# Gecombineerde mitraal- en tricuspidalis-TEER verbetert overleving bij multivalvulair lijden

*geplaatst 2026-05-07 · Algemeen · European heart journal · doi 10.1093/eurheartj/ehag186 · https://hartvaat.nl/2026/04/24/gecombineerde-mitraal-en-tricuspidalis-teer-verbetert-overleving-bij-multivalvul/*

In het EuroTR-register (3100 patiënten met ernstige tricuspidalisinsufficiëntie) had 30% tegelijk matige mitraalinsufficiëntie, geassocieerd met hogere 2-jaarssterfte (37% vs 23%). Na propensity score matching (217 paren) liet gelijktijdige mitraal-TEER bovenop tricuspidalis-TEER een grotere TI-reductie zien, betere NYHA-klasse en 6-minutenwandeltest, en significant hogere overleving (87% vs 76% op 1 jaar; 81% vs 70% op 2 jaar). Multivariabele analyse: matige MI voorspelde meer mortaliteit (HR 1,81), gecombineerde M-TEER voorspelde overleving (HR 0,46). Hypothesegenererend; bevestiging in een gerandomiseerde studie is nodig.

## English: 

In the EuroTR registry of 3,100 patients with severe tricuspid regurgitation, 30% also had moderate mitral regurgitation — associated with higher 2-year mortality (37% vs 23%). After propensity score matching (217 pairs), concomitant mitral TEER added to tricuspid TEER produced greater TR reduction, better NYHA class and 6-minute walk distance, and significantly higher survival (87% vs 76% at 1 year; 81% vs 70% at 2 years). On multivariable analysis, moderate MR predicted death (HR 1.81) and combined M-TEER predicted survival (HR 0.46). Hypothesis-generating — a dedicated RCT is needed.

## Abstract (original, from the publication)

BACKGROUND AND AIMS: The coexistence of moderate mitral regurgitation (MR) and severe tricuspid regurgitation (TR) is common, yet evidence guiding optimal management remains limited. Transcatheter edge-to-edge repair (TEER) of both valves-performed either sequentially or in combination-has emerged as a potential therapeutic strategy. This study aimed to assess the prognostic impact of moderate MR in patients undergoing tricuspid TEER (T-TEER) for severe TR and to evaluate whether concomitant mitral TEER (M-TEER) improves clinical outcomes. METHODS: Data from the EuroTR registry (2016-25) were analysed, including patients with severe TR treated with T-TEER. Outcomes were compared between patients with untreated moderate MR and those who underwent concomitant M-TEER using propensity score matching (PSM). The primary endpoint was all-cause mortality at 2 years. Secondary endpoints included New York Heart Association (NYHA) class, 6 min walk distance (6MWD), TR severity, and heart failure rehospitalizations. RESULTS: Among 3100 patients, 30% had moderate MR, which was associated with higher 2-year mortality (23% vs 37%, p<0.0001). After PSM, 217 matched patients treated with concomitant M-TEER had greater TR reduction (-1.9 vs -1.6 grades, P = .001), better NYHA improvement, and increased 6MWD at follow-up. Survival was higher in the combined treatment group (87% vs 76% at 1 year; 81% vs 70% at 2 years, P = .005). In a multivariable analysis, moderate MR predicted increased mortality [hazard ratio (HR) 1.81, P = .005), while combined M-TEER predicted better survival (HR 0.46, P < .0001). CONCLUSIONS: Moderate MR predicts impaired prognosis in patients undergoing T-TEER for treatment of severe TR. Concomitant M-TEER is associated with improved survival and functional outcomes in this population with multivalve disease. These findings are hypothesis-generating and need to be tested in a dedicated randomized controlled trial.

Auteurs: Mohammad Kassar, Fabien Praz, Muhammed Gerçek, Vera Fortmeier, Karl-Patrik Kresoja, Jennifer von Stein, Christoph Pauschinger, Wolfgang Rottbauer, Bjoern Goebel, Paolo Denti, Paul Achouh, Tienush Rassaf, Manuel Barreiro-Perez, Peter Boekstegers, Andreas Rück, Monika Zdanyte, Marianna Adamo, Flavien Vincent, Philipp Schlegel, Sebastian Rosch, Mirjam G Wild, Christian Besler, Stefan Toggweiler, Stephanie Brunner, Julia Grapsa, Tiffany Patterson, Holger Thiele, Tobias Kister, Giuseppe Tarantini, Giulia Masiero, Marco De Carlo, Alessandro Sticchi, Fabian Voss, Amin Polzin, Antonio Popolo Rubbio, Francesco Bedogni, Mathias H Konstandin, Eric Van Belle, Marco Metra, Tobias Geisler, Rodrigo Estévez-Loureiro, Amir Mahabadi, Nicole Karam, Francesco Maisano, Philipp Lauten, Mirjam Kessler, Daniel Kalbacher, Christos Iliadis, Philipp Lurz, Jörg Hausleiter, Felix Mahfoud, Stephan Windecker, Lukas Stolz, Nicolas Brugger, Volker Rudolph

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Bron: European heart journal, https://doi.org/10.1093/eurheartj/ehag186. Bijgewerkt 2026-07-03T13:31:47Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.