Findings from four late-breaking clinical trials presented at EuroPCR 2026 in Paris, France, were simultaneously published in JACC: Cardiovascular Interventions. Together they lend new insights into residual tricuspid regurgitation (TR) after tricuspid valve transcatheter edge-to-edge repair (T-TEER), the safety of transfemoral (TF) transcatheter mitral valve replacement (TMVR), the novel BATMAN-TMVR technique, and the effect of implant depth on TAVR outcomes.

As the severity of residual TR increased, even from mild to moderate, after T-TEER, there was a significant decrease in the rates of two-year survival and survival free from heart failure hospitalization (HFH), according to research using EuroTR registry data presented by Lukas Stolz, MD, and colleagues.

Of the 2,545 patients (79 years, 54% women) who underwent T-TEER at 26 European centers from 2016 to 2024, the TR was severe in 44%, massive in 33% and torrential in 20%. Their mean LVEF was 53% and mean tricuspid annular plane systolic excursion was 17.3 mm.

Post procedure, residual TR severity was ≤1+ in 47%, 2+ in 36% and ≥3+ in 17%. In these groups, respectively, the primary endpoint of two-year survival was 76%, 72% and 59% (overall p<0.001) and for survival free from HFH it was 66%, 61% and 50% (overall p<0.001).

"Particularly in the context of the increasing use of transcatheter tricuspid valve replacement (TTVR), this finding is of considerable clinical relevance, as the latter almost always completely eliminates TR," write the study authors. "It raises the question of whether patients at high risk for residual TR (even if only moderate) might benefit from being treated primarily with a TTVR strategy rather than T-TEER."

Using data from the CHOICE-MI Registry, Lena Strotmann, MD, and colleagues, found that TF TMVR was safe and effective in high-risk patients with mitral regurgitation (MR).

Among 124 patients (79 years, 50% women) with symptomatic MR (EuroSCORE II 5%), TF TMVR procedure was technically successful in 91% and procedural mortality was 0.8%. At discharge, 95% had residual MR ≤1+, largely sustained through two years.

The primary composite outcome of all-cause mortality or heart failure hospitalization (HFH) at two years occurred in 53% of patients, and cardiovascular mortality occurred in 20%. At one year, these rates were 44% and 15%, respectively. Significant improvement in NYHA class was seen at both time points.

Atrial fibrillation independently predicted all-cause mortality/HFH (hazard ratio [HR], 3.97; p=0.022) and technical success linked to survival (HR, 0.31; p=0.040).

"When placed into the context of early TMVR experiences, which were predominantly performed via a [transapical] access, mortality rates appear favorable," write the authors. "This evolution represents a crucial step forward, offering a definitive valve replacement strategy to a frail, comorbid patient population previously deemed unsuitable for more invasive interventions."

The BATMAN anterior mitral leaflet (AML) technique was safe and effective for preventing left ventricular outflow obstruction (LVOT) in valve-in-ring (ViR) and valve-in-valve (ViV) TMVR, and effective but with higher adverse events in valve-in-mitral annular calcification (ViMAC) cases according to research presented by Gennaro Giustino, MD, and colleagues.

Among 83 high-risk patients (77 years, 66% women), technical success was 99% for all procedures, and BATMAN was associated with short procedure and fluoroscopic time. Successful TMVR without LVOT obstruction or procedural death, the primary efficacy endpoint, occurred in 95% of patients (ViR, 100%; ViV, 96%; ViMAC, 84%; p=0.03), while the primary efficacy endpoint of in-hospital death, stroke or major cardiac complications occurred in 7% of all patients (ViR, 0%; ViV, 8%; ViMAC, 21%; p=0.02). A major cardiac structural complication directly attributed to BATMAN occurred in one ViMAC case.

"AML modification techniques that produce a laceration directed from base to tip of the leaflet should be preferred in ViMAC cases with incomplete anterior annular calcium and incomplete mitral rings or bands in which the aortic-mitral curtain remains unprotected from unintended lacerations," the authors recommend.

In the Optimize PRO study, higher TAVR implant depth was linked to better clinical outcomes with similar safety across depths in symptomatic aortic stenosis patients, according to research presented by Danny Dvir, MD, and colleagues.

Among 603 patients stratified by available depth data, one-year all-cause mortality, stroke and valve migration were comparable across all four arms of implant depth: <1mm; 1-≤3 mm; >3 to ≤5 mm; >5 mm. However, higher implants were linked to less resheathing or recapture (27.3% vs. 33.7% vs. 48.8% vs. 51.7%; p<0.001), shorter hospital stays (one vs. two days) and significantly lower rates of permanent pacemaker implantation (2.3% vs. 9.2% vs. 15.9% vs. 20.3%; p<0.001) and new left bundle branch block (11.6% vs. 24.2% vs. 29.9% vs. 44.5%; p<0.001).

"The proximity of the prosthesis frame to the membranous septum and conduction system has been shown to be strongly depth-dependent, supporting a strategy of higher implantation to minimize mechanical interaction with the atrioventricular conduction tissue," conclude the authors, noting that "A key unresolved question remains: at what point is high too high?"

Visit the JACC Journals at EuroPCR event page to read all the science simultaneously published across the journals.