Tricuspid Valve Transcatheter Edge-to-Edge Repair in Patients With Cardiac Implantable Electronic Devices
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Tricuspid valve transcatheter edge-to-edge repair (T-TEER) is increasingly used in patients with severe tricuspid regurgitation (TR) at high surgical risk. Long-term outcomes in those with transvalvular cardiac implantable electronic devices (CIEDs) remain insufficiently characterized. OBJECTIVES: The aim of this study was to evaluate procedural and clinical outcomes of T-TEER in patients with CIED leads in a real-world cohort. METHODS: Among 3,025 patients undergoing T-TEER at 26 centers (2016-2024), 851 (28.1%) had transvalvular CIED leads. Residual TR at discharge and follow-up and the composite of all-cause mortality or heart failure hospitalization at 2 years were assessed. CIED function was evaluated preprocedure and postprocedure. Propensity score matching (1:1) was conducted to compare outcomes between patients with and those without CIEDs. RESULTS: CIED function remained stable, and no lead revision was required. At discharge, TR ≤1+ and ≤2+ was achieved in 39.9% and 79.8%, respectively; at follow-up (median 269 days; Q1-Q3: 63-423 days), TR ≤1+ and ≤2+ persisted in 29.3% and 69.1%. In 385 matched pairs, residual TR, functional status, and 2-year heart failure hospitalization-free survival were comparable between patients with and those without CIEDs (67.1% [95% CI: 62.1%-72.5%] vs 73.6% [95% CI: 68.9%-78.6%]; P = 0.176). CIED presence showed a nonsignificant association with more adverse outcomes (HR: 1.31; 95% CI: 0.99-1.74; P = 0.063) but was not associated with residual TR >2+ (OR: 0.98; 95% CI: 0.70-1.38; P = 0.915). Achieving residual TR ≤2+ conferred significantly better survival irrespective of CIED presence (P < 0.001). CONCLUSIONS: T-TEER is safe and effective in selected patients with transvalvular CIED leads. Effective TR reduction remains prognostically relevant, even in this high-risk real-world population.
Authors: Jennifer von Stein, Philipp von Stein, Roman Pfister, Karl-Patrik Kresoja, Vera Fortmeier, Benedikt Koell, Wolfgang Rottbauer, Mohammad Kassar, Bjoern Goebel, Paolo Denti, Paul Achouh, Tienush Rassaf, Manuel Barreiro-Perez, Peter Boekstegers, Andreas Rück, Monika Zdanyte, Marianna Adamo, Flavien Vincent, Philipp Schlegel, Sebastian Rosch, Mirjam G. Wild, Christian Besler, Stefan Toggweiler, Stephanie Brunner, Julia Grapsa, Tiffany Patterson, Holger Thiele, Tobias Kister, Giuseppe Tarantini, Giulia Masiero, Marco De Carlo, Alessandro Sticchi, Fabian Voss, Amin Polzin, Antonio P. Rubbio, Francesco Bedogni, Thorald Stolte, Thomas Nestelberger, Tomás Benito González, Mathias H. Konstandin, Eric Van Belle, Marco Metra, Tobias Geisler, Rodrigo Estévez-Loureiro, Amir A. Mahabadi, Nicole Karam, Francesco Maisano, Philipp Lauten, Fabien Praz, Mirjam Kessler, Daniel Kalbacher, Volker Rudolph, Philipp Lurz, Juan F. Granada, Jörg Hausleiter, Lukas Stolz, Christos Iliadis
Institutions: University of Cologne, Cardiovascular Research Foundation, Johannes Gutenberg University Mainz, University Medical Center of the Johannes Gutenberg University Mainz, Bielefeld University, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Universität Hamburg, Universität Ulm, University of Bern, University Hospital of Bern, LWL-Universitätsklinikum Bochum, Zentralklinik Bad Berka, IRCCS Ospedale San Raffaele, Université Paris Cité, Hôpital Européen Georges-Pompidou, Essen University Hospital, West German Heart and Vascular Center Essen, University of Duisburg-Essen, University Hospital Complex Of Vigo, Helios Hospital Siegburg, Karolinska University Hospital, Universitätsklinikum Tübingen, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, University of Brescia, Centre Hospitalier Universitaire de Lille, Heidelberg University, University Hospital Heidelberg, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Luzerner Kantonsspital, Guy's and St Thomas' NHS Foundation Trust, Leipzig Heart Institute, Leipzig University, University of Padua, Azienda Ospedaliera Universitaria Pisana, Heinrich Heine University Düsseldorf, IRCCS Policlinico San Donato, University of Basel, University Hospital of Basel, Complejo Asistencial Universitario de León, LMU Klinikum, Ludwig-Maximilians-Universität München
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,000
OpenAlex ID: W4415547298