Quality of Life After Mitral Transcatheter Edge-to-Edge Repair According to Baseline Tricuspid Regurgitation

TL;DR

This study finds that most patients undergoing a heart procedure called M-TEER experience improved quality of life, even if they have severe tricuspid regurgitation.

Contribution

The study provides new evidence on quality of life outcomes after M-TEER in patients with varying degrees of tricuspid regurgitation.

Findings

Most patients with moderate/severe TR had large improvements in quality of life after M-TEER.

Quality of life outcomes were similar for patients with moderate/severe TR compared to no/mild TR.

Thirty-day mortality was higher in patients with moderate/severe TR, but adjusted outcomes showed no significant difference.

Abstract

There is a high prevalence of significant tricuspid regurgitation (TR) in patients undergoing mitral transcatheter edge-to-edge repair (M-TEER). Significant TR is associated with poor prognosis and affects decision-making between M-TEER and concomitant mitral and tricuspid valve surgery. Improved quality of life (QoL) is an important metric for patients.

We analyzed data from 1838 patients undergoing M-TEER included in a multicenter statewide registry from 2015 to 2023. QoL was assessed using baseline and 30-day Kansas City Cardiomyopathy Questionnaire (KCCQ) scores. Patients were classified as no/mild TR or moderate/severe TR, and changes in KCCQ scores were compared. The primary outcome was an adjusted analysis consisting of survival to 30 days with a ≥15-point improvement in KCCQ score.

Complete endpoint data were available for 1421 patients (77.3%). On average, patients undergoing M-TEER experienced large improvements in QoL, regardless of baseline TR group. Thirty-day mortality for patients with moderate/severe TR was higher than for those with no/mild TR (42 [4.1%] vs. 16 [2.0%], respectively, p ​= ​0.018). The majority of patients survived to 30 days with ΔKCCQ ≥15 (63.8% for no/mild TR vs. 59.6% for moderate/severe TR, p ​= ​0.120). Patients with moderate/severe TR exhibited no difference in the primary adjusted outcome (adjusted odds ratio: 0.851, p ​= ​0.177).

The majority of patients experience a large improvement in QoL after M-TEER, regardless of baseline TR severity. Further research should explore a staged approach of M-TEER followed by tricuspid valve intervention as needed compared to concomitant mitral/tricuspid valve surgery.

Left: Unadjusted changes in KCCQ score from baseline to 30 days after M-TEER according to baseline TR group. Right: Comparison of adjusted primary outcome of survival to 30 days and ΔKCCQ ≥15 and adjusted analysis according to subgroups. Abbreviations: KCCQ, Kansas City Cardiomyopathy Questionnaire; TR, tricuspid regurgitation; M-TEER, mitral transcatheter edge-to-edge repair; MR, mitral regurgitation.

•Tricuspid regurgitation (TR) is associated with adverse outcomes after mitral transcatheter edge-to-edge repair (M-TEER).•Data are limited regarding the effect of TR on quality of life (QoL) after M-TEER.•Most patients with moderate/severe TR had large improvements in QoL after M-TEER.•QoL outcomes were similar for patients with moderate/severe TR compared to no/mild TR.•Future studies should compare treatment strategies for patients with concomitant mitral regurgitation and TR.

Tricuspid regurgitation (TR) is associated with adverse outcomes after mitral transcatheter edge-to-edge repair (M-TEER).

Data are limited regarding the effect of TR on quality of life (QoL) after M-TEER.

Most patients with moderate/severe TR had large improvements in QoL after M-TEER.

QoL outcomes were similar for patients with moderate/severe TR compared to no/mild TR.

Future studies should compare treatment strategies for patients with concomitant mitral regurgitation and TR.

Figures