Management and Outcome of Failed Transcatheter Tricuspid Edge-to-Edge Repair: Insights From the FATE International Registry.
Background Tricuspid regurgitation (TR) is linked to significant morbidity and mortality. Tricuspid transcatheter edge-to-edge repair (T-TEER) provides a less invasive option for high-risk patients, but real-world data on device failure mechanisms and outcomes remain limited.Objectives The aim of this study was to investigate the incidence, management, and outcomes of T-TEER device-related failures due to loss of leaflet insertion, single-leaflet device attachment, or device embolization, offering insights into these adverse events.Methods The retrospective, multicenter FATE (Failed Tricuspid Transcatheter Edge-to-Edge) registry identified all device-related failures associated with moderate or greater residual or recurrent TR among 2,278 consecutive T-TEER procedures performed at 31 centers from 2017 to 2024. Failure mechanisms were classified by multiparametric echocardiography. Coprimary endpoints were the incidence and management of device-related failure and the composite of death or heart failure rehospitalization.Results Among 2,278 T-TEER procedures, 123 device-related failures (5.4%) were identified (loss of leaflet insertion, 24%; single-leaflet device attachment, 75%; embolization, 1%), mostly diagnosed early and associated with severe or greater TR in 73%. Management was medical therapy in 54% and reintervention in 46%. Reintervention achieved greater TR reduction and right atrial reverse remodeling than medical therapy, but over a median follow-up period of 255 days, the composite of death or heart failure rehospitalization remained frequent (38.2%) and did not differ between strategies. Higher TRI-SCORE, acute kidney injury, and greater discharge TR severity independently predicted adverse outcomes.Conclusions Device-related failure after T-TEER is uncommon but clinically relevant. Reintervention achieves greater TR reduction and right atrial reverse remodeling than medical therapy, but events remain similar between both strategies.
Authors
- Joris F. Ooms (ORCID: https://orcid.org/0000-0001-7881-7609)
- O. Oliva (ORCID: https://orcid.org/0000-0002-5538-5222)
- Elvis Brscic (ORCID: https://orcid.org/0000-0001-6942-7182)
- Valentina Ardizzone
- Gabriele Crimi (ORCID: https://orcid.org/0000-0002-2852-061X)
- Alfonso Ielasi (ORCID: https://orcid.org/0000-0002-5982-1669)
- Fabien Praz (ORCID: https://orcid.org/0000-0001-5416-165X)
- Christina Brinkmann (ORCID: https://orcid.org/0000-0001-7284-5473)
- Maria Agustina Lopez-Laporte
- Alessandro Sticchi
- Martin J. Swaans (ORCID: https://orcid.org/0000-0003-1608-2760)
- Stefan Toggweiler (ORCID: https://orcid.org/0000-0002-7860-0298)
- Giuseppe Calamita (ORCID: https://orcid.org/0000-0003-4666-9546)
- Leo Timmers (ORCID: https://orcid.org/0000-0001-9788-9392)
- Cristina Ferrari (ORCID: https://orcid.org/0000-0003-4918-3453)
- Horst Sievert
- Mirjam Winkel
- Marina Urena
- Dabit Arzamendi
- Gregory Ducrocq
- Jérémie Arlanda
- Giulia Maisero
- Marianna Adamo
- Joachim Schofer
- Fausto Castriota
- Francesco Giannini
- Italo Porto
- Muhammed Gercek
- Marino Labinaz
- Azeem Latib
- Federico De Marco
- Augustin Coisne
- Francesco Bedogni
- Antonio Mangieri
- Maurizio Taramasso
- Giuseppe Tarantini
- Tobias Geisler
- Luca Ferri
- Jan-Malte Sinning
- Rodrigo Estévez-Loureiro
- Peter Lüdike
- Fabio Fazzari
- Giulia Antonelli
- Antonio Popolo Rubbio
- David Messika-Zeitoun
- Antonella Millin
- Felix Rudolph
- Didier Tchetchè
- Alessia Azzano
- Philipp Lurz
- Nicolas M Van Mieghem
- Stephanie Brunner
- Matteo Montorfano
- Nicolas Dumonteil
- Mohammad Kassar
- Neil P Fam
Publication Details
- Journal
- Open Access CRIS of the University of Bern
- Published
- 2026-03-23
- DOI
- https://doi.org/10.48620/96478
- Primary Topic
- Cardiac Valve Diseases and Treatments
- Type
- article
- Field-Weighted Citation Impact
- 0.00