Impact of Previous Cardiac Surgery on Outcomes After Tricuspid Valve Transcatheter Edge-to-Edge Repair: Insights from EuroTR

Clinical Research in Cardiology https://doi.org/10.1007/s00392-026-02914-6 ORIGINAL PAPER Impact of Previous Cardiac Surgery on Outcomes After Tricuspid Valve Transcatheter Edge‑to‑Edge Repair: Insights from EuroTR Dario Grassini · Karl‑Patrik Kresoja · Jennifer von Stein · Vera Fortmeier · Christoph Pauschinger · Wolfgang Rottbauer, et al. [full author details at the end of the article] Received: 24 January 2026 / Accepted: 3 April 2026 © The Author(s) 2026 Abstract Background Data on the association of previous cardiac surgery (PCS) with outcomes following tricuspid valve transcatheter edge-to-edge repair (T-TEER) are limited. Objectives This study aimed to evaluate the impact of PCS on outcomes after T-TEER. Methods This analysis included patients from the EuroTR registry (European Registry of Transcatheter Repair for Tricuspid Regurgitation; NCT0630726) who underwent T-TEER for clinically relevant tricuspid regurgitation (TR) between 2016 and 2024 and had available information on cardiac surgical history. Study endpoints were procedural TR reduction, improvement in NYHA functional class, all-cause mortality, and the composite of death or heart failure hospitalization (HFH) at 2 years. Results Among 2929 patients, 27.2% had a history of PCS. These patients exhibited a higher comorbidity burden and more advanced right heart remodeling. TR severity at baseline was comparable between groups (P = 0.095), whereas residual TR at discharge and followup was higher in patients with PCS (both P < 0.001). PCS independently predicted residual TR ≥ 3 + at discharge (OR: 1.41; 95% CI: 1.11–1.79; P = 0.01). T-TEER was associated with an improvement in NYHA class in patients with and without PCS (≥ 1-class reduction: 66.2% in PCS vs. 59.6% in non-PCS patients; P = 0.15). At 2 years, PCS patients had higher all-cause mortality (HR: 1.25; 95% CI: 1.04–1.50; P = 0.02) and a higher incidence of the composite endpoint of death or HFH (HR: 1.24; 95% CI: 1.05–1.46; P = 0.01). Conclusions PCS is an independent predictor of outcomes in patients undergoing T-TEER, identifying a subgroup with less pronounced TR reduction and lower long-term survival despite significant functional improvement. Lukas Stolz MD and Jörg Hausleiter MD contributed equally to this work and shared the last authorship. Vol.:(0123456789) Clinical Research in Cardiology Graphical Abstract Impact of previous cardiac surgery on outcomes after T-TEER: Insights from EuroTR Survival NYHA class Key Question: What is the impact of previous cardiac surgery on outcomes after T-TEER? TR severity Conclusion: PCS is associated with less pronounced TR reduction and lower long-term survival despite significant functional improvement. Keywords Tricuspid regurgitation · Transcatheter tricuspid valve repair · Previous cardiac surgery · Heart failure Abbreviations Afib Atrial fibrillation CAD Coronary artery disease eGFR Estimated glomerular filtration rate HFH Heart failure hospitalization LVEF Left ventricular ejection fraction NYHA New York Heart Association PCS Previous cardiac surgery T-TEER Tricuspid valve transcatheter edge-to-edge repair TV Tricuspid valve Introduction Tricuspid regurgitation (TR) is a common valvular disorder with rising prevalence among elderly and comorbid patients [1]. In recent years, tricuspid valve transcatheter edge-to-edge repair (T-TEER) emerged as a safe and effective treatment strategy for symptomatic severe TR [3]. The TRILUMINATE trial demonstrated the clinical superiority of T-TEER over medical therapy for reducing heart failure hospitalizations (HFH) and improving quality of life, with real-world registries confirming its reproducibility and therapeutic benefit in routine practice [4–9]. Current guidelines report that T-TEER should be considered to improve quality of life and right ventricular remodeling in patients with high surgical risk and symptomatic severe TR despite optimal medical therapy [10]. Patients with previous cardiac surgery (PCS) are a common subgroup among individuals undergoing T-TEER. In the TRILUMINATE Pivotal trial, 16.8% of patients had a history of coronary artery bypass grafting, while 37.9% had undergone prior aortic or mitral intervention, including both surgical and percutaneous procedures [6]. In the Tri.FR trial, rates of CABG and surgical mitral valve repair were 7.9% and 3.9%, respectively, and 11.8% had a history of any aortic intervention [7]. Patients with PCS often present in an advances disease stage and right ventricular remodeling, which may contribute to reduced procedural success and adverse long-term prognosis [11, 12]. However, data evaluating outcomes specifically in T-TEER patients with PCS remain limited. This Clinical Research in Cardiology study aims to investigate the impact of PCS on procedural, functional, and long-term clinical outcomes in patients undergoing T-TEER, using data from the European Registry of Transcatheter Repair for Tricuspid Regurgitation (EuroTR). significance in a univariable analysis. Statistical significance of survival differences was calculated using the log-rank test. The level of statistical significance was set to a 2-sided P value < 0.05. All analyses were performed using Python 3.11 (Python Software Foundation, Wilmington, DE, USA). Methods Results Study population and treatment Baseline characteristics This study is a retrospective analysis derived from the European Registry of Transcatheter Repair for Tricuspid Regurgitation (EuroTR; NCT06307262) and included patients treated with transcatheter tricuspid valve edge-to-edge repair (T-TEER) between 2016 and 2024 with available data on PCS. All patients were deemed symptomatic despite maximally tolerated medical therapy and were considered for intervention after interdisciplinary Heart Team discussion. The indication for T-TEER was established after evaluation of all available treatment options, including surgical therapy. Procedures were performed using either the PASCAL device (Edwards Lifesciences) or the MitraClip or TriClip system (Abbot Vascular). Echocardiographic evaluation was performed in line with current guidelines and as previously described for the EuroTR registry [12, 13]. TR severity was assessed using a five-grade scale [14]: mild, moderate, severe, massive, and torrential. Study endpoints were procedural TR reduction, improvement in NYHA functional class, and clinical outcomes including all-cause mortality and the composite of death or heart failure hospitalization at 2 years. This study adhered to the principles outlined in the Declaration of Helsinki and received ethical oversight according to institutional protocols. A total of 2929 patients undergoing transcatheter tricuspid edge-to-edge repair (T-TEER) were included. TR severity was graded as severe (3 +) in 44.7%, massive (4 +) in 32.7%, and torrential (5 +) in 19.9% of patients. Overall, 798 patients (27.2%) had a history of PCS. Among those, prior tricuspid v (...truncated)