Abstract 4141090: Implications of Tricuspid Regurgitation Severity in Patients Undergoing Mitral Transcatheter Edge-to-Edge Repair

Background– Prognostically-meaningful tricuspid regurgitation (TR) surrounding transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) is ill-defined. Objective– To explore the prevalence, correlates, and consequences of TR grades and postprocedural trends among mitral TEER patients. Methods– This is a single-center, retrospective analysis of isolated, first-time interventions. Pre-, intra-, and post-procedural aspects up to 1-year, of them the primary composite outcome of all-cause deaths or heart failure (HF) hospitalizations, were assessed according to continuous/categorical TR severity at baseline and 1-month post-TEER. Results– Overall, 1,287 individuals (60.3% males, age 78 (IQR, 69-85) years, 52.9% with functional MR) were included. Below-moderate, moderate, and above-moderate TR affected 48.4%, 29.5%, and 22.1% of patients, respectively. Increasing TR severity was accompanied by higher rates of functional, severe MR, greater comorbidity, and more advanced HF. Although not affecting technical and echocardiographic procedural success, moderate-and-above TR degrees were associated with higher incidence of mortality, HF admissions, and functional class III-IV post-procedure, with moderate-to-severe and greater TR independently conferring increased risks for the various outcomes (primary endpoint – HR 1.36, 95% CI 1.21-1.80, p=0.027). One-month postprocedural TR severity directly correlated with and was generally similar to or worse than its baseline counterpart. Rather than the direction/magnitude of change between the two, moderate-and-above grade at 1-month, observed in 37.1% of eligible patients, emerged as predictive of the primary outcome’s risk. Conclusion– Among mitral TEER patients, above-moderate TR at baseline and the closely-related moderate-and-above TR at 1-month post-procedure are highly prevalent and signal suboptimal outcomes. The potential benefit of simultaneously addressing such significant TR at the time of mitral TEER warrants further investigation.