Cardiology Resident Mcgill University Health Center Montreal, Quebec, Canada
Background: Transcatheter edge-to-edge repair (TEER) has emerged as an effective treatment for patients with severe tricuspid regurgitation (TR) who are high surgical candidates. While TEER provides promising short-term results, the natural history of residual and recurrent TR post-procedure remains incompletely characterized.
METHODS AND RESULTS: We analyzed outcomes from major multicenter registries-including TriValve, CLASP TR, bRIGHT, EUROTR, PASTE and TRILUMINATE, TRI-SPA- comprising thousands of patients treated with MitraClip/TriClip or PASCAL systems. TR severity was assessed at discharge, 30 days, 6 months, and 1 year. The primary endpoints included (1) the proportion of patients with sustained TR reduction (≤ moderate) and (2) the prognostic implications of recurrent or progressive ≥ moderate-to-severe TR including symptom burden, mortality and heart failure hospitalisations.
Procedural success according to Tricuspid Valve Academic Research Consortium (TVARD) was observed in over 80% of patients at 30 days. However, recurrent or progressive TR (≥ moderate) occurred in up to 30–40% of patients within one year. In the TriValve registry, approximately 25% experienced worsening TR over time. Similar recurrence patterns were observed in the CLASP TR cohorts, where residual or recurrent TR was associated with increased heart failure hospitalizations and decreased survival. The bRIGHT registry identified anatomical predictors-such as large coaptation gaps and baseline right atrial dimensions- that are associated with reduced durability of TR reduction.
Conclusion: Despite favorable immediate outcomes, recurrent or progressive TR post-TEER is frequent and associated with worse clinical outcomes. These findings- consistently demonstrated across large, multicenter registries and now supported by randomized data from the TRILUMINATE trial-highlight the need for improved patient selection, procedural strategies, and post-procedural surveillance to enhance the durability and effectiveness of TEER in tricuspid disease.
