Clinical impact of tricuspid regurgitation on transcatheter edge-to-edge mitral valve repair for mitral regurgitation

• Published in: Cardiovascular revascularization medicine 2022-08, Vol.41, p.1-9
• Main Authors: Chitturi, Kalyan R., Bhardwaj, Bhaskar, Murtaza, Ghulam, Karuparthi, Poorna R., Faza, Nadeen N., Goel, Sachin S., Reardon, Michael J., Kleiman, Neal S., Aggarwal, Kul
• Format: Article
• Language: English
• Subjects: Heart failure; Mitral valve disease; Percutaneous intervention; Structural heart disease intervention; Transcatheter edge-to-edge repair; Tricuspid regurgitation
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2022.01.027

This study aimed to evaluate whether baseline tricuspid regurgitation (TR) impacted clinical outcomes after mitral valve transcatheter edge-to-edge repair (M-TEER) for severe secondary mitral regurgitation (MR). Baseline TR is common among patients undergoing M-TEER for secondary MR, although its impact on clinical outcomes is unclear. The Cochrane Library, PubMed/MEDLINE, and Google Scholar were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from January 1, 2011 through January 31, 2021. Randomized controlled trials and nonrandomized prospective studies that evaluated baseline TR by echocardiography before M-TEER for MR were included. The primary outcome was a composite of mortality and heart failure hospitalization (HFH) at 1-year. A total of 5 studies (n = 1395 patients) were included in the primary analysis. Concurrent moderate/severe TR was associated with a worse 1 year composite of all-cause mortality and HFH (OR: 2.13; 95% CI: 1.12–4.05; p = 0.02) after M-TEER for severe MR. In studies that reported TR grade pre- and post-M-TEER for severe MR, 32% of patients with moderate-to-severe baseline TR had a reduction in TR severity after the intervention. Baseline moderate-to-severe TR was associated with increased 1-year mortality and heart failure hospitalizations among patients undergoing M-TEER. Further randomized studies are needed to assess the interaction of TR among patients undergoing M-TEER. •Tricuspid regurgitation occurs often with secondary mitral regurgitation.•Higher mortality with transcatheter edge-to-edge mitral valve repair in patients with concomitant tricuspid regurgitation.•Tricuspid annular diameter and sPAP predicted reduction in tricuspid regurgitation.