Interventions for valvular disease and heart failure

Leaflet-to-annulus index and residual tricuspid regurgitation following tricuspid transcatheter edge-to-edge repair

EuroIntervention 2022;18:e169-e178. DOI: 10.4244/EIJ-D-21-00862

Tetsu Tanaka
Tetsu Tanaka1, MD; Atsushi Sugiura1, MD, PhD; Refik Kavsur1, MD; Johanna Vogelhuber1, MD; Can Öztürk1, MD; Marc Ulrich Becher1, MD; Sebastian Zimmer1, MD; Georg Nickenig1, MD; Marcel Weber1, MD
1. Medzinische Klinik und Poliklinik Ⅱ, Universitätsklinikum Bonn, Bonn, Germany

Background: A mismatch between tricuspid leaflet size and annular dilation is one of the morphological features tied to the development of tricuspid regurgitation (TR).

Aims: We assessed the association of the leaflet-to-annulus index (LAI) with residual TR after transcatheter edge-to-edge repair (TEER).

Methods: Consecutive patients who underwent TEER for TR were enrolled. Significant residual TR was defined as a post-procedural TR ≥3+, and patients were divided into two groups according to the amount of residual TR. The LAI was retrospectively calculated using procedural transoesophageal echocardiography and was defined as follows: (anterior leaflet length+septal leaflet length)/septolateral tricuspid annulus diameter.

Results: Of 140 patients, 43 patients had residual TR ≥3+ after TEER. The patients with residual TR ≥3+ had a lower LAI compared to those with residual TR <3+ (1.04±0.10 vs 1.13±0.09; p=0.001). In multivariable analysis, the LAI was associated with residual TR ≥3+ (odds ratio [OR] [per 0.1 increase]: 0.57; 95% confidence interval [95% CI]: 0.35–0.94; p=0.02), independent of baseline TR severity or coaptation gap size. Patients with residual TR ≥3+ had a higher incidence of the composite outcome, consisting of all-cause mortality and heart failure hospitalisation within one year after TEER (47.1% vs 26.6%, p=0.02). Residual TR ≥3+ was an independent predictor of the composite outcome within one year (hazard ratio: 2.04; 95% CI: 1.01–4.11; p=0.04).

Conclusions: The leaflet-to-annulus mismatch (i.e., LAI) is associated with residual TR ≥3+ after TEER for TR. A detailed echocardiographic analysis of the tricuspid valve will be conducive to identifing suitable subjects for TEER.

Sign in to read and download the full article

Forgot your password?

No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from

transcatheter edge-to-edge repairtransoesophageal echocardiogramtricuspid regurgitation
Read next article
Transcatheter aortic valve repair for aortic regurgitation with the Cusper device

Latest news