Transcatheter valve repair of tricuspid regurgitation: 1-year outcomes from the TriCLASP study

Stephan Baldus¹, MD; Harald Lapp², MD; Niklas Schofer³, MD; Tobias Geisler⁴, MD; Tobias Kister⁵, MD; Peter Lüdike⁶^,⁷, MD; Tienush Rassaf⁶, MD; Jörg Hausleiter⁸, MD; Kai Friedrichs⁹, MD; Christian Frerker¹⁰, MD; Edith Lubos¹¹, MD; Mirjam Kessler¹², MD; Konstantinos Spargias¹³, MD; Thomas Schmitz¹⁴, MD; Georg Nickenig¹⁵, MD; Fabien Praz¹⁶, MD; Sergio Berti¹⁷, MD; Claudia Walther¹⁸, MD; Dennis Mehrkens¹, MD; Bjorn Goebel², MD; Daniel Kalbacher³, MD; Monika Zdanyte⁴, MD; Maximilian von Roeder⁵, MD; Amir Mahabadi⁶, MD; Ludwig Weckbach⁸, MD; Maria Ivannikova⁹, MD; Christoph Marquetand¹⁰, MD; Inge Dotz¹¹, MD; Matthias Gröger¹², MD; Michael Chrissoheris¹³, MD; Mareike Eißmann¹⁴, MD; Johanna Vogelhuber¹⁵, MD; Nicolas Brugger¹⁶, MD; Andreina D’Agostino¹⁷, MD; Manuela Kroll¹⁸, MD; Claire B. Ren¹⁹, MD, PhD; Philipp Lurz⁵^,²⁰, MD, PhD; on behalf of the TriCLASP study investigators

Abstract

Background: Patients with tricuspid regurgitation (TR) are at high risk for morbidity and mortality, with poorer outcomes associated with increasing TR severity. Tricuspid transcatheter edge-to-edge repair (T-TEER) has emerged as a promising treatment option.

Aims: TriCLASP is a prospective, single-arm, European post-market study evaluating the safety and effectiveness of T-TEER with the PASCAL system to treat patients with ≥severe TR.

Methods: The TriCLASP study enrolled 300 patients to evaluate the safety and performance of T-TEER. Major adverse events (MAE), reduction in TR grade, and clinical, functional, and quality-of-life outcomes were assessed at 1 year.

Results: Enrolled patients had a mean age of 80.1 years, 52.0% were female, and 75.8% had ≥severe TR. Tricuspid regurgitation was reduced to ≤moderate in 87.7% of patients (p<0.001). The composite MAE rate was 1.7% at 30 days and 12.7% at 1 year. Kaplan-Meier estimates for survival and freedom from heart failure hospitalisation (HFH) were 88.3±1.9% and 83.2±2.3%, respectively. Annualised HFH rates decreased by 72.2% in the 12 months pre- versus post-procedure (p<0.001). Significant functional and quality-of-life improvements were observed from baseline to 1 year, including 74.5% of patients in New York Heart Association Class I/II, a 29.4-metre increase in the 6-minute walk distance, and an 8.3-point increase in the Kansas City Cardiomyopathy Questionnaire score (p<0.001).

Conclusions: The 1-year results of the TriCLASP study confirm the safety and effectiveness of T-TEER with the PASCAL system in patients with ≥severe TR. Patients experienced significant TR reduction, low mortality, high freedom from HFH, and significant improvements in symptoms, functional capacity, and quality of life.

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