard ratio (HR) 1.81, P = .005), while combined M-TEER predicted better survival (HR 0.46, P .0001). Conclusions Moderate MR predicts impaired prognosis in patients undergoing T-TEER for treatment of severe TR. Concomitant M-TEER is associated with improved survival and functional outcomes in this population with multivalve disease. These findings are hypothesis-generating and need to be tested in a dedicated randomized controlled trial.