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Combined transcatheter mitral and tricuspid edge-to-edge repair or tricuspid edge-to-edge repair alone in moderate mitral regurgitation: a propensity-matched analysis

The coexistence of moderate mitral regurgitation (MR) and severe tricuspid regurgitation (TR) is common, yet evidence guiding optimal management remains limited. Transcatheter edge-to-edge repair (TEER) of both valves - performed either sequentially or in combination - has emerged as a potential the...

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Main Authors: Kassar, Mohammad (Author) , Praz, Fabien (Author) , Gerçek, Muhammed (Author) , Fortmeier, Vera (Author) , Kresoja, Karl-Patrik (Author) , von Stein, Jennifer (Author) , Pauschinger, Christoph (Author) , Rottbauer, Wolfgang (Author) , Goebel, Bjoern (Author) , Denti, Paolo (Author) , Achouh, Paul (Author) , Rassaf, Tienush (Author) , Barreiro-Perez, Manuel (Author) , Boekstegers, Peter (Author) , Rück, Andreas (Author) , Zdanyte, Monika (Author) , Adamo, Marianna (Author) , Vincent, Flavien (Author) , Schlegel, Philipp (Author) , Rosch, Sebastian (Author) , Wild, Mirjam G (Author) , Besler, Christian (Author) , Toggweiler, Stefan (Author) , Brunner, Stephanie (Author) , Grapsa, Julia (Author) , Patterson, Tiffany (Author) , Thiele, Holger (Author) , Kister, Tobias (Author) , Tarantini, Giuseppe (Author) , Masiero, Giulia (Author) , De Carlo, Marco (Author) , Sticchi, Alessandro (Author) , Voss, Fabian (Author) , Polzin, Amin (Author) , Rubbio, Antonio Popolo (Author) , Bedogni, Francesco (Author) , Konstandin, Mathias (Author) , Van Belle, Eric (Author) , Metra, Marco (Author) , Geisler, Tobias (Author) , Estévez-Loureiro, Rodrigo (Author) , Mahabadi, Amir (Author) , Karam, Nicole (Author) , Maisano, Francesco (Author) , Lauten, Philipp (Author) , Kessler, Mirjam (Author) , Kalbacher, Daniel (Author) , Iliadis, Christos (Author) , Lurz, Philipp (Author) , Hausleiter, Jörg (Author) , Mahfoud, Felix (Author) , Windecker, Stephan (Author) , Stolz, Lukas (Author) , Brugger, Nicolas (Author) , Rudolph, Volker (Author) , Pfister, Roman (Author) , Frey, Norbert (Author) , Volz, Martin J. (Author)
Format: Article (Journal)
Language:English
Published: 24 April 2026
In: European heart journal
Year: 2026, Volume: 47, Issue: 30, Pages: 4113-4128
ISSN:1522-9645
DOI:10.1093/eurheartj/ehag186
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1093/eurheartj/ehag186
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Author Notes:Mohammad Kassar, Fabien Praz, Muhammed Gerçek, Vera Fortmeier, Karl-Patrik Kresoja, Jennifer von Stein, Christoph Pauschinger, Wolfgang Rottbauer, Bjoern Goebel, Paolo Denti, Paul Achouh, Tienush Rassaf, Manuel Barreiro-Perez, Peter Boekstegers, Andreas Rück, Monika Zdanyte, Marianna Adamo, Flavien Vincent, Philipp Schlegel, Sebastian Rosch, Mirjam G Wild, Christian Besler, Stefan Toggweiler, Stephanie Brunner, Julia Grapsa, Tiffany Patterson, Holger Thiele, Tobias Kister, Giuseppe Tarantini, Giulia Masiero, Marco De Carlo, Alessandro Sticchi, Fabian Voss, Amin Polzin, Antonio Popolo Rubbio, Francesco Bedogni, Mathias H Konstandin, Eric Van Belle, Marco Metra, Tobias Geisler, Rodrigo Estévez-Loureiro, Amir Mahabadi, Nicole Karam, Francesco Maisano, Philipp Lauten, Mirjam Kessler, Daniel Kalbacher, Christos Iliadis, Philipp Lurz, Jörg Hausleiter, Felix Mahfoud, Stephan Windecker, Lukas Stolz, Nicolas Brugger, and Volker Rudolph, on behalf of the EuroTR Investigators*
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Summary:The coexistence of moderate mitral regurgitation (MR) and severe tricuspid regurgitation (TR) is common, yet evidence guiding optimal management remains limited. Transcatheter edge-to-edge repair (TEER) of both valves - performed either sequentially or in combination - has emerged as a potential therapeutic strategy. This study aimed to assess the prognostic impact of moderate MR in patients undergoing tricuspid TEER (T-TEER) for severe TR and to evaluate whether concomitant mitral TEER (M-TEER) improves clinical outcomes.Data from the EuroTR registry (2016-25) were analysed, including patients with severe TR treated with T-TEER. Outcomes were compared between patients with untreated moderate MR and those who underwent concomitant M-TEER using propensity score matching (PSM). The primary endpoint was all-cause mortality at 2 years. Secondary endpoints included New York Heart Association (NYHA) class, 6 min walk distance (6MWD), TR severity, and heart failure rehospitalizations.Among 3100 patients, 30% had moderate MR, which was associated with higher 2-year mortality (23% vs 37%, p<0.0001). After PSM, 217 matched patients treated with concomitant M-TEER had greater TR reduction (−1.9 vs −1.6 grades, P = .001), better NYHA improvement, and increased 6MWD at follow-up. Survival was higher in the combined treatment group (87% vs 76% at 1 year; 81% vs 70% at 2 years, P = .005). In a multivariable analysis, moderate MR predicted increased mortality [hazard ratio (HR) 1.81, P = .005), while combined M-TEER predicted better survival (HR 0.46, P < .0001).Moderate MR predicts impaired prognosis in patients undergoing T-TEER for treatment of severe TR. Concomitant M-TEER is associated with improved survival and functional outcomes in this population with multivalve disease. These findings are hypothesis-generating and need to be tested in a dedicated randomized controlled trial.
Item Description:*The EuroTR Investigators: Roman Pfister, Norbert Frey, Martin Kraus [und 30 weitere Personen]
Gesehen am 16.06.2026
Physical Description:Online Resource
ISSN:1522-9645
DOI:10.1093/eurheartj/ehag186

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