One-Year Recurrent Tricuspid Regurgitation After Successful Transcatheter Edge to Edge Repair: The TRI-SPA Registry

Abstract

Recurrent tricuspid regurgitation (TR) following transcatheter edge-to-edge repair (TEER) has not been thoroughly investigated. We aimed to examine the predictive factors and mid-term outcomes of recurrent TR following successful TEER. Procedural success was defined as the reduction of TR grade to ≤2+, assessed at discharge. Recurrence of TR was defined as TR grade 3+ or worse at 1 year after initially successful TEER. The primary endpoint of this study was the composite of all-cause mortality and heart failure (HF) hospitalization at 2 years-follow up. Among 163 T-TEER patients with a reduction in TR to ≤2+, 37 patients developed recurrent TR within the first 12 months (76% females, mean age 75.5 ± 8.3 years). Fractional area change (odds ratio, 1.05; p = 0.013), residual TR2+ (odds ratio, 5.08; p = 0.002) and primary TR etiology (odds ratio, 3.45, p = 0.043) were independent predictors of recurrent TR. Over a median follow-up of 18.4 months, the primary endpoint occurred in 11 (13.5%) and 17 (20.7%) of patients in the nonrecurrent and recurrent TR groups, respectively, with a hazard ratio of 2.39 (1.09 to 5.26, p = 0.030). In the survival analysis, there was a strong tendency toward higher rates of freedom from the primary endpoint in nonrecurrent TR patients (84.5% vs 73.2%; p = 0.066), mainly driven by lower rates of HF hospitalization (79.8% vs 65.2%; log-rank p = 0.048) compared to patients with recurrent TR. In conclusion, recurrent TR was associated with worse outcomes. Right ventricular fractional area change, residual TR and primary TR were independent predictors for recurrent TR.