Brooks Collin J, Duggal Neal, Seth Milan, Joseph Megan S, Sukul Devraj, Chetcuti Stan J, Ailawadi Gorav, Patel Himanshu, Grossman P Michael, Alnajjar Raed, Harris Andrew W
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA.
Struct Heart. 2025 Jan 2;9(6):100408. doi: 10.1016/j.shj.2024.100408. eCollection 2025 Jun.
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.
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.
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, = 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, = 0.120). Patients with moderate/severe TR exhibited no difference in the primary adjusted outcome (adjusted odds ratio: 0.851, = 0.177).
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.
在接受二尖瓣经导管缘对缘修复术（M-TEER）的患者中，严重三尖瓣反流（TR）的患病率很高。严重TR与预后不良相关，并影响M-TEER与同期二尖瓣和三尖瓣手术之间的决策。生活质量（QoL）的改善是患者的一项重要指标。
我们分析了2015年至2023年纳入全州多中心登记处的1838例接受M-TEER患者的数据。使用基线和30天堪萨斯城心肌病问卷（KCCQ）评分评估QoL。患者分为无/轻度TR或中度/重度TR，并比较KCCQ评分的变化。主要结局是一项校正分析，包括30天生存率且KCCQ评分提高≥15分。
1421例患者（77.3%）可获得完整的终点数据。平均而言，无论基线TR分组如何，接受M-TEER的患者QoL均有大幅改善。中度/重度TR患者的30天死亡率高于无/轻度TR患者（分别为42例[4.1%]和16例[2.0%]，P = 0.018）。大多数患者30天时KCCQ变化≥15分（无/轻度TR组为63.8%，中度/重度TR组为59.6%，P = 0.120）。中度/重度TR患者在主要校正结局方面无差异（校正比值比：0.851，P = 0.177）。
无论基线TR严重程度如何，大多数患者在M-TEER后QoL都有大幅改善。与同期二尖瓣/三尖瓣手术相比，进一步的研究应探索先进行M-TEER，然后根据需要进行三尖瓣干预的分期方法。
