Reply: Balancing, timing, and efficiency in tricuspid TEER

We appreciate the perspectives of Ktenopoulos et al1 and agree that the 1-year results from the TriCLASP study provide important insights into this evolving field and opportunities for further research.

Our study evaluates the effects of tricuspid transcatheter edge-to-edge repair (T-TEER) in treating patients with ≥severe tricuspid regurgitation (TR). Ktenopoulos and colleagues correctly highlight the echocardiographic discordance between site assessments and post-enrolment core laboratory grading of baseline TR and the treatment of patients with moderate TR, which we explicitly discussed in our manuscript. Even with moderate TR patients in TriCLASP, the population was similarly or more symptomatic at baseline compared with patients treated with T-TEER in contemporary studies, especially regarding heart failure metrics2345. Despite the treatment of some patients with moderate TR, we observed a substantial increase in quality of life and functional status, signs of improved right ventricular remodelling, and importantly, a dramatic reduction in heart failure hospitalisation. These data are hypothesis-generating and provide an opportunity to evaluate outcomes for patients in earlier disease stages.

Along these lines, the authors bring up an important point regarding...