Association of Tricuspid Regurgitation With Clinical and Echocardiographic Outcomes After Percutaneous Mitral Valve Repair With the MitraClip System: Thirty-Day and Twelve-Month Follow-up From the GRASP Registry

Aim The aim of this study was to evaluate the association of baseline tricuspid regurgitation (TR) on the outcomes after percutaneous mitral valve repair (PMVR) with the MitraClip system. Methods and results Data from 146 consecutive patients with functional mitral regurgitation (MR) were obtained. Two different groups, dichotomized according to the degree of pre-procedural TR (moderate/severe, n = 47 and none/mild, n = 99), had their clinical and echocardiographic outcomes through 12-month compared. At 30-day, the primary safety endpoint was significantly higher inmoderate/severe TR compared with none/mildTR(10.6 vs. 2.0%, P = 0.035). Marked reduction in MR grades observed post-procedurewere maintained through 12 months. Although NYH Afunctional class significantly improved in both groups compared with baseline, it was impaired in moderate/severeTRcompared with the none/mild TR group (NYHA . II at 30 day: 33.3 vs. 9.2%, P> 0.001; at 1 year: 38.5 vs. 12.3%, respectively, P = 0.006). Left ventricle reverse remodelling and ejection fraction improvement were revealed in both groups. The primary efficacy endpoint at 12-month determined by freedom from death, surgery for mitral valve dysfunction, or grade ≤3± MR was comparable between groups, but combined death and re-hospitalization for heart failure rateswere higher in the moderate/severeTR group. Multivariable Cox regression analysis demonstrated that baseline moderate/severeTR and chronic kidney disease were independent predictors of this combined endpoint. Conclusions Although PMVR with MitraClip led to improvement in MR, TR, and NYHA functional class in patients with baseline moderate/severe TR, the primary safety endpoint at 30-day was impaired, while moderate/severe TR independently predicted death and re-hospitalization for heart failure at 12-month