Prognostic Implications of Residual Tricuspid Regurgitation Grading After Transcatheter Tricuspid Valve Repair.

Dreyfus, Julien; Taramasso, Maurizio; Kresoja, Karl-Patrik; Omran, Hazem; Iliadis, Christos; Russo, Giulio; Weber, Marcel; Nombela-Franco, Luis; Estevez Loureiro, Rodrigo; Hausleiter, Jörg; Latib, Azeem; Stolz, Lukas; Praz, Fabien; Windecker, Stephan; Zamorano, Jose Luis; von Bardeleben, Ralph Stephan; Tang, Gilbert H L; Hahn, Rebecca; Lubos, Edith; Webb, John; ... (2024). Prognostic Implications of Residual Tricuspid Regurgitation Grading After Transcatheter Tricuspid Valve Repair. JACC. Cardiovascular Interventions, 17(12), pp. 1485-1495. Elsevier 10.1016/j.jcin.2024.04.023

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BACKGROUND

The safety profile of transcatheter tricuspid valve (TTV) repair techniques is well established, but residual tricuspid regurgitation (TR) remains a concern.

OBJECTIVES

The authors sought to assess the impact of residual TR severity post-TTV repair on survival.

METHODS

We evaluated the survival rate at 2 years of 613 patients with severe isolated functional TR who underwent TTV repair in TRIGISTRY according to the severity of residual TR at discharge using a 3-grade (mild, moderate, and severe) or 4-grade scheme (mild, mild to moderate, moderate to severe, and severe).

RESULTS

Residual TR was none/mild in 33%, moderate in 52%, and severe in 15%. The 2-year adjusted survival rates significantly differed between the 3 groups (85%, 70%, and 44%, respectively; restricted mean survival time [RMST]: P = 0.0001). When the 319 patients with moderate residual TR were subdivided into mild to moderate (n = 201, 33%) and moderate to severe (n = 118, 19%), the adjusted survival rate was also significantly different between groups (85%, 80%, 55%, and 44%, respectively; RMST: P = 0.001). Survival was significantly lower in patients with moderate to severe residual TR compared to patients with mild to moderate residual TR (P = 0.006). No difference in survival rates was observed between patients with no/mild and mild to moderate residual TR (P = 0.67) or between patients with moderate to severe and severe residual TR (P = 0.96).

CONCLUSIONS

The moderate residual TR group was heterogeneous and encompassed patients with markedly different clinical outcomes. Refining TR grade classification with a more granular 4-grade scheme improved outcome prediction. Our results highlight the importance of achieving a mild to moderate or lower residual TR grade during TTV repair, which could define a successful intervention.

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