Transcatheter Edge-to-Edge Repair in Patients With Primary Tricuspid Regurgitation

• Published in: JACC. Cardiovascular interventions Vol. 18; no. 10; pp. 1289 - 1299
• Main Authors: Sugiura, Atsushi, Dreyfus, Julien, Bombace, Sara, Ivannikova, Maria, Bartkowiak, Joanna, Haussig, Stephan, Schneider, Leonhard Moritz, Kassar, Mohammad, Horn, Patrick, Taramasso, Maurizio, Iliadis, Christos, Osawa, Itsuki, Goto, Tadahiro, Weber, Marcel, Tanaka, Tetsu, Zimmer, Sebastian, Obadia, Jean-François, Habib, Gilbert, Bazire, Baptiste, Iung, Bernard, Bohbot, Yohan, Tribouilloy, Christophe, Donal, Erwan, Nejjari, Mohammed, Riant, Elisabeth, Le Tourneau, Thierry, Lavie-Badie, Yoan, Coisne, Augustin, Modine, Thomas, Lim, Pascal, Doguet, Fabien, Selton-Suty, Christine, Baldus, Stephan, Kelm, Malte, Praz, Fabien, Rottbauer, Wolfgang, Hans-Peter Linke, Axel, Hahn, Rebecca, Volker, Rudolph, Messika-Zeitoun, David, Lurz, Philip, Nickenig, Georg
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 26.05.2025; Elsevier/American College of Cardiology
• Subjects: Aged; Aged, 80 and over; Bioengineering; Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Cardiac Catheterization - mortality; Cardiology and cardiovascular system; Feasibility Studies; Female; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - mortality; Hemodynamics; Human health and pathology; Humans; Life Sciences; Male; primary tricuspid regurgitation; Recovery of Function; Registries; Retrospective Studies; Risk Factors; surgery; Time Factors; transcatheter edge-to-edge repair; Treatment Outcome; tricuspid regurgitation; Tricuspid Valve - diagnostic imaging; Tricuspid Valve - physiopathology; Tricuspid Valve - surgery; Tricuspid Valve Insufficiency - diagnostic imaging; Tricuspid Valve Insufficiency - mortality; Tricuspid Valve Insufficiency - physiopathology; Tricuspid Valve Insufficiency - surgery; tricuspid regurgitation; transcatheter edge-to-edge repair; RV; primary tricuspid regurgitation; TEER; TAPSE; TR; surgery; RVFAC
• ISSN: 1936-8798; 1876-7605; 1876-7605
• DOI: 10.1016/j.jcin.2025.03.023

Tricuspid regurgitation (TR) leads to right heart congestion and increased mortality risk. Unlike secondary TR, primary TR results from leaflet degeneration. Transcatheter edge-to-edge repair (TEER) is widely used for TR. However, its feasibility primary TR remains uncertain. The aim of this study was to assess the safety and feasibility of TEER in patients with primary TR. The primary TR registry is a multicenter cohort study of patients with primary TR undergoing TEER. Echocardiographic assessment classified leaflet pathology into type 1 (flail), type 2 (billowing prolapse), type 3 (perforation), and type 4 (restricted mobility). The primary endpoint was TR reduction to moderate or less at discharge. From December 2016 to April 2023, 114 patients (mean age 79.9 years, 53.5% men) were included. Most patients were in NYHA functional class III or IV (83.3%), with a median TRI-SCORE of 5.0. The TR pathologies were type 1 (28.1%), type 2 (61.4%), and type 4 (10.5%), with no type 3 cases. Device deployment was achieved in 95.6%, and 83.3% showed TR reduction to moderate or less. In-hospital mortality was 1.8%, and single-leaflet device attachment occurred in 3.5%. At 1 year, 79.7% of patients had TR moderate or less, with significant reductions in vena contracta (−5.0 mm; P < 0.001), annular diameter (−2.0 mm; P = 0.003), and mid right ventricular diameter (−3.0 mm; P < 0.001). NYHA functional class also improved significantly (NYHA functional class I or II: 17.1% at baseline vs 66.5% at follow-up; P < 0.001). TEER is a safe and effective option for primary TR, promoting right heart reverse remodeling and symptomatic relief, offering a vital alternative to surgery in selected patients. [Display omitted]