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Multicenter Study
. 2025 May 26;18(10):1289-1299.
doi: 10.1016/j.jcin.2025.03.023.

Transcatheter Edge-to-Edge Repair in Patients With Primary Tricuspid Regurgitation

Atsushi Sugiura  1 , Julien Dreyfus  2 , Sara Bombace  3 , Maria Ivannikova  4 , Joanna Bartkowiak  5 , Stephan Haussig  6 , Leonhard Moritz Schneider  7 , Mohammad Kassar  8 , Patrick Horn  9 , Maurizio Taramasso  10 , Christos Iliadis  11 , Itsuki Osawa  12 , Tadahiro Goto  13 , Marcel Weber  14 , Tetsu Tanaka  14 , Sebastian Zimmer  14 , Jean-François Obadia  15 , Gilbert Habib  16 , Baptiste Bazire  2 , Bernard Iung  17 , Yohan Bohbot  18 , Christophe Tribouilloy  18 , Erwan Donal  19 , Mohammed Nejjari  2 , Elisabeth Riant  2 , Thierry Le Tourneau  20 , Yoan Lavie-Badie  21 , Augustin Coisne  22 , Thomas Modine  23 , Pascal Lim  24 , Fabien Doguet  25 , Christine Selton-Suty  26 , Stephan Baldus  27 , Malte Kelm  9 , Fabien Praz  8 , Wolfgang Rottbauer  7 , Axel Hans-Peter Linke  6 , Rebecca Hahn  5 , Rudolph Volker  4 , David Messika-Zeitoun  28 , Philip Lurz  3 , Georg Nickenig  14
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Free article
Multicenter Study

Transcatheter Edge-to-Edge Repair in Patients With Primary Tricuspid Regurgitation

Atsushi Sugiura et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: Tricuspid regurgitation (TR) leads to right heart congestion and increased mortality risk. Unlike secondary TR, primary TR results from leaflet degeneration. Transcatheter edge-to-edge repair (TEER) is widely used for TR. However, its feasibility primary TR remains uncertain.

Objectives: The aim of this study was to assess the safety and feasibility of TEER in patients with primary TR.

Methods: The primary TR registry is a multicenter cohort study of patients with primary TR undergoing TEER. Echocardiographic assessment classified leaflet pathology into type 1 (flail), type 2 (billowing prolapse), type 3 (perforation), and type 4 (restricted mobility). The primary endpoint was TR reduction to moderate or less at discharge.

Results: From December 2016 to April 2023, 114 patients (mean age 79.9 years, 53.5% men) were included. Most patients were in NYHA functional class III or IV (83.3%), with a median TRI-SCORE of 5.0. The TR pathologies were type 1 (28.1%), type 2 (61.4%), and type 4 (10.5%), with no type 3 cases. Device deployment was achieved in 95.6%, and 83.3% showed TR reduction to moderate or less. In-hospital mortality was 1.8%, and single-leaflet device attachment occurred in 3.5%. At 1 year, 79.7% of patients had TR moderate or less, with significant reductions in vena contracta (-5.0 mm; P < 0.001), annular diameter (-2.0 mm; P = 0.003), and mid right ventricular diameter (-3.0 mm; P < 0.001). NYHA functional class also improved significantly (NYHA functional class I or II: 17.1% at baseline vs 66.5% at follow-up; P < 0.001).

Conclusions: TEER is a safe and effective option for primary TR, promoting right heart reverse remodeling and symptomatic relief, offering a vital alternative to surgery in selected patients.

Keywords: primary tricuspid regurgitation; surgery; transcatheter edge-to-edge repair; tricuspid regurgitation.

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Conflict of interest statement

Funding Support and Author Disclosures This study received a research grant from Edwards Lifesciences. Dr Sugiura has received lecture and proctoring fees from Abbott and Edwards Lifesciences. Dr Dreyfus has received speaker and proctoring fees from Abbott. Dr Tanaka has received grants from the Japanese College of Cardiology and the Uehara Memorial Foundation; and has received honoraria from Canon Medical Systems. Dr Weber has received lecture and proctoring fees from Abbott and Edwards Lifesciences. Dr Messika-Zeitoun has received a grant from Edwards Lifesciences. Dr Nickenig has received research funding from Deutsche Forschungsgemeinschaft, the German Federal Ministry of Education and Research, the European Union, Abbott, Edwards Lifesciences, Medtronic, and St. Jude Medical; and has received honoraria for lectures and advisory board membership from Abbott, Edwards Lifesciences, Medtronic, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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