Patients whose New York Heart Association (NYHA) functional class worsens one year after tricuspid transcatheter edge-to-edge repair (T-TEER) face markedly higher risks of adverse outcomes. These findings were presented at European Society of Cardiology (ESC) Congress 2025, underscoring the prognostic value of post-procedural functional assessment.

The multicenter Spanish registry enrolled 245 patients undergoing T-TEER between June 2020 and January 2024. Patients were categorized as NYHA-worsening (NYHA-w) if their functional class progressed to III or IV after one year, and NYHA-improvement (NYHA-i) otherwise. Of the cohort, 42 patients (17.1%) fell into the NYHA-w group.

Patients with worsening NYHA class had more severe baseline symptoms, higher congestion, and greater comorbidity burden. Over a median follow-up of 494 days, NYHA-w patients experienced significantly higher rates of the composite endpoint of all-cause mortality and heart failure hospitalization (40.5% vs 11.9%), as well as individually higher mortality and HFH. Multivariate analysis confirmed NYHA worsening as an independent predictor (HR 2.92).

Chronic obstructive pulmonary disease, severe heart failure, recurrent HF hospitalizations, congestive signs, and residual tricuspid regurgitation ≥3+ predicted a lack of functional improvement, highlighting the need for personalized follow-up and optimized procedural outcomes.