Vera Fortmeier

Background: Transcatheter tricuspid edge‐to‐edge repair (T‐TEER) has developed as a treatment option for patients experiencing severe tricuspid regurgitation. T‐TEER consistently reduces tricuspid regurgitation, but data on subsequent right heart remodeling remain limited. The aim of this study was to evaluate changes in right heart dimension and function after T‐TEER using extended echocardiographic follow‐up. Methods: The study was based on the international EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation), including patients undergoing T‐TEER between 2016 and 2024 at 18 European centers. Eligible were patients with available baseline and follow‐up (≥90 days postprocedure) echocardiographic assessment. Results: A total of 699 patients (mean age, 78±8 years; 56% women) were included in the analysis. Echocardiographic follow‐up was performed at a median of 407 days (interquartile range, 205–801 days). Right heart dimensions significantly decreased: right ventricular (RV) midventricular diameter from 40.2±8.9 to 37.1±8.4 mm ( P 2 ( P P P <0.001) was observed. Conclusions: In the subset of surviving patients with available echocardiographic follow‐up, treatment with T‐TEER led to favorable long‐term changes with reduced RV dimension, associated with procedural success. RV function modestly decreased, likely reflecting normalization after volume unloading.

Background: Tricuspid regurgitation (TR) frequently develops in patients with long‐standing pulmonary hypertension, and both pathologies are associated with increased morbidity and mortality. This study aimed to improve prognostic assessment in patients with severe TR undergoing transcatheter tricuspid valve intervention (TTVI) by relating the extent of TR to pulmonary artery pressures. Methods and Results: In this multicenter study, we included 533 patients undergoing TTVI for moderate‐to‐severe or severe TR. The proportionality framework was based on the ratio of tricuspid valve effective regurgitant orifice area to mean pulmonary artery pressure. An optimal threshold for tricuspid valve effective regurgitant orifice area/mean pulmonary artery pressure ratio was derived on 353 patients with regard to 2‐year all‐cause mortality and externally validated on 180 patients. Patients with a tricuspid valve effective regurgitant orifice area/mean pulmonary artery pressure ratio ≤1.25 mm ² /mm Hg (defining proportionate TR) featured significantly lower 2‐year survival rates after TTVI than patients with disproportionate TR (56.6% versus 69.6%; P =0.005). In contrast with patients with disproportionate TR (n=398), patients with proportionate TR (n=135) showed more pronounced mPAP levels (37.9±9.06 mm Hg versus 27.9±8.17 mm Hg; P −16 ) and more severely impaired right ventricular function (tricuspid annular plane systolic excursion: 16.0±4.11 versus 17.0±4.64 mm; P =0.012). Moreover, tricuspid valve effective regurgitant orifice area was smaller in patients with proportionate TR when compared with disproportionate TR (0.350±0.105 cm ² versus 0.770±0.432 cm ² ; P −16 ). Importantly, proportionate TR remained a significant predictor for 2‐year mortality after adjusting for demographic and clinical variables (hazard ratio, 1.7; P =0.006). Conclusions: The proposed proportionality framework promises to improve future risk stratification and clinical decision‐making by identifying patients who benefit the most from TTVI (disproportionate TR). As a next step, randomized controlled studies with a conservative treatment arm are needed to quantify the net benefit of TTVI in patients with proportionate TR.