Real-World Experience in Tricuspid Transcatheter Edge-to-Edge Repair: Transcatheter Tricuspid Valve Repair in Spain Registry

Abstract

BACKGROUND: Significant tricuspid regurgitation (TR) is associated with increased morbidity and mortality. The development of transcatheter valve repair therapies has opened a wide range of opportunities for treatment of patients with high surgical risk. Real-world data might improve patient selection and outcome. The authors sought to investigate acute and short-term cardiovascular outcomes of tricuspid transcatheter edge-to-edge repair (T-TEER) with dedicated devices in a real-world setting. METHODS AND RESULTS: This is a retrospective, single-arm, multicenter registry conducted at 15 sites in Spain. The primary end point was a composite of all-cause death, rehospitalization for heart failure, and tricuspid valve re-intervention. Patients included (n=283) were older (76±9 years, 70% female), and showed significant comorbidities. Massive or torrential TR was present in 55% of subjects, with secondary cause being the main mechanism of regurgitation in ≈80% of individuals. Intraprocedural success was achieved in 79% of patients. At 1-year follow-up, significant improvements in TR grade (≥3+, 100% to 25%, P <0.001) and New York Heart Association functional class (I/II, 33%–86%, P <0.001) were observed. Lead-induced cause and single leaflet device attachment emerged as independent predictors of at least severe predischarge residual TR. In-hospital mortality occurred in 4 (1.4%) patients, whereas the Kaplan–Meier estimated 1-year primary end point occurrence rate was 21%. Intraprocedural success (hazard ratio, 0.353 [95% CI, 0.156–0.798]; P=0.012), was found to be an independent predictor of primary end point.CONCLUSIONS: In a real-world contemporary setting, tricuspid transcatheter edge-to-edge repair with dedicated devices emerged as effective therapeutic option for patients with severe TR.