title: Impact of tricuspid valve regurgitation in surgical high-risk patients undergoing MitraClip implantation: results from the TRAMI registry.
abstract: OBJECTIVE
  We sought to assess the impact of tricuspid regurgitation (TR) severity on patient outcome in a collective with relevant mitral regurgitation undergoing MitraClip implantation..
  
  
  RESULTS
  From August 2010 to July 2013, 766 patients (age 75.3±8.5 years, 61% male, median EuroSCORE 24.3%±18.4) were prospectively enrolled in the TRAMI registry and stratified by echocardiography into no/mild, moderate and severe TR. Overall, the mean number of implanted MitraClips was higher in patients with severe TR but increasing TR severity was not associated with procedural success. In-hospital and one-year mortality as well as MACE and MACCE (death, myocardial infarction±stroke) rates were higher with increasing TR severity. Kaplan-Meier curves indicated a significant difference for mortality (p<0.0001), but not for rehospitalisation for heart failure. After multivariate Cox regression, severe TR proved to be a predictor for one-year mortality (HR 2.01, 95% CI: 1.25-3.26, p=0.004). Higher rates of severe bleeding were more frequent with increasing TR grades.
  
  
  CONCLUSIONS
  In patients with MitraClip implantation, increasing TR severity is associated with adverse outcome, higher bleeding rates and decreased survival rates.
authors.affiliation: Universitäres Herzzentrum Hamburg, Hamburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kalbacher
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schäfer
authors.forename: R Stephan
authors.initials: RS
authors.lastname: von Bardeleben
authors.forename: Christine S
authors.initials: CS
authors.lastname: Zuern
authors.forename: Raffi
authors.initials: R
authors.lastname: Bekeredjian
authors.forename: Taoufik
authors.initials: T
authors.lastname: Ouarrak
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.forename: Peter
authors.initials: P
authors.lastname: Boekstegers
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schillinger
authors.forename: Edith
authors.initials: E
authors.lastname: Lubos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011446:Prospective Studies; D012042:Registries; D012306:Risk; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000601:surgery*