Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan 2;9(6):100408.
doi: 10.1016/j.shj.2024.100408. eCollection 2025 Jun.

Quality of Life After Mitral Transcatheter Edge-to-Edge Repair According to Baseline Tricuspid Regurgitation

Collin J Brooks  1 , Neal Duggal  2 , Milan Seth  3 , Megan S Joseph  4 , Devraj Sukul  4 , Stan J Chetcuti  4 , Gorav Ailawadi  5 , Himanshu Patel  5 , P Michael Grossman  4 , Raed Alnajjar  6 , Andrew W Harris  4
Affiliations

Quality of Life After Mitral Transcatheter Edge-to-Edge Repair According to Baseline Tricuspid Regurgitation

Collin J Brooks et al. Struct Heart. .

Abstract

Background: There is a high prevalence of significant tricuspid regurgitation (TR) in patients undergoing mitral transcatheter edge-to-edge repair (M-TEER). Significant TR is associated with poor prognosis and affects decision-making between M-TEER and concomitant mitral and tricuspid valve surgery. Improved quality of life (QoL) is an important metric for patients.

Methods: We analyzed data from 1838 patients undergoing M-TEER included in a multicenter statewide registry from 2015 to 2023. QoL was assessed using baseline and 30-day Kansas City Cardiomyopathy Questionnaire (KCCQ) scores. Patients were classified as no/mild TR or moderate/severe TR, and changes in KCCQ scores were compared. The primary outcome was an adjusted analysis consisting of survival to 30 days with a ≥15-point improvement in KCCQ score.

Results: Complete endpoint data were available for 1421 patients (77.3%). On average, patients undergoing M-TEER experienced large improvements in QoL, regardless of baseline TR group. Thirty-day mortality for patients with moderate/severe TR was higher than for those with no/mild TR (42 [4.1%] vs. 16 [2.0%], respectively, p ​= ​0.018). The majority of patients survived to 30 days with ΔKCCQ ≥15 (63.8% for no/mild TR vs. 59.6% for moderate/severe TR, p ​= ​0.120). Patients with moderate/severe TR exhibited no difference in the primary adjusted outcome (adjusted odds ratio: 0.851, p ​= ​0.177).

Conclusions: The majority of patients experience a large improvement in QoL after M-TEER, regardless of baseline TR severity. Further research should explore a staged approach of M-TEER followed by tricuspid valve intervention as needed compared to concomitant mitral/tricuspid valve surgery.

Keywords: Health-related quality of life (QoL); Mitral regurgitation (MR); Mitral transcatheter edge-to-edge repair (M-TEER); Tricuspid regurgitation (TR); Tricuspid transcatheter edge-to-edge repair (T-TEER).

PubMed Disclaimer

Figures

None
Graphical abstract
Figure 1
Figure 1
Kaplan-Meier 1-year mortality following M-TEER according to TR severity. Kaplan-Meier curves comparing mortality estimates to 1 ​year for no/mild TR compared to moderate/severe TR groups. Estimated 1-year survival rates with 95% CI are reported, with comparisons made by the log-rank test. Abbreviations: M-TEER, ​mitral tricuspid edge-to-edge repair; TR, ​tricuspid regurgitation.
Figure 2
Figure 2
Median 30-day KCCQ change after M-TEER. Box plot displaying change in KCCQ from baseline to 30 days according to TR group. Center line displays median change, boxes represent interquartile range, and whiskers represent 95% CIs. Abbreviations: KCCQ, Kansas City Cardiomyopathy Questionnaire; M-TEER, ​mitral tricuspid edge-to-edge repair; TR, ​tricuspid regurgitation.
Figure 3
Figure 3
Magnitude of KCCQ change according to baseline TR. Magnitudes of change in baseline to 30-day KCCQ scores according to TR group. Side brackets display the proportion of patients with at least a 15-point improvement. Abbreviations: KCCQ, Kansas City Cardiomyopathy Questionnaire; TR, ​tricuspid regurgitation.
Figure 4
Figure 4
Multivariable-weighted logistic regression: survival with improved quality of life. Forest plot depicting the primary adjusted outcome of survival to 30 days with ≥15-point improvement in baseline to 30-day KCCQ scores. A lower OR favors no/mild TR in likelihood of achieving the primary endpoint. The overall primary adjusted analysis is displayed on the top row, with further subgroup analysis below. Abbreviations: aOR, ​adjusted odds ratio; KCCQ, Kansas City Cardiomyopathy Questionnaire; MR, ​mitral regurgitation; OR, odds ratio; TR, ​tricuspid regurgitation.
Supplemental Figure 1
Supplemental Figure 1
Supplemental Figure 2
Supplemental Figure 2
Supplemental Figure 3a
Supplemental Figure 3a
Supplemental Figure 3a
Supplemental Figure 3a
Supplemental Figure 4
Supplemental Figure 4
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Sagie A., Freitas N., Chen M.H., Marshall J.E., Weyman A.K., Levine R.A. Echocardiographic assessment of mitral stenosis and its associated valvular lesions in 205 patients and lack of association with mitral valve prolapse. J Am Soc Echocardiogr. 1997;10(2):141–148. doi: 10.1016/S0894-7317(97)70086-5. - DOI - PubMed
    1. Dreyfus G.D., Corbi P.J., Chan K.M.J., Bahrami T. Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair? Ann Thorac Surg. 2005;79(1):127–132. doi: 10.1016/j.athoracsur.2004.06.057. - DOI - PubMed
    1. Nkomo V.T., Gardin J.M., Skelton T.N., Gottdiener J.S., Scott C.G., Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005–1011. doi: 10.1016/S0140-6736(06)69208-8. - DOI - PubMed
    1. Mirabel M., Iung B., Baron G., et al. What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? Eur Heart J. 2007;28(11):1358–1365. doi: 10.1093/eurheartj/ehm001. - DOI - PubMed
    1. Vakil K., Roukoz H., Sarraf M., et al. Safety and efficacy of the MitraClip ® system for severe mitral regurgitation. Catheter Cardiovasc Interv. 2014;84(1):129–136. doi: 10.1002/ccd.25347. - DOI - PubMed

LinkOut - more resources