ArticleStructural heart : the journal of the Heart Team2026
Persistent Severe Tricuspid Regurgitation After Mitral Transcatheter Edge-to-Edge Repair: Prognostic Implications of Guideline-Based Eligibility for Transcatheter Tricuspid Valve Intervention.
Article in Structural heart : the journal of the Heart Team, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Persistent tricuspid regurgitation (TR) after mitral transcatheter edge-to-edge repair (M-TEER) is common and associated with adverse outcomes. However, the prognostic relevance of persistent TR may differ depending on anatomical suitability for staged transcatheter tricuspid valve intervention (TTVI). This study aimed to characterize the prevalence, determinants, and prognostic significance of persistent severe TR after M-TEER, with a particular focus on TTVI eligibility. Methods: In this dual-center retrospective cohort study, 905 patients undergoing M-TEER for severe mitral regurgitation between 2015 and 2025 were analyzed. TR severity was assessed at baseline and at 3-month follow-up. Patients with persistent severe TR were categorized as TTVI eligible or TTVI ineligible according to current guideline-based criteria. Multivariable logistic regression identified factors associated with persistent TR, and survival analyses evaluated the prognostic impact of TR persistence. Results: Among 905 patients (median age 79.7 years; 43.4% female), 1-year and 2-year survival rates after M-TEER were 87.7% (95% CI: 85.6%-89.9%) and 77.6% (95% CI: 74.9%-80.4%), respectively. Follow-up echocardiography was available in 454 patients (50.2%). Persistent severe TR was present in 16.3% at 3 months. TTVI-ineligible patients had markedly reduced 2-year survival (39.5%; 95% CI: 22.8%-68.4%), whereas TTVI-eligible patients showed survival similar to those without persistent TR (82.9% [95% CI: 72.8%-94.5%] vs. 87.7% [95% CI: 84.4%-91.2%]). In multivariable analysis, TTVI ineligibility was independently associated with elevated 2-year mortality (hazard ratio [HR]: 5.25 [95% CI: 1.39-19.8]). Advanced right heart remodeling and higher baseline TR severity were strongly associated with TR persistence. Moreover, female sex was independently associated with persistent TR despite similar mitral regurgitation etiology and baseline TR severity between sexes. Conclusion: Persistent TR after M-TEER identifies a high-risk subgroup, but adverse outcomes are primarily driven by patients ineligible for TTVI. Early anticipation of TR persistence, particularly in women, and structured assessment of TTVI eligibility may enable timely intervention and prevent progression to untreatable right-sided heart failure.
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