Our Summary

This research paper is about a study that looked at the effect of tricuspid regurgitation (TR) on the results and functionality after a specific heart valve repair procedure, called mitral valve transcatheter edge-to-edge repair (M-TEER).

TR is a condition where blood flows back into the heart’s upper right chamber when the lower right chamber contracts, and M-TEER is a procedure to fix a failing mitral valve, which is on the left side of the heart.

The researchers studied 740 patients who underwent M-TEER at their center between 2010 and 2021. They divided these patients into three groups based on the severity of their TR at the time of the M-TEER procedure: low-grade TR, moderate TR, and high-grade TR.

They found that patients with moderate to high-grade TR had higher rates of other health conditions. The success rate of the M-TEER procedure was similar across all three groups. The severity of TR decreased significantly after the M-TEER procedure, with only 48.0% of high-grade TR patients still having high-grade TR 3 months after the procedure, and 46.8% after 12 months.

However, patients with high-grade TR had a higher death rate up to 12 months after the M-TEER procedure. But their results showed that having high-grade TR doesn’t independently predict a higher death rate or adverse results after the M-TEER procedure.

In simpler terms, the study suggests that the severity of TR doesn’t necessarily affect the success of the M-TEER procedure or the patient’s survival rate after the procedure. So, it might be reasonable to wait and monitor these patients instead of rushing to treat them.

FAQs

  1. Does the severity of tricuspid regurgitation (TR) affect the success rate of mitral valve transcatheter edge-to-edge-repair (M-TEER)?
  2. Does high-grade TR independently predict mortality after a M-TEER procedure?
  3. Does TR severity decrease after the M-TEER procedure?

Doctor’s Tip

A helpful tip a doctor might tell a patient about mitral valve repair is to closely monitor and manage any concomitant tricuspid regurgitation (TR) before and after the procedure. While high-grade TR may not independently predict adverse outcomes following mitral valve transcatheter edge-to-edge repair (M-TEER), it is important to address and treat any TR to optimize overall outcomes and improve long-term prognosis. Regular follow-up appointments and echocardiographic assessments can help track the progression of TR and guide treatment decisions.

Suitable For

Patients who are typically recommended mitral valve repair are those with mitral regurgitation (MR) who are symptomatic, have severe MR, and have a reasonable life expectancy. In this study, patients with moderate to high-grade tricuspid regurgitation (TR) undergoing mitral valve transcatheter edge-to-edge repair (M-TEER) were evaluated. The study found that while patients with moderate to high-grade TR had higher morbidity, TR severity decreased rapidly and consistently after M-TEER. High-grade TR did not independently predict adverse outcomes following M-TEER, suggesting that a wait-and-observe approach may be reasonable for these patients. Echocardiographic and functional outcomes were similar in both secondary and primary MR patients.

Timeline

  • Before mitral valve repair: Patients undergo evaluation for mitral valve disease, including symptoms such as shortness of breath, fatigue, and chest pain. Diagnostic tests, such as echocardiograms and cardiac catheterization, are performed to assess the severity of the mitral valve regurgitation. Treatment options are discussed, including medication management and surgical repair.

  • Mitral valve repair procedure: The patient undergoes minimally invasive transcatheter edge-to-edge repair (M-TEER) of the mitral valve. The procedure is successful in the majority of cases, with a high rate of procedural success.

  • After mitral valve repair: Patients experience a rapid decrease in tricuspid regurgitation (TR) severity following M-TEER, with significant improvement seen at 3 months and 12 months post-procedure. Patients with moderate to high-grade TR may have higher morbidity and mortality rates, but high-grade TR does not independently predict adverse outcomes. Echocardiographic and functional outcomes are similar for patients with secondary and primary mitral regurgitation. A wait-and-observe approach may be reasonable for patients with high-grade concomitant TR after M-TEER.

What to Ask Your Doctor

  1. How does the severity of my tricuspid regurgitation (TR) impact the outcome of mitral valve transcatheter edge-to-edge repair (M-TEER)?
  2. What are the potential risks and complications associated with M-TEER in patients with concomitant TR?
  3. Will the M-TEER procedure also address the TR, or will I need separate treatment for that?
  4. How quickly can I expect to see improvement in my TR severity after M-TEER?
  5. How often will I need follow-up evaluations to monitor my TR and overall heart health post-procedure?
  6. What lifestyle changes or medications may be recommended to help manage my TR after M-TEER?
  7. Are there any specific factors or conditions that may affect the success of M-TEER in patients with concomitant TR?
  8. What are the long-term implications of having both mitral valve repair and TR treatment simultaneously?
  9. Will I need additional interventions or surgeries in the future to address my TR following M-TEER?
  10. Are there any ongoing research or clinical trials that may benefit patients with both mitral valve repair and TR?

Reference

Authors: Gröger M, Zeiml KP, Schneider LM, Rottbauer W, Markovic S, Keßler M. Journal: Catheter Cardiovasc Interv. 2023 Sep;102(3):528-537. doi: 10.1002/ccd.30787. Epub 2023 Jul 28. PMID: 37506125