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Multicenter Study
. 2025 Jul 28;18(14):1737-1745.
doi: 10.1016/j.jcin.2025.05.037.

The Relevance of Right Ventricular Function and Dimension in Patients Undergoing Transcatheter Tricuspid Edge-to-Edge Repair

Stephanie Brunner  1 , Lukas Stolz  2 , Karl-Patrik Kresoja  3 , Jennifer von Stein  4 , Vera Fortmeier  5 , Benedikt Koell  6 , Wolfgang Rottbauer  7 , Mohammad Kassar  8 , Bjoern Goebel  9 , Paolo Denti  10 , Paul Achouh  11 , Tienush Rassaf  12 , Manuel Barreiro-Perez  13 , Peter Boekstegers  14 , Andreas Rück  15 , Monika Zdanyte  16 , Flavien Vincent  17 , Philipp Schlegel  18 , Ralph Stephan von Bardeleben  3 , Mirjam G Wild  19 , Christian Besler  19 , Matteo Pagnesi  20 , Marianna Adamo  20 , Julia Grapsa  21 , Tiffany Patterson  21 , Holger Thiele  22 , Tobias Kister  22 , Giuseppe Tarantini  23 , Giulia Masiero  23 , Marco De Carlo  24 , Alessandro Sticchi  24 , Mathias H Konstandin  18 , Eric Van Belle  17 , Tobias Geisler  16 , Rodrigo Estévez-Loureiro  13 , Peter Luedike  12 , Nicole Karam  11 , Francesco Maisano  10 , Philipp Lauten  9 , Fabien Praz  8 , Mirjam Kessler  7 , Daniel Kalbacher  6 , Volker Rudolph  5 , Christos Iliadis  4 , Philipp Lurz  3 , Marco Metra  20 , Jörg Hausleiter  2 , Stefan Toggweiler  25 ; EuroTR Investigators
Affiliations
Multicenter Study

The Relevance of Right Ventricular Function and Dimension in Patients Undergoing Transcatheter Tricuspid Edge-to-Edge Repair

Stephanie Brunner et al. JACC Cardiovasc Interv. .

Abstract

Background: Patients with severe tricuspid regurgitation (TR) often present with abnormal right ventricular (RV) function and dimensions.

Objectives: The aim of this study was to investigate the impact of RV dysfunction and dilation on clinical outcomes in patients undergoing transcatheter tricuspid edge-to-edge repair (T-TEER).

Methods: Patients from the international EuroTR registry undergoing T-TEER between 2016 and 2023 at 20 heart valve centers across Europe were included. RV dysfunction was defined as tricuspid annular plane systolic excursion <17 mm, and RV dilation was defined as RV mid-diameter >35 mm, determined on baseline echocardiography.

Results: A total of 2,191 patients (mean age 78 ± 7 years, 53% [1,111 of 2,092] women) were analyzed. TR was successfully reduced to a severity grade of ≤2+ in 80% of patients (1,608 of 2,001). In multivariable analysis, significant predictors of mortality after T-TEER included RV dysfunction (HR: 1.05 per 1-mm tricuspid annular plane systolic excursion decrease; 95% CI: 1.03-1.08), RV dilation (HR: 1.02 per 1-mm RV mid-diameter increase; 95% CI: 1.00-1.03), and residual TR after T-TEER (HR: 1.70 for TR grade ≤2; 95% CI: 1.36-2.13). These parameters were also predictive of the combined endpoint of mortality and heart failure hospitalization. The worst prognosis was observed in patients exhibiting both RV dysfunction and dilation.

Conclusions: RV size and function, along with residual TR severity, were significant predictors of clinical outcomes, including all-cause mortality and heart failure hospitalization. Accordingly, early intervention to prevent RV dilation and dysfunction, as well as achieving maximal TR reduction, appears crucial for improving prognosis in patients undergoing T-TEER.

Keywords: dilation; dysfunction; right ventricle; transcatheter; tricuspid regurgitation.

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Conflict of interest statement

Funding Support and Author Disclosures Data collection for the Hamburg patients in the registry was supported by a grant from the German Heart Foundation. Dr Stolz has received speaker honoraria from Edwards Lifesciences. Dr Kresoja is a consultant to Edwards Lifesciences and ReCor Medical. Dr von Stein has received lecture honoraria from Edwards Lifesciences. Dr Rottbauer has received speaker honoraria Edwards Lifesciences and Abbott Laboratories. Dr Denti has served as a consultant for InnovHeart, Pi-Cardia, HVR, and Approxima; and has received speaker honoraria from Abbott Laboratories and Edwards Lifesciences. Dr Rassaf has received speaker honoraria and consulting fees from AstraZeneca, Bayer, Pfizer, and Daiichi-Sankyo. Dr Barreiro-Perez has received speaker fees from Abbott Vascular, Edwards Lifesciences, and Venus Medtech. Dr von Bardeleben has received institutional grants from and has served as a speaker for Abbott Vascular and Edwards Lifesciences. Dr Pagnesi has received personal fees from Abbott Laboratories, AstraZeneca, Boehringer Ingelheim, Novartis, Roche Diagnostics, and Vifor Pharma. Dr Tarantini has received speaker fees from Abbott Vascular and Edwards Lifesciences. Dr Sticchi has served on an advisory board for Edwards Lifesciences. Dr Geisler has received speaker honoraria and research grants from AstraZeneca, Bayer, Bristol Myers Squibb/Pfizer, Ferrer/Chiesi, Medtronic, and Edwards Lifesciences (none related to this study). Dr Estévez-Loureiro has received speaker fees from Abbott Vascular, Edwards Lifesciences, Boston Scientific, and Venus Medtech. Dr Lüdike has received speaker honoraria and consulting fees from AstraZeneca, Bayer, Pfizer, and Edwards Lifesciences; and has received research honoraria from Edwards Lifesciences. Dr Karam has received consultant fees from Edwards Lifesciences, Boston Scientific, and Medtronic; and has received proctor fees from Abbott Laboratories. Dr Maisano received grants and/or research institutional support from Abbott Laboratories, Medtronic, Edwards Lifesciences, Biotronik, Boston Scientific, NVT, Terumo, and Venus; has received consulting fees and personal and institutional honoraria from Abbott Laboratories, Medtronic, Edwards Lifesciences, Xeltis, Cardiovalve, Occlufit, Simulands, Mtex, Venus, Squadra, and Valgen; has received royalty income from and holds intellectual property rights with Edwards Lifesciences; and is a shareholder (including share options) in Magenta, Transseptal Solutions, and 4Tech. Dr Praz has received travel expenses from Edwards Lifesciences, Abbott Vascular, Polares Medical, Medira, and Siemens Healthineers. Dr Kessler has received speaker honoraria from Edwards Lifesciences and Abbott Laboratories. Dr Kalbacher has received personal fees from Abbott Laboratories, Edwards Lifesciences, Pi-Cardia, and Medtronic. Dr Rudolph has received research grants from Abbott Medical, Boston Scientific, and Edwards Lifesciences. Dr Iliadis has received consultant fees and travel expenses from Abbott Laboratories and Edwards Lifesciences. Dr Lurz has received institutional grants from Edwards Lifesciences and honoraria from Innoventrics. Dr Hausleiter has received research grant support and speaker honoraria from Edwards Lifesciences. Dr Metra has received consulting fees in the past 3 years from Abbott Structural Heart, AstraZeneca, Bayer, Boehringer Ingelheim, Edwards Lifesciences, and Roche Diagnostics. Prof Dr Med Toggweiler has received personal honoraria from Medtronic, Boston Scientific, Biosensors, Abbott Vascular, Medira, Shockwave Medical, Teleflex, atHeart Medical, Cardiac Dimensions, Polares Medical, Amarin, Sanofi, AstraZeneca, ReCor Medical, and Daiichi-Sankyo; has received institutional research grants from Edwards Lifesciences, Boston Scientific, Fumedica, Novartis, Boehringer Ingelheim, Polares Medical, and Abbott Vascular; and holds equity in Hi-D Imaging. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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