Abstract 4142677: Impact of baseline tricuspid regurgitation on outcomes after transcatheter edge – to - edge repair in patients with mitral regurgitation

A moderate or severe tricuspid regurgitation (TR) is frequently associated with mitral regurgitation (MR) and may impact prognosis after mitral valve intervention. It is yet unclear whether both valves should be treated simultaneously, especially using a percutaneous approach. Therefore, we sought to determine the impact of TR on outcomes in patients with moderate-to-severe or severe MR treated by edge-to-edge repair (TEER). Methods: Consecutive patients undergoing transcatheter mitral valve edge - to edge repair for moderate or severe MR from 2 tertiary centers were retrospectively included in a registry. The primary endpoint was one-year primary composite of death and heart failure hospitalization (HFH) and with the separate endpoints as secondary endpoints. 268 patients (76.4 ± 9.0 years old, 61.9% males) were included in the study, divided into 2 groups by baseline TR severity: none/trace/mild TR (≤Mild TR) (n=144) and moderate/severe TR (≥Mod TR) (n= 124). Primary MR was present in 124 (46.3%) patients, 117 (43.7%) patients had a secondary MR and 27 (10.0%) patients had a mixed MR etiology. In the total population, 45 patients reached the primary endpoint: 26 patients died and 24 patients had a HFH during the follow - up period of 1 year. An associated ≥Mod TR was an independent predictor of the primary endpoint in the global study population (OR 3.737, CI 1.020 – 13.694, p = 0.047). Other independent predictors of the primary endpoint in the global population by multivariable logistic regression analysis were left ventricle ejection fraction (OR 0.951, CI 0.916 – 0.987, p =0.009) and glomerular filtration rate (OR 0.960, CI 0.933 – 0. 987, p =0.009). In the primary MR subgroup, 14 (11.2%) patients reached the primary endpoint. In this subgroup, a ≥Mod TR was present in 56 (45.2%) of the patients and it was significantly associated with a worse outcome by univariable logistic regression analysis (OR 5.296, CI 1.398 - 20.065, p=0.014). In the secondary MR group, 21 (17.9%) patients reached the primary endpoint. In this subgroup, an associated ≥Mod TR was present in 47 (40.2 %) of the patients. A ≥Mod TR was not significantly associated with the occurrence of the primary endpoint in the secondary MR subgroup analysis. In conclusion ≥Mod TR conveys a worse 1-year outcome after TEER for MR. TEER for primary MR is associated with a worse outcome when ≥Mod TR is present, suggesting that, in this subgroup, a concomitant TEER for the TR could improve prognosis.