title: Impact of baseline tricuspid regurgitation on long-term clinical outcomes and survival after interventional edge-to-edge repair for mitral regurgitation.
abstract: OBJECTIVE
  Tricuspid regurgitation (TR) in patients with mitral valve disease is associated with poor outcome and mortality. Only limited data on the impact of TR on functional outcome and survival in patients undergoing MitraClip procedures are available.
  
  
  RESULTS
  261 patients (mean age 76.6 ± 10, EuroScore 15.9 ± 15.1%) with symptomatic mitral regurgitation (MR) (75.2% functional MR) undergoing MitraClip procedure were included and followed for 721 ± 19.4 days. At baseline 54.7% presented with TR grade 0/I, 29.5% with grade II, 13.4% with grade III and 2.3% with grade IV. When dividing groups according to baseline TR grades, follow-up (FU)-NYHA class was significantly improved only in patients with TR ≤ II (p = 0.05). FU-6-min walking distance increased significantly in the overall cohort (p = 0.05), in patients with TR ≤ II (p = 0.007), but not in patients with TR > II (p = 0.4). Moreover, FU-NT-pro-BNP levels were higher in patients with TR > II (p = 0.05), compared to patients with TR ≤ II. There was a higher mortality according to baseline TR > II and multivariate Cox regression revealed TR > II as the strongest independent predictor for mortality (hazard ratio 2.04).
  
  
  CONCLUSIONS
  Concomitant TR at baseline negatively influences functional outcome and mortality in patients undergoing MitraClip procedures. Our results underline the need for dedicated interventional strategies for the treatment of TR in patients with symptomatic MR.
authors.affiliation: Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany. robert.schueler@ukb.uni-bonn.de.
authors.forename: Robert
authors.initials: R
authors.lastname: Schueler
authors.affiliation: Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
authors.forename: Can
authors.initials: C
authors.lastname: Öztürk
authors.affiliation: Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
authors.forename: Jan-Malte
authors.initials: JM
authors.lastname: Sinning
authors.affiliation: Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
authors.forename: Nikos
authors.initials: N
authors.lastname: Werner
authors.affiliation: Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Welz
authors.affiliation: Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
authors.affiliation: Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
mesh_terms: D000368:Aged; D015984:Causality; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000401:mortality* / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D058386:Mitral Valve Annuloplasty / Q000295:instrumentation* / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality* / Q000517:prevention & control; D012307:Risk Factors; D013525:Surgical Instruments / Q000706:statistics & numerical data; D016019:Survival Analysis; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality* / Q000517:prevention & control
keywords: Heart failure; MitraClip; Percutaneous repair; Tricuspid regurgitation