Abstract 12654: Reduction of Tricuspid Regurgitation as Predictor of Successful Percutaneous Edge-to-Edge Repair: Clinical Outcomes Comparison Between Patients With Residual Severe and Moderate-or-Less Regurgitation

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INTRODUCTION: Transcatheter tricuspid valve repair (TTVR) for high-grade regurgitation (TR) is emerging as a viable option, but defining procedure-related clinical success is challenging, as considerable reduction is not possible in all patients with massive or torrential TR. This study compared clinical outcomes of edge-to-edge TTVR, in patients with residual severe vs moderate-or-less TR. Methods: Eligible patients had chronic symptomatic functional TR despite diuretic therapy, and were deemed inoperable by the local Heart Team. TR was assessed by the current five-grade classification. Efficacy and safety outcomes were compared at baseline and 6 months, with follow-up between January 2021 and May 2022. Results: Forty-three patients had ≥severe (III/V) functional TR, 65% presenting with massive (IV/V) and 14% with torrential (V/V) TR. Mean age was 81.8±4.9 years, with 10.8±6.3% STS-Score. The primary efficacy endpoint of at least one-grade TR reduction was recorded in 91% of all patients, with no device related complications.Residual severe TR (STR subgroup) was present in 15 patients, while 20 (MTR subgroup) had moderate-or-less (≤II/V). By 6 months, 4 patients died, 4 patients had no TR reduction, and MACE rate was 18.6%. Improvement in initial NYHA class III/IV occurred in 61% of STR and 77% of MTR patients. KCCQ Score increased by 17±10.6 pts. (p<0.001) vs 21±11.8 (p<0.001), and six-minute walk test by 69.6±48.7 meters (p<0.001) vs 74.2±63 (p<0.001). Renal and liver function equally improved in both groups [GFR 50±16ml/min/1,73m 2 to 57.8±20.4 (p=0.012) vs 57.4±18.5 to 65.5±21.2 (p=0.002); AST 27.5±9.3U/L to 22.9±7.3 (p=0.039) vs 37.2±25.6 to 26.8±7.3 (p=0.069)]. CONCLUSIONS: Although TTVR should always aim for trace to mild TR, considerable reduction is not always possible. This study indicates that even one-grade TR reduction can significantly impact quality of life, functional capacity and multiorgan involvement, similarly in STR and MTR patients.