Transcatheter Edge-to-Edge Repair in Patients With Primary Tricuspid Regurgitation
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 w...
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| Published in | JACC. Cardiovascular interventions Vol. 18; no. 10; pp. 1289 - 1299 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
26.05.2025
Elsevier/American College of Cardiology |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1936-8798 1876-7605 1876-7605 |
| DOI | 10.1016/j.jcin.2025.03.023 |
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| Abstract | 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.
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| AbstractList | Background: 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.Objectives: The aim of this study was to assess the safety and feasibility of TEER in patients with primary TR.Methods: 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.Results: 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).Conclusions: 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. 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] 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. 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.BACKGROUNDTricuspid 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.OBJECTIVESThe 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.METHODSThe 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).RESULTSFrom 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.CONCLUSIONSTEER 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. |
| Author | Bartkowiak, Joanna Lim, Pascal Volker, Rudolph Nejjari, Mohammed Riant, Elisabeth Kelm, Malte Goto, Tadahiro Schneider, Leonhard Moritz Iung, Bernard Le Tourneau, Thierry Hahn, Rebecca Bohbot, Yohan Selton-Suty, Christine Modine, Thomas Tanaka, Tetsu Tribouilloy, Christophe Lavie-Badie, Yoan Coisne, Augustin Bazire, Baptiste Nickenig, Georg Zimmer, Sebastian Dreyfus, Julien Doguet, Fabien Rottbauer, Wolfgang Praz, Fabien Hans-Peter Linke, Axel Sugiura, Atsushi Weber, Marcel Messika-Zeitoun, David Horn, Patrick Baldus, Stephan Bombace, Sara Obadia, Jean-François Donal, Erwan Ivannikova, Maria Haussig, Stephan Kassar, Mohammad Lurz, Philip Iliadis, Christos Habib, Gilbert Osawa, Itsuki Taramasso, Maurizio |
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Medical Center, New York, New York, USA – sequence: 6 givenname: Stephan surname: Haussig fullname: Haussig, Stephan organization: Department for Cardiology, University Heart Center Dresden, Dresden, Germany – sequence: 7 givenname: Leonhard Moritz surname: Schneider fullname: Schneider, Leonhard Moritz organization: Department of Cardiology, Ulm University Heart Center, Ulm, Germany – sequence: 8 givenname: Mohammad orcidid: 0000-0002-7576-2224 surname: Kassar fullname: Kassar, Mohammad organization: Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland – sequence: 9 givenname: Patrick surname: Horn fullname: Horn, Patrick organization: Department of Cardiology, Pulmonology, and Vascular Diseases, University Hospital Düsseldorf, Düsseldorf, Germany – sequence: 10 givenname: Maurizio surname: Taramasso fullname: Taramasso, Maurizio organization: HerzZentrum Hirslanden Zürich, Switzerland – sequence: 11 givenname: Christos orcidid: 0000-0001-7655-8500 surname: 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| Keywords | tricuspid regurgitation transcatheter edge-to-edge repair RV primary tricuspid regurgitation TEER TAPSE TR surgery RVFAC |
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| Snippet | Tricuspid regurgitation (TR) leads to right heart congestion and increased mortality risk. Unlike secondary TR, primary TR results from leaflet degeneration.... Background: Tricuspid regurgitation (TR) leads to right heart congestion and increased mortality risk. Unlike secondary TR, primary TR results from leaflet... |
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| SubjectTerms | 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 |
| Title | Transcatheter Edge-to-Edge Repair in Patients With Primary Tricuspid Regurgitation |
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