Abstract 17806: Outcome Prediction Score for Mitral Transcatheter Edge-to-Edge Repair in Patients With Concomitant Significant Tricuspid Regurgitation

Abstract

Introduction: Tricuspid regurgitation (TR) adversely affects the post-procedural course following mitral transcatheter edge-to-edge repair (TEER). We aimed to derive a clinical risk stratification model for patients undergoing TEER for mitral regurgitation while exhibiting significant TR. Methods: This is a single-center, retrospective study of 217 consecutive individuals referred to an isolated mitral TEER who had above-moderate TR at baseline. The primary outcome of interest was the 1-year composite of all-cause mortality or heart failure hospitalizations. The cohort was randomly split in a 75% to 25% ratio, creating train (n=163) and test (n=54) datasets. Model development, discrimination and calibration were based on the train dataset. Internal validation was applied to the test dataset. Results: By 1-year, 81 (37.3%) patients died or were hospitalized for heart failure. After multivariable analysis, a score for predicting the primary outcome was constructed that utilized a 0-3 scaling system, in which each point represented one of three baseline variables associated with this combined endpoint: serum B-natriuretic peptide (BNP) level >1,000 pg/mL, qualitative right ventricular (RV) dysfunction on transthoracic echocardiogram, and a cardiac implantable electronic device (CIED). C-statistic of the model for the primary outcome was 0.66 (95% CI, 0.58-0.74, p=0.001) and 0.76 (95% CI, 0.62-0.90, p=0.004) in the train and test datasets, respectively - representing a significantly better discrimination ability than the MitraScore and the Society of Thoracic Surgeons score for mitral valve repair. Conclusions: The BNP-RV-CIED (BRC) score is a simple clinical prediction tool that may aid in the triage of mitral TEER candidate with significant pre-existing TR.