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

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).

Graphical abstract

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

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

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

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.

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