Prognostic impact of tricuspid regurgitation improvement after transcatheter mitral valve replacement: results from an international multicentre registry

Abstract Background Tricuspid regurgitation (TR) frequently coincides with severe mitral regurgitation (MR). Transcatheter mitral valve replacement (TMVR) effectively eliminates MR and may secondarily affect TR severity. Aims This study aimed to assess incidence and prognostic value of TR improvement after TMVR using data from an international multicentre registry. Methods and results Patients with symptomatic MR and baseline TR undergoing TMVR from the CHoice of OptImal transCatheter trEatment for Mitral Insufficiency international multicentre registry were analysed. Tricuspid regurgitation improvement was defined as a ≥1-grade TR reduction at discharge. The primary endpoint was all-cause mortality or heart failure (HF) hospitalization at 1 year. Stepwise Cox regression was performed to assess the adjusted prognostic impact of TR improvement. Among 309 patients (median age 77 years), TR improvement occurred in 33.0% after TMVR. Patients with TR improvement were younger, had higher European System for Cardiac Operative Risk Evaluation II, less coronary artery disease, and lower baseline tricuspid annular plane systolic excursion. Mitral regurgitation was durably eliminated in most patients, irrespective of TR evolution. At 1 year, there was no statistically significant difference in all-cause mortality or HF hospitalization between patients with and without TR improvement (27.0% vs 36.9%; P = .14). Following stepwise Cox regression, TR improvement was an independent predictor of all-cause mortality or HF hospitalization 1 year after TMVR (hazard ratio 0.45, 95% confidence interval 0.23–0.88; P = .02). Conclusion TR improvement occurs frequently following TMVR and is associated with favourable 1-year outcomes. These results support the clinical relevance of concomitant TR and the systematic assessment of TR after TMVR.