Data on the association of previous cardiac surgery (PCS) with outcomes following tricuspid valve transcatheter edge-to-edge repair (T-TEER) are limited. This study aimed to evaluate the impact of PCS on outcomes after T-TEER. This analysis included patients from the EuroTR registry (European Registry of Transcatheter Repair for Tricuspid Regurgitation; NCT0630726) who underwent T-TEER for clinically relevant tricuspid regurgitation (TR) between 2016 and 2024 and had available information on cardiac surgical history. Study endpoints were procedural TR reduction, improvement in NYHA functional class, all-cause mortality, and the composite of death or heart failure hospitalization (HFH) at 2 years. Among 2929 patients, 27.2
BACKGROUND:N-terminal pro-B-type natriuretic peptide (NT-proBNP) is an established marker of myocardial stress, yet its prognostic role in tricuspid valve transcatheter edge-to-edge repair (T-TEER) for tricuspid regurgitation (TR) remains unclear. OBJECTIVES:The aim of this study was to evaluate the prognostic value of baseline NT-proBNP and its early postprocedural trajectory after T-TEER. METHODS:Patients undergoing T-TEER with available baseline NT-proBNP measurements in the EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation) registry were analyzed. NT-proBNP was evaluated continuously and by tertiles, with longitudinal changes assessed when serial measurements were available. Endpoints were the 2-year composite of all-cause mortality or first heart failure hospitalization, changes in NT-proBNP, symptomatic alleviation, and residual TR. RESULTS:In total, 2,282 patients (median age 80 years [Q1-Q3: 76-83 years], 54% women, 86% in NYHA functional class III or IV) with baseline NT-proBNP values (tertile 1, ≤1,674 pg/mL; tertile 2, 1,674-3,743 pg/mL; and tertile 3, >3,743 pg/mL) were included. Higher tertiles were associated with greater comorbidity burden, more advanced biventricular remodeling, and more severe TR. Baseline NT-proBNP was independently associated with the primary endpoint (adjusted HR: 1.62; 95% CI: 1.29-2.04). Residual TR ≤2+ at discharge occurred in 86.3%, 82.9%, and 81.4% across tertiles (P = 0.040), and higher NT-proBNP was associated with a lower likelihood of symptomatic alleviation (adjusted OR per log10 increase: 0.63; 95% CI: 0.48-0.84; P < 0.001). Both baseline NT-proBNP and higher than expected 30-day levels relative to baseline were independently associated with higher subsequent risk for the primary endpoint. CONCLUSIONS:Baseline NT-proBNP was independently associated with 2-year mortality or heart failure hospitalization after T-TEER. Early postprocedural NT-proBNP trajectories provided incremental prognostic information and may identify patients at increased risk.
BACKGROUND:Risk stratification for tricuspid valve transcatheter edge-to-edge repair (T-TEER) is paramount in the decision-making process to appropriately select patients with severe tricuspid regurgitation. OBJECTIVES:The aim of this study was to develop and validate an artificial intelligence-driven risk score, the EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation) score, to predict 1-year mortality in patients undergoing T-TEER. METHODS:The EuroTR score was developed using data from the EuroTR registry, comprising 1,225 patients in the derivation cohort and 601 patients in the validation cohort. On the basis of 18 clinical, laboratory, echocardiographic, and hemodynamic parameters, an extreme gradient boosting algorithm was trained and independently validated against established risk models. RESULTS:Among the entire study cohort (N = 1,826), the overall 1-year survival rate was 82.1% (95% CI: 80.1%-84.2%), with no significant differences between the derivation and validation cohorts. The EuroTR score successfully stratified patients into low-risk and high-risk groups for 1-year mortality after T-TEER (HR: 4.26; 95% CI: 2.71-6.67; P < 0.001), and it significantly outperformed established risk scores such as the EuroScore and the TRI-SCORE in the validation cohort. Beyond mortality prediction (Harrell's C index [validation cohort] = 0.741; 95% CI: 0.699-0.783), increasing EuroTR score values were associated with a higher likelihood of a clinically relevant combined endpoint of 1-year mortality, need for heart failure hospitalization, or persistent dyspnea corresponding to NYHA functional class ≥III. The likelihood of poor outcomes increased from 30.6% in patients with the lowest EuroTR scores (EuroTR risk rank <5%) to 85.5% in the highest risk group (EuroTR risk rank ≥95%). The EuroTR score's performance was confirmed in several subgroups (atrial vs nonatrial tricuspid regurgitation, TRILUMINATE-eligible vs TRILUMINATE-noneligible patients, and patients with vs without cardiac implantable electronic device leads). CONCLUSIONS:The EuroTR score offers an easy-to-use, externally validated, accurate risk stratification tool for patients undergoing T-TEER. It supports personalized treatment strategies and the design of future clinical trials, helping optimize patient selection and enhance shared decision-making within multidisciplinary heart teams.
INTRODUCTION:The impact of coexisting left-sided valvular heart disease (VHD) on clinical outcomes following tricuspid valve edge-to-edge repair (T-TEER) for tricuspid regurgitation (TR) remains unclear, particularly under real-world conditions. To evaluate the prevalence and prognostic impact of concomitant left-sided VHD in patients undergoing T-TEER. METHODS:This study included all patients undergoing T-TEER from the European Registry of Transcatheter Repair for Tricuspid Regurgitation (EuroTR; NCT06307262) with complete echocardiographic data on left-sided valve disease. Study endpoints included survival and heart failure hospitalizations (HFH) at 2 years, NYHA functional class, and TR reduction. RESULTS:Among a total of 1647 eligible patients, 95.8%, 35.6%, and 3.8% had ≥mild, moderate, and severe concomitant VHD, respectively. Moderate or higher VHD was associated with a significantly reduced 2-year survival (P < .001) and reduced 2-year HFH-free survival (P = .005). Multivariate regression analysis confirmed ≥ moderate VHD to be an independent predictor of mortality (hazard ratio 1.54, 95% CI 1.21-1.96, P < .001). Despite worse TR and NYHA functional class at baseline in patients with ≥moderate VHD, T-TEER was associated with a significant TR reduction (P < .001) and symptomatic improvement (P < .001). CONCLUSION:Concomitant left-sided VHD is common among patients undergoing T-TEER and is independently associated with worse survival and higher rates of HFH. Nevertheless, T-TEER provides meaningful symptomatic benefit and durable TR reduction in patients with and without VHD burden.
Background: Arterial grafts are widely believed to offer superior long-term patency compared with saphenous vein grafts, yet in multisegmental coronary artery disease the diseased runoff bed may attenuate this advantage. In this study, we compared the long-term patency of arterial and venous conduits in patients revascularised for multisegmental coronary artery disease. Methods: We retrospectively analysed 467 bypass grafts (100 arterial internal thoracic artery grafts, 351 saphenous vein grafts and 16 radial artery grafts) in 133 patients with multisegmental coronary artery disease treated by coronary artery bypass grafting, including long anastomoses where required. Graft patency was assessed by multidetector computed tomography or coronary angiography. Patency over time was estimated by the Kaplan–Meier method and compared with the log-rank test. Because imaging was symptom-driven rather than protocol-based, patency estimates apply to the imaged subgroup. Results: Early patency was comparably high for arterial (97%) and venous (96%) conduits. Patency curves diverged progressively: at 12 years, estimated patency was 83% for arterial grafts versus 65% for venous grafts (p < 0.01). Radial artery grafts maintained 87% patency over the available follow-up. Conclusions: These findings suggest that the long-term patency advantage of arterial conduits may be preserved in patients with multisegmental coronary artery disease, including where long anastomoses are required, and warrant confirmation in larger cohorts with systematic imaging follow-up.
