Impact of Tricuspid Regurgitation on Outcomes After Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation: The PRIME-MR Registry

BACKGROUND: The presence of tricuspid regurgitation (TR) may affect prognosis in patients with primary mitral regurgitation. This study sought to investigate the impact of concomitant TR on clinical outcomes in patients with primary mitral regurgitation undergoing mitral transcatheter edge-to-edge repair (M-TEER). METHODS: The PRIME-MR registry (Outcomes of Patients Treated With Mitral Transcatheter Edge-to-edge Repair for Primary Mitral Regurgitation) included 3083 patients with severe primary mitral regurgitation undergoing M-TEER from 2008 to 2022 at 25 international sites. Only patients with successful M-TEER procedures (mitral regurgitation≤Moderate) were analyzed. The study population was stratified by baseline TR severity: TR≤Moderate (TR≤Mod) versus TR≥Severe (TR≥Sev). The primary end point was 2-year all-cause mortality. RESULTS: A total of 2155 patients were analyzed: TR≥Sev (n=421 [20%]) versus TR≤Mod (n=1734 [80%]). Patients with TR≥Sev were more likely to be New York Heart Association III/IV ( P =0.003), have shorter 6-minute walk distance ( P <0.001), higher NT-proBNP (N-terminal pro-B-type natriuretic peptide; P <0.001), higher creatinine ( P <0.001), higher pulmonary artery pressures ( P <0.001), atrial fibrillation ( P <0.001), and more diuretics ( P <0.001) than those with TR≤Mod. At 2 years, patients with TR≥Sev had higher mortality (29.6% versus 19.6%; P log-rank <0.0001) and heart failure hospitalization (21.1% versus 16.8%; P Gray =0.018) than TR≤Mod. Baseline TR≥Sev was an independent predictor of 2-year mortality (adjusted hazard ratio, 2.01 [95% CI, 1.35–3.00]; P <0.001). Although TR≥Sev decreased in 30% of patients after successful M-TEER, residual TR≥Sev was still associated with higher mortality (30.4% versus 19.9%; P log-rank =0.0037) than TR≤Mod. CONCLUSIONS: In the PRIME-MR registry, 20% of patients with primary mitral regurgitation had severe TR at baseline. TR severity improved in 30% of TR≥Sev patients after successful M-TEER. The presence of TR≥Sev was independently associated with increased all-cause mortality at 2 years.

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Journal
Circulation Cardiovascular Interventions
Published
2026-09-11
DOI
https://doi.org/10.1161/circinterventions.126.016634
Primary Topic
Cardiac Valve Diseases and Treatments
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article

Impact of Tricuspid Regurgitation on Outcomes After Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation: The PRIME-MR Registry

Simon Redwood, Muhammed Gerçek, Juan F. Granada, Christos Iliadis et al.
Circulation Cardiovascular Interventions
Cardiac Valve Diseases and Treatments
article

Impact of Tricuspid Regurgitation on Outcomes After Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation: The PRIME-MR Registry

Simon Redwood, Muhammed Gerçek, Juan F. Granada, Christos Iliadis, Chiara Primerano, Julien Dreyfus, Daryoush Samim, Yohann Bohbot, Ole De Backer, Rodrigo Estévez‐Loureiro, Anne Bernard, Erwan Donal, Andrea Scotti, Teresa Trenkwalder, Jean‐Michel Paradis, Nicole Karam, Philipp von Stein, Bruno Melica, Robin Le Ruz, Yusuke Kobari, Marco De Carlo, Fabien Praz, Mirjam Keßler, Jörg Hausleiter, Cristina Giannini, Marco Metra, Azeem Latib, Benedikt Koell, Jessica Weimann, Lukas Stolz, Yoan Lavie‐Badie, Sebastian Ludwig, Ignacio Cruz‐González, A. Adams, Marianna Adamo, Tetsu Tanaka, Erion Xhepa, Tanja K. Rudolph, Augustin Coisne, Thomas Modine, Edith Lubos, Georg Nickenig, Adrian Heinze, Dhairya Patel, Raj Makkar, on behalf of the PRIME-MR Investigators, Daniel Feldman, Felix Rudolph, Daniel Kalbacher, Marcel Weber, Omar Chehab
article en

Abstract

BACKGROUND: The presence of tricuspid regurgitation (TR) may affect prognosis in patients with primary mitral regurgitation. This study sought to investigate the impact of concomitant TR on clinical outcomes in patients with primary mitral regurgitation undergoing mitral transcatheter edge-to-edge repair (M-TEER). METHODS: The PRIME-MR registry (Outcomes of Patients Treated With Mitral Transcatheter Edge-to-edge Repair for Primary Mitral Regurgitation) included 3083 patients with severe primary mitral regurgitation undergoing M-TEER from 2008 to 2022 at 25 international sites. Only patients with successful M-TEER procedures (mitral regurgitation≤Moderate) were analyzed. The study population was stratified by baseline TR severity: TR≤Moderate (TR≤Mod) versus TR≥Severe (TR≥Sev). The primary end point was 2-year all-cause mortality. RESULTS: A total of 2155 patients were analyzed: TR≥Sev (n=421 [20%]) versus TR≤Mod (n=1734 [80%]). Patients with TR≥Sev were more likely to be New York Heart Association III/IV ( P =0.003), have shorter 6-minute walk distance ( P <0.001), higher NT-proBNP (N-terminal pro-B-type natriuretic peptide; P <0.001), higher creatinine ( P <0.001), higher pulmonary artery pressures ( P <0.001), atrial fibrillation ( P <0.001), and more diuretics ( P <0.001) than those with TR≤Mod. At 2 years, patients with TR≥Sev had higher mortality (29.6% versus 19.6%; P log-rank <0.0001) and heart failure hospitalization (21.1% versus 16.8%; P Gray =0.018) than TR≤Mod. Baseline TR≥Sev was an independent predictor of 2-year mortality (adjusted hazard ratio, 2.01 [95% CI, 1.35–3.00]; P <0.001). Although TR≥Sev decreased in 30% of patients after successful M-TEER, residual TR≥Sev was still associated with higher mortality (30.4% versus 19.9%; P log-rank =0.0037) than TR≤Mod. CONCLUSIONS: In the PRIME-MR registry, 20% of patients with primary mitral regurgitation had severe TR at baseline. TR severity improved in 30% of TR≥Sev patients after successful M-TEER. The presence of TR≥Sev was independently associated with increased all-cause mortality at 2 years.

Circulation Cardiovascular Interventions
Albert Einstein College of Medicine (US), Valve (United States) (US), St Thomas' Hospital (GB), Montefiore Medical Center (US), Inserm (FR), Universität Hamburg (DE), Universität Ulm (DE), Heart and Diabetes Center North Rhine-Westphalia (DE), University Hospital Complex Of Vigo (ES), Copenhagen University Hospital (DK), Rigshospitalet (DK), Centre Hospitalier Universitaire de Bordeaux (FR), Centre Hospitalier Universitaire de Lille (FR), LMU Klinikum (DE), Université Rennes 2 (FR), Universitätsklinik für Neurologie (AT), Centre Hospitalier Universitaire de Tours (FR), Centre Hospitalier Universitaire Amiens-Picardie (FR), Lung Institute (US), Hôpital Européen Georges-Pompidou (FR), Surgical Specialties (Canada) (CA), White Plains Hospital (US), University Medical Center Hamburg-Eppendorf (DE), Hôpital Rangueil (FR), German Centre for Cardiovascular Research (DE), Marienkrankenhaus Hamburg (DE), Instituto de Investigación Biomédica de Salamanca (ES), Cedars-Sinai Smidt Heart Institute (US), Centro Hospitalar de Vila Nova de Gaia (PT), Institut du Thorax (FR), Cardiovascular Research Foundation (US), Deutsches Herzzentrum München (DE), University Hospital Cologne (DE), Centre Cardiologique du Nord (FR), Azienda Ospedaliera Universitaria Pisana (IT), Université de Rennes (FR), University of Brescia (IT)
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Cardiac Valve Diseases and Treatments
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