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Impact of Tricuspid Regurgitation on Outcomes of Mitral Valve Surgery after Transcatheter Edge-to-Edge Repair

  • Author Footnotes
    1 Dr Zaid, Dr Denti, and Dr Tang contributed equally to this manuscript.
    Syed Zaid
    Footnotes
    1 Dr Zaid, Dr Denti, and Dr Tang contributed equally to this manuscript.
    Affiliations
    Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
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  • Author Footnotes
    1 Dr Zaid, Dr Denti, and Dr Tang contributed equally to this manuscript.
    Paolo Denti
    Footnotes
    1 Dr Zaid, Dr Denti, and Dr Tang contributed equally to this manuscript.
    Affiliations
    San Raffaele University Hospital, Milan, Italy
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  • Author Footnotes
    1 Dr Zaid, Dr Denti, and Dr Tang contributed equally to this manuscript.
    Gilbert H.L. Tang
    Correspondence
    Address reprint requests to Gilbert H.L. Tang, MD, MSc, MBA, Department of Cardiovascular Surgery, Mount Sinai Health System, 1190 Fifth Ave, GP2W, Box 1028, New York, NY 10029
    Footnotes
    1 Dr Zaid, Dr Denti, and Dr Tang contributed equally to this manuscript.
    Affiliations
    Mount Sinai Health System, New York, New York
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  • Tamim N. Nazif
    Affiliations
    Columbia University Irving Medical Center, New York, New York
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  • Vinayak N. Bapat
    Affiliations
    Abbott Northwestern Hospital, Minneapolis, Minnesota
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  • Tsuyoshi Kaneko
    Affiliations
    Brigham & Women's Hospital, Boston, Massachusetts
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  • Thomas Modine
    Correspondence
    Address reprint requests to Thomas Modine, MD, PhD, MBA, Department of Cardiac Surgery, CHU Bordeaux, Bordeaux, France.
    Affiliations
    CHU Bordeaux, Bordeaux, France
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  • CUTTING-EDGE Investigators
    Author Footnotes
    2 CUTTING-EDGE Investigators: full author list in Supplementary Online Appendix on the last page with all the investigators to be indexed to PubMed.
  • Author Footnotes
    1 Dr Zaid, Dr Denti, and Dr Tang contributed equally to this manuscript.
    2 CUTTING-EDGE Investigators: full author list in Supplementary Online Appendix on the last page with all the investigators to be indexed to PubMed.
      Tricuspid regurgitation (TR) severity after mitral transcatheter edge-to-edge repair (TEER) has been shown to impact outcomes but unknown in patients requiring mitral valve (MV) surgery after TEER. We sought to determine the impact of preoperative TR severity and right ventricular (RV) dysfunction on MV surgery after TEER. From 7/2009 to 7/2020, 260/332 patients in the CUTTING-EDGE registry who underwent MV surgery after TEER had paired echocardiographic evaluation on TR severity, and ≥moderate (2+) vs <2+ TR at the time of index TEER were compared. Median follow-up post-MV surgery was 9.1 months, 96.5% complete at 30 days and 81.9% complete at 1 year. Mean age was 73.8 ± 10.3; with primary/mixed and secondary MR present in 65.6% and 32.0%, respectively. Proportion of ≥2+ TR increased from TEER to MV surgery (40% vs 57%, P < 0.001). Compared to <2+ TR group, ≥2+ pre-TEER TR patients were older, had higher STS risk score at TEER, higher RVSP, more RV dysfunction, more MR post-TEER, and a shorter median interval from TEER to MV surgery (1.9 vs 4.9 months, P = 0.023). Mortality was higher in the ≥2+ pre-TEER TR group at 30 days(24.2% vs 13.8%, P = 0.043) and 1 year (45.3% vs 22.3%, P = 0.003). On Kaplan-Meier analysis, cumulative mortality was 23.8% at 1 year and 31.6% at 3 years after MV surgery overall, and was associated with preoperative RV dysfunction (P = 0.023), ≥2+ TR at pre-TEER (P = 0.001) and presurgery (P = 0.004), but not concomitant tricuspid surgery. Moderate or greater pre-TEER TR was associated with worse outcomes, and pre-TEER TR worsened significantly at MV surgery. Concomitant tricuspid surgery did not increase overall mortality.

      Graphical Abstract

      Keywords

      Abbreviations:

      CPB (cardiopulmonary bypass), IQR (interquartile range), LVEF (left ventricular ejection fraction), MR (mitral regurgitation), MV (mitral valve), O/E (observed-to-expected ratio), RV (right ventricle), RVSP (right ventricular systolic pressure), STS-PROM (Society of Thoracic Surgeons – Predicted Risk of Mortality), TEER (transcatheter edge-to-edge repair), TR (tricuspid regurgitation), TV (tricuspid valve)
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