Impact of Ventricular Stroke Work on Outcomes After Tricuspid Transcatheter Edge-to-Edge Repair

Tricuspid transcatheter edge-to-edge repair (T-TEER) is an effective treatment for severe tricuspid regurgitation, but predictors of outcome and clinical benefit after T-TEER remain limited.

In 144 patients with severe symptomatic tricuspid regurgitation who underwent T-TEER, left and right ventricular stroke work indices (LVSWI and RVSWI) were calculated using invasive hemodynamic measurements obtained during right heart catheterization. Patients were stratified according to median values (LVSWI 27 cJ/m², RVSWI 6 cJ/m²) into 4 subgroups. The primary end point was 1-year all-cause mortality.

After T-TEER, all-cause mortality was 28%. Outcomes differed significantly across subgroups: LVSWI high, RVSWI high: 15%; LVSWI high, RVSWI low: 15%; LVSWI low, RVSWI high: 55%; and LVSWI low, RVSWI low: 31% (Kaplan-Meier, log-rank P = 0.00027). Patients with low LVSWI but high RVSWI had the poorest survival, characterized by elevated pulmonary artery pressures, pulmonary capillary wedge pressure, and left ventricular transmural pressure. In univariate Cox regression, LVSWI below the median predicted mortality (≤ 27 cJ/m²; hazard ratio, 4.73; 95% confidence interval, 2.07-10.8; P < 0.001), whereas RVSWI did not. LVSWI remained an independent predictor after adjusting in multivariate analysis (hazard ratio, 0.44; 95% confidence interval, 0.27-0.71; P < 0.001).

LVSWI is a robust, independent prognostic marker after T-TEER, whereas RVSWI alone lacks predictive value. A discordant profile of low LVSWI with high RVSWI identifies a particularly high-risk subgroup with > 50% mortality within 1 year. Incorporating stroke work indices into preprocedural assessment might refine risk stratification and optimize management strategies in T-TEER candidates.