Impact of Previous Cardiac Surgery on Outcomes After Tricuspid Valve Transcatheter Edge-to-Edge Repair: Insights from EuroTR

Abstract Background Data on the association of previous cardiac surgery (PCS) with outcomes following tricuspid valve transcatheter edge-to-edge repair (T-TEER) are limited. Objectives This study aimed to evaluate the impact of PCS on outcomes after T-TEER. Methods This analysis included patients from the EuroTR registry (European Registry of Transcatheter Repair for Tricuspid Regurgitation; NCT0630726) who underwent T-TEER for clinically relevant tricuspid regurgitation (TR) between 2016 and 2024 and had available information on cardiac surgical history. Study endpoints were procedural TR reduction, improvement in NYHA functional class, all-cause mortality, and the composite of death or heart failure hospitalization (HFH) at 2 years. Results Among 2929 patients, 27.2% had a history of PCS. These patients exhibited a higher comorbidity burden and more advanced right heart remodeling. TR severity at baseline was comparable between groups ( P = 0.095), whereas residual TR at discharge and follow-up was higher in patients with PCS (both P < 0.001). PCS independently predicted residual TR ≥ 3 + at discharge (OR: 1.41; 95% CI: 1.11–1.79; P = 0.01). T-TEER was associated with an improvement in NYHA class in patients with and without PCS (≥ 1-class reduction: 66.2% in PCS vs. 59.6% in non-PCS patients; P = 0.15). At 2 years, PCS patients had higher all-cause mortality (HR: 1.25; 95% CI: 1.04–1.50; P = 0.02) and a higher incidence of the composite endpoint of death or HFH (HR: 1.24; 95% CI: 1.05–1.46; P = 0.01). Conclusions PCS is an independent predictor of outcomes in patients undergoing T-TEER, identifying a subgroup with less pronounced TR reduction and lower long-term survival despite significant functional improvement. Graphical Abstract

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Journal
Clinical Research in Cardiology
Published
2026-05-18
DOI
https://doi.org/10.1007/s00392-026-02914-6
Primary Topic
Cardiac Valve Diseases and Treatments
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article
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article

Impact of Previous Cardiac Surgery on Outcomes After Tricuspid Valve Transcatheter Edge-to-Edge Repair: Insights from EuroTR

Edoardo Pancaldi, Vera Fortmeier, Sebastian Rosch, Thorald Stolte et al.
Clinical Research in Cardiology
Cardiac Valve Diseases and Treatments
article

Impact of Previous Cardiac Surgery on Outcomes After Tricuspid Valve Transcatheter Edge-to-Edge Repair: Insights from EuroTR

Edoardo Pancaldi, Vera Fortmeier, Sebastian Rosch, Thorald Stolte, Francesco Maisano, Dario Grassini, Federico Arturi, Amin Polzin, Hazem Omran, Karl‐Patrik Kresoja, Florian Schindhelm, Cristina Giannini, Alessandro Sticchi, Natacha Rousse, Benedikt Koell, Stefan Toggweiler, Andreas Goldschmied, Matteo Mazzola, Philipp Lauten, Christoph Pauschinger, Samy Aghezzaf, Leonhard‐Moritz Schneider, Katalin Berschiminski, M H Konstandin, Paul Achouh, Kaspar Volz, Karl-Philip Rommel, Enrique Sánchez-Muñóz, Quentin de Baynast, Amir Abbas Mahabadi, M Adamo, Julia Grapsa, Martin Swaans, P Lurz, H Thiele, F Praz, Sebastian Ludwig, Tomás Benito-González, Martin Kraus, Anke von Peter, Daniel Kalbacher, Hannah Kempton, Giulia Masiero, Roman Pfister, Mirjam Kessler, Muhammed Gerçek, Paolo Denti, Flavien Vincent, Alain Berrebi, Peter Boekstegers, Christian Besler, Martijn Vrijkorte, Eric Van Belle, Andreas Rück, Manuel Barreiro-Perez, Carsten Salomon, Tobias Geisler, Tienush Rassaf, Harald Lapp, Ludwig T. Weckbach, Stephanie Brunner, Mauro Massussi, Felix Rudolph, Julio Echarte-Morales, Giuseppe Tarantini, Marco De Carlo, Philipp von Stein, Lukas Stolz, Fabian Voss, Antonio Popolo Rubbio, Bjoern Goebel, Marco Metra, Elisa Pezzola, Mirjam G. Wild, Jörg Hausleiter, Thomas J. Stocker, Dominik Felbel, Wolfgang Rottbauer, Dirk Westermann, Philipp Schlegel, on behalf of the EuroTR Investigators, Volker Rudolph, Laura Lupi, Jennifer von Stein, Berenice Caneiro-Queija, Francesco Bedogni, Norbert Frey, Julia Novotny, Thomas Nestelberger, Christos Iliadis, Stephan Baldus, Ralph Stephan von Bardeleben, Philipp Doldi, Rodrigo Estévez-Loureiro, Nicole Karam, Mohammad Kassar, Tiffany Patterson, Monika Zdanyte, Tobias Kister
article en

Abstract

Abstract Background Data on the association of previous cardiac surgery (PCS) with outcomes following tricuspid valve transcatheter edge-to-edge repair (T-TEER) are limited. Objectives This study aimed to evaluate the impact of PCS on outcomes after T-TEER. Methods This analysis included patients from the EuroTR registry (European Registry of Transcatheter Repair for Tricuspid Regurgitation; NCT0630726) who underwent T-TEER for clinically relevant tricuspid regurgitation (TR) between 2016 and 2024 and had available information on cardiac surgical history. Study endpoints were procedural TR reduction, improvement in NYHA functional class, all-cause mortality, and the composite of death or heart failure hospitalization (HFH) at 2 years. Results Among 2929 patients, 27.2% had a history of PCS. These patients exhibited a higher comorbidity burden and more advanced right heart remodeling. TR severity at baseline was comparable between groups ( P = 0.095), whereas residual TR at discharge and follow-up was higher in patients with PCS (both P < 0.001). PCS independently predicted residual TR ≥ 3 + at discharge (OR: 1.41; 95% CI: 1.11–1.79; P = 0.01). T-TEER was associated with an improvement in NYHA class in patients with and without PCS (≥ 1-class reduction: 66.2% in PCS vs. 59.6% in non-PCS patients; P = 0.15). At 2 years, PCS patients had higher all-cause mortality (HR: 1.25; 95% CI: 1.04–1.50; P = 0.02) and a higher incidence of the composite endpoint of death or HFH (HR: 1.24; 95% CI: 1.05–1.46; P = 0.01). Conclusions PCS is an independent predictor of outcomes in patients undergoing T-TEER, identifying a subgroup with less pronounced TR reduction and lower long-term survival despite significant functional improvement. Graphical Abstract

Clinical Research in Cardiology
University of Pisa (IT), University of Bern (CH), Brigham and Women's Hospital (US), Guy's Hospital (GB), Karolinska University Hospital (SE), University of Padua (IT), University of Cologne (DE), University of Basel (CH), Johannes Gutenberg University Mainz (DE), Université Paris Cité (FR), Heidelberg University (DE), Heart and Diabetes Center North Rhine-Westphalia (DE), University Hospital of Bern (CH), University Hospital Heidelberg (DE), University Hospital Complex Of Vigo (ES), University Hospital of Basel (CH), Centre Hospitalier Universitaire de Lille (FR), LMU Klinikum (DE), University Medical Center of the Johannes Gutenberg University Mainz (DE), Helios Hospital Siegburg (DE), IRCCS Policlinico San Donato (IT), Hôpital Européen Georges-Pompidou (FR), Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT), St. Antonius Ziekenhuis (NL), Zentralklinik Bad Berka (DE), University Medical Center Hamburg-Eppendorf (DE), Leipzig Heart Institute (DE), Luzerner Kantonsspital (CH), German Centre for Cardiovascular Research (DE), Universitäts-Herzzentrum Freiburg-Bad Krozingen (DE), Istituti di Ricovero e Cura a Carattere Scientifico (IT), University Hospital Cologne (DE), West German Heart and Vascular Center Essen (DE), Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT), Heinrich Heine University Düsseldorf (DE), University of Duisburg-Essen (DE), University of Brescia (IT), Ludwig-Maximilians-Universität München (DE), Leipzig University (DE)
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Cardiac Valve Diseases and Treatments
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