Initial Real-World Experience of Tricuspid Transcatheter Edge-to-Edge Repair in Asia

Abstract

Background Tricuspid regurgitation (TR) causes significant morbidity. Transcatheter edge-to-edge repair (TEER) has been proven effective in relieving TR symptoms. Access to tricuspid TEER and the associated experience are limited in Asia. Objectives This study aimed to summarize the initial experience with the tricuspid TEER system (Abbott) in Asia. Methods Patients undergoing tricuspid TEER (Abbott) from 2017 to 2024 were enrolled from 4 centers in Asia. The primary endpoint was device success (TR ≤moderate) at 30 days. Secondary endpoints included inpatient complications, 30-day NYHA functional class, and 30-day major adverse events. Risk factors for 30-day device success were identified. Results A total of 106 patients were included, with a mean age of 76.1 ± 10 years, and 88.7% (n = 94 of 106) had atrial fibrillation. Most TR cases treated were functional (88.7% [n = 94 of 106]), with over half classified as massive or torrential (56.6% [n = 60 of 106]). Tricuspid TEER was performed using off-label MitraClip in 22.6% (n = 24), while the remaining 77.4% (n = 82) utilized TriClip. Combined procedures (with mitral TEER and others) were common (47.2% [n = 50 of 106]). At 30 days, 74.0% (n = 77 of 104) achieved device success (TR ≤moderate), and 95.2% (n = 99 of 104) experienced at least a 1-grade TR reduction. Additionally, 96.2% (n = 100 of 104) were NYHA functional class I/II, and major adverse events were 1.9% (n = 2 of 106) at 30 days. Baseline nontorrential TR and increased clinical experience (second half of cases) were associated with 30-day device success ( P = 0.010 and P = 0.044, respectively). Conclusions The early experience with tricuspid TEER in Asia is promising, demonstrating a reasonable device success rate and a high safety profile. Clinical experience is associated with improved device success.