Severe tricuspid regurgitation (TR) often occurs alongside heart failure (HF), yet the impact of different HF phenotypes on outcomes after tricuspid valve transcatheter edge-to-edge repair (T-TEER) remains uncertain. An analysis from the EuroTR registry examined outcomes after T-TEER according to HF phenotype in patients with severe TR. The study was published in the European Journal of Heart Failure. 

Patients were stratified by left ventricular ejection fraction (LVEF) into reduced or mildly reduced HF (HFmrEF/HFrEF; LVEF <50%) and preserved LVEF (≥50%). Individuals with preserved LVEF were further categorized according to pulmonary capillary wedge pressure (PCWP) into HF with preserved ejection fraction (HFpEF; >15 mmHg) and non-overt left-sided HF (≤15 mmHg).
Among 1,773 patients, 30% had HFmrEF/HFrEF, 44% HFpEF, and 26% non-overt left-sided HF. Procedural success, defined as TR ≤moderate after T-TEER, occurred most frequently in the non-overt left-sided HF group (87%) and least frequently in HFmrEF/HFrEF (78%). Symptom burden improved across all phenotypes (p<0.001). Estimated 2-year mortality was 25.0% in HFmrEF/HFrEF, 20.3% in HFpEF, and 13.1% in non-overt left-sided HF. Procedural success was associated with improved outcomes across all groups (p<0.01). 

Among patients with successful procedures, survival was similar between HFmrEF/HFrEF and HFpEF at 1 year but was higher in HFpEF at 2 years (p=0.027). Predictors of survival differed by phenotype: right ventricular function in HFmrEF/HFrEF, right-sided pressures in HFpEF, and baseline TR severity in non-overt left-sided HF.

These findings suggest that outcomes after T-TEER vary according to HF phenotype. Procedural success showed an association with survival across HF phenotypes.