Transcatheter Edge-to-Edge Repair in Patients With Primary Tricuspid Regurgitation

Abstract

Background: Tricuspid regurgitation (TR) leads to right heart congestion and increased mortality risk. Unlike secondary TR, primary TR results from leaflet degeneration. Transcatheter edge-to-edge repair (TEER) is widely used for TR. However, its feasibility primary TR remains uncertain.

Objectives: The aim of this study was to assess the safety and feasibility of TEER in patients with primary TR.

Methods: The primary TR registry is a multicenter cohort study of patients with primary TR undergoing TEER. Echocardiographic assessment classified leaflet pathology into type 1 (flail), type 2 (billowing prolapse), type 3 (perforation), and type 4 (restricted mobility). The primary endpoint was TR reduction to moderate or less at discharge.

Results: From December 2016 to April 2023, 114 patients (mean age 79.9 years, 53.5% men) were included. Most patients were in NYHA functional class III or IV (83.3%), with a median TRI-SCORE of 5.0. The TR pathologies were type 1 (28.1%), type 2 (61.4%), and type 4 (10.5%), with no type 3 cases. Device deployment was achieved in 95.6%, and 83.3% showed TR reduction to moderate or less. In-hospital mortality was 1.8%, and single-leaflet device attachment occurred in 3.5%. At 1 year, 79.7% of patients had TR moderate or less, with significant reductions in vena contracta (-5.0 mm; P < 0.001), annular diameter (-2.0 mm; P = 0.003), and mid right ventricular diameter (-3.0 mm; P < 0.001). NYHA functional class also improved significantly (NYHA functional class I or II: 17.1% at baseline vs 66.5% at follow-up; P < 0.001).

Conclusions: TEER is a safe and effective option for primary TR, promoting right heart reverse remodeling and symptomatic relief, offering a vital alternative to surgery in selected patients.

Keywords: primary tricuspid regurgitation; surgery; transcatheter edge-to-edge repair; tricuspid regurgitation.