Impact of Tricuspid Regurgitation on Outcomes After Transcatheter Mitral Valve Replacement

Development of functional tricuspid regurgitation (TR) due to chronic mitral disease and subsequent heart failure is common. However, the effect of TR on clinical outcomes following transcatheter mitral valve replacement (TMVR) remains unclear. We aimed to evaluate the impact of baseline TR on outcomes after TMVR. This was a single-center retrospective analysis of patients who received valve-in-valve or valve-in-ring TMVR between 2012 and 2022. Patients were categorized into none/mild TR and moderate/severe TR based on baseline echocardiography. Primary outcome was 3-years all-cause death and secondary outcomes were in-hospital events. Among the 135 patients who underwent TMVR, 64 (47%) exhibited none/mild TR at baseline, while 71 (53%) demonstrated moderate/severe TR. There were no significant differences in in-hospital events among the groups. At 3-years, the moderate/severe TR group exhibited a significantly elevated risk of all-cause death (adjusted HR 3.37, 95% CI 1.35-8.41, p = 0.009). When patients with baseline moderate/severe TR were stratified by echocardiography at 30 days into improved (36%) and non-improved (64%) TR groups, although limited by small sample size, there was no significant difference in 3-year all-cause mortality (p = 0.48). In conclusion, this study investigating the impact of baseline TR on clinical outcomes revealed that moderate/severe TR is prevalent among those undergoing TMVR, and was an independent predictor of 3-years all-cause mortality. Earlier mitral valve intervention, prior to the development of significant TR, may play a pivotal role in improving outcomes following TMVR.