Evolution of tricuspid regurgitation after transcatheter edge‐to‐edge mitral valve repair for secondary mitral regurgitation and its impact on mortality

Aim To evaluate short‐term changes in tricuspid regurgitation (TR) after transcatheter edge‐to‐edge mitral valve repair (M‐TEER) in secondary mitral regurgitation (SMR), their predictors and impact on mortality. Methods and results This is a retrospective analysis of SMR patients undergoing successful M‐TEER (post‐procedural mitral regurgitation ≤2+) at 13 European centres. Among 503 patients evaluated 79 (interquartile range [IQR] 40–152) days after M‐TEER, 173 (35%) showed ≥1 degree of TR improvement, 97 (19%) had worsening of TR, and 233 (46%) remained unchanged. Smaller baseline left atrial diameter and residual mitral regurgitation 0/1+ were independent predictors of TR ≤2+ after M‐TEER. There was a significant association between TR changes and New York Heart Association class and pulmonary artery systolic pressure decrease at echocardiographic re‐assessment. At a median follow‐up of 590 (IQR 209–1103) days from short‐term echocardiographic re‐assessment, all‐cause mortality was lower in patients with improved compared to those with unchanged/worsened TR (29.6% vs. 42.3% at 3 years; log‐rank p = 0.034). Baseline TR severity was not associated with mortality, whereas TR 0/1+ and 2+ at short‐term follow‐up was associated with lower all‐cause mortality compared to TR 3/4+ (30.6% and 35.6% vs. 55.6% at 3 years; p < 0.001). A TR ≤2+ after M‐TEER was independently associated with a 42% decreased risk of mortality ( p = 0.011). Conclusion More than one third of patients with SMR undergoing successful M‐TEER experienced an improvement in TR. Pre‐procedural TR was not associated with outcome, but a TR ≤2+ at short‐term follow‐up was independently associated with long‐term mortality. Optimal M‐TEER result and a small left atrium were associated with a higher likelihood of TR ≤2+ after M‐TEER.