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Characteristics and outcomes of patients with atrial versus ventricular secondary tricuspid regurgitation undergoing tricuspid transcatheter edge-to-edge repair - Results from TriValve Registry.

European journal of heart failure

Authors: Giulio Russo, Luigi P Badano, Marianna Adamo, Hannes Alessandrini, Martin Andreas, Daniel Braun, Kim A Connelly, Paolo Denti, Rodrigo Estevez-Loureiro, Neil Fam, Mara Gavazzoni, Rebecca T Hahn, Claudia Harr, Joerg Hausleiter, Dominique Himbert, Daniel Kalbacher, Edwin Ho, Azeem Latib, Edith Lubos, Sebastian Ludwig, Philipp Lurz, Vanessa Monivas, Georg Nickenig, Daniela Pedicino, Giovanni Pedrazzini, Alberto Pozzoli, Denise Pires Marafon, Roberta Pastorino, Fabien Praz, Joseph Rodes-Cabau, Christian Besler, Joachim Schofer, Andrea Scotti, Kerstin Piayda, Horst Sievert, Gilbert H L Tang, Holger Thiele, Florian Schlotter, Ralph Stephan von Bardeleben, John Webb, Stephan Windecker, Martin Leon, Francesco Maisano, Marco Metra, Maurizio Taramasso

BACKGROUND: Secondary or functional tricuspid regurgitation (STR) is the most common phenotype of tricuspid regurgitation (TR) with atrial STR (ASTR) and ventricular STR (VSTR) being recently identified as two distinct entities. Data on tricuspid transcatheter edge-to-edge repair (T-TEER) in patients with STR according to phenotype (i.e. ASTR vs VSTR) are lacking.

OBJECTIVES: The aim of this study was to assess characteristics and outcomes of patients with ASTR vs VSTR undergoing T-TEER.

METHODS: Patients with STR undergoing T-TEER were selected from the TriValve (Transcatheter Tricuspid Valve Therapies) registry. ASTR was defined by 1) left ventricular ejection fraction ≥50%; 2) atrial fibrillation and 3) systolic pulmonary arterial pressure < 50 mmHg. Patients not matching these criteria were classified as VSTR. Patients with primary TR and cardiac implantable electronic device were excluded. Key end-points included procedural success and survival at follow-up.

RESULTS: Two-hundred-ninety-eight patients were enrolled in the study: 65 (22%) with ASTR and 233 (78%) with VSTR. Procedural success was similar in the two groups (80% vs 83% for ASTR and VSTR, respectively, p = 0.56) and TEER was effective in reducing TR in both groups (from 97% of patients with baseline TR ≥3+ to 23% in ASTR and to 15% in VSTR, all p = 0.001). At 12 months follow-up, survival was significantly higher in ASTR vs VSTR cohort (91% vs 72%, log rank p = 0.02), with VSTR being an independent predictor of mortality at multivariable analysis (hazard ratio 4.75).

CONCLUSIONS: In a real-world, multicenter registry, T-TEER was effective in reducing TR grade in both ASTR and VSTR. At 12-months follow-up, ASTR showed better survival than VSTR. This article is protected by copyright. All rights reserved.

© 2023 European Society of Cardiology.

PMID: 37905381

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