(CCSP078) RESIDUAL TRICUSPID REGURGITATION AFTER EDGE-TO-EDGE REPAIR AS PROGNOSTIC PARAMETER FOR LONG-TERM CLINICAL OUTCOMES

Background: Transcatheter edge-to-edge tricuspid valve repair (T-TEER) for high-grade regurgitation (TR) is an emerging option in inoperable patients, and can improve quality of life. Based on the new 5-grade TR classification, all studies have defined procedural success by at least one-grade reduction. While a higher degree of TR reduction should translate into better clinical outcomes, considerable reduction is not always possible, as the regurgitant area is often too large for coaptation devices. Difficult periprocedural guidance, suboptimal acoustic window, shadowing from pacemaker leads, multiple scallops also contribute to suboptimal results. This study compared long-term clinical outcomes of T-TEER in patients with residual severe TR (STR; III/V) vs moderate-or-less TR (MTR; ≤II/V), despite procedural success.

METHODS AND RESULTS: Eligible inoperable patients had chronic symptomatic functional TR despite diuretic therapy, and underwent T-TEER at our institution after heart-team assessment. The primary efficacy endpoint was at least one-grade TR reduction at 30 days. The secondary endpoints related to long-term improvement in symptoms, quality of life and multiorgan function. Follow-up was carried out between January 2021 and January 2023.

Forty-three patients, 51% females, had ≥severe (III/V) functional TR, 65% of them massive (IV/V) and 14% torrential (V/V). Mean age was 81.8±4.9 years, with 10.8±6.3% STS-Score. The primary efficacy endpoint was recorded in 91% of all patients, with 100% technical success and no device related complications. According to the degree of residual TR we defined 3 subgroups: STR (n=17), MTR (n=22), and no reduction (n=4). Two- or more-grade reduction was present in 91% of MTR and 24% of STR cases (Figure 1). By 12 months, 6 patients died, 2 from each group, 3 of non-cardiac cause. MACE rate was 18.6%.

Long-term outcomes in the remaining 15 STR and 20 MTR patients were compared (Figure 2). Improvement in initial NYHA class III/IV occurred in 54% of STR and 77% of MTR patients. KCCQ Score increased by 21.6±17.9 pts. (p < 0.001) vs 29.8±15.6 (p < 0.001), six-minute walk test by 103.365.7 meters (p < 0.001) vs 117.593.2 (p < 0.001). Renal and liver function equally improved in both groups [GFR 51.3±16.5ml/min/1,73m2 to 56.4±21.6 (p=0.043) vs 59.9±17 to 60.1±18.2 (p=0.930); AST 27.4±9.9U/L to 22.2±6.9 (p=0.009) vs 37.5±26.9 to 29.7±10.3 (p=0.112)].

Conclusion: Although T-TEER should always aim for trace to mild TR, considerable reduction is not always possible. This study indicates that even one-grade TR reduction can significantly impact quality of life, functional capacity and multiorgan involvement, similarly in STR and MTR patients.