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Prognostic Implications of Residual Tricuspid Regurgitation Grading After Transcatheter Tricuspid Valve Repair.

JACC. Cardiovascular interventions

Authors: Julien Dreyfus, Maurizio Taramasso, Karl-Patrik Kresoja, Hazem Omran, Christos Iliadis, Giulio Russo, Marcel Weber, Luis Nombela-Franco, Rodrigo Estevez Loureiro, Jörg Hausleiter, Azeem Latib, Lukas Stolz, Fabien Praz, Stephan Windecker, Jose Luis Zamorano, Ralph Stephan von Bardeleben, Gilbert H L Tang, Rebecca Hahn, Edith Lubos, John Webb, Joachim Schofer, Neil Fam, Alexander Lauten, Giovanni Pedrazzini, Josep Rodés-Cabau, Mohammed Nejjari, Luigi Badano, Hannes Alessandrini, Dominique Himbert, Horst Sievert, Kerstin Piayda, Erwan Donal, Thomas Modine, Georg Nickenig, Roman Pfister, Volker Rudolph, Jordan Bernick, George A Wells, Jeroen Bax, Philipp Lurz, Maurice Enriquez-Sarano, Francesco Maisano, David Messika-Zeitoun

BACKGROUND: The safety profile of transcatheter tricuspid valve (TTV) repair techniques is well established, but residual tricuspid regurgitation (TR) remains a concern.

OBJECTIVES: The authors sought to assess the impact of residual TR severity post-TTV repair on survival.

METHODS: We evaluated the survival rate at 2 years of 613 patients with severe isolated functional TR who underwent TTV repair in TRIGISTRY according to the severity of residual TR at discharge using a 3-grade (mild, moderate, and severe) or 4-grade scheme (mild, mild to moderate, moderate to severe, and severe).

RESULTS: Residual TR was none/mild in 33%, moderate in 52%, and severe in 15%. The 2-year adjusted survival rates significantly differed between the 3 groups (85%, 70%, and 44%, respectively; restricted mean survival time [RMST]: P = 0.0001). When the 319 patients with moderate residual TR were subdivided into mild to moderate (n = 201, 33%) and moderate to severe (n = 118, 19%), the adjusted survival rate was also significantly different between groups (85%, 80%, 55%, and 44%, respectively; RMST: P = 0.001). Survival was significantly lower in patients with moderate to severe residual TR compared to patients with mild to moderate residual TR (P = 0.006). No difference in survival rates was observed between patients with no/mild and mild to moderate residual TR (P = 0.67) or between patients with moderate to severe and severe residual TR (P = 0.96).

CONCLUSIONS: The moderate residual TR group was heterogeneous and encompassed patients with markedly different clinical outcomes. Refining TR grade classification with a more granular 4-grade scheme improved outcome prediction. Our results highlight the importance of achieving a mild to moderate or lower residual TR grade during TTV repair, which could define a successful intervention.

Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PMID: 38752971

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