Concomitant mitral and tricuspid TEER improved 2-year survival compared to tricuspid TEER alone in patients with severe TR and moderate MR (81% vs 70%, P=0.005; HR 0.46, P<0.0001).
Observational (n=3,100)
Yes
Does concomitant mitral TEER improve survival and functional outcomes compared to tricuspid TEER alone in patients with severe TR and moderate MR?
In patients with severe tricuspid regurgitation and moderate mitral regurgitation, concomitant mitral and tricuspid TEER is associated with significantly improved 2-year survival and functional outcomes compared to tricuspid TEER alone.
Effect estimate: HR 0.46
Absolute Event Rate: 19% vs 30%
p-value: p=<0.0001
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%, p<0.0001). 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.
Kassar et al. (2026) conducted an observational in Severe tricuspid regurgitation and moderate mitral regurgitation (n=3,100). Concomitant mitral and tricuspid transcatheter edge-to-edge repair (M-TEER and T-TEER) vs. Tricuspid TEER alone was evaluated on All-cause mortality at 2 years (HR 0.46, p=<0.0001). Concomitant mitral and tricuspid TEER improved 2-year survival compared to tricuspid TEER alone in patients with severe TR and moderate MR (81% vs 70%, P=0.005; HR 0.46, P<0.0001).