Tricuspid-Valve Intervention in Heart Failure.
Jörg Hausleiter, Thomas J Stocker, Tobias Geisler et al.
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In 30 seconds
This multicenter randomized trial compared transcatheter tricuspid-valve repair plus medical therapy with medical therapy alone in 360 patients with symptomatic severe tricuspid regurgitation and increased risk of future heart-failure events. At 1 year, repair favored the hierarchical composite of death, heart-failure hospitalization, and quality-of-life improvement (win ratio, 2.42; 95% CI, 1.76 to 3.33; P<0.001). Through 3 years, freedom from death or heart-failure hospitalization was 52.4% with repair and 21.0% with medical therapy; the hazard ratio was 0.40 (95% CI, 0.29 to 0.55; P<0.001).
Key findings
- The 1-year hierarchical primary end point favored repair, with a win ratio of 2.42 (95% CI, 1.76 to 3.33; P<0.001).
- Through 3 years, freedom from death or heart-failure hospitalization was 52.4% (95% CI, 43.2 to 63.6) with repair versus 21.0% (95% CI, 12.7 to 34.6) with medical therapy.
- The hazard ratio for death or heart-failure hospitalization through 3 years was 0.40 (95% CI, 0.29 to 0.55; P<0.001).
- Major adverse events within 30 days occurred in 14 patients (5.9%) in the repair group.
Why it matters
Severe tricuspid regurgitation in symptomatic patients at increased risk of heart-failure events can carry substantial clinical burden. In this randomized comparison, adding transcatheter repair to medical therapy improved a composite that included quality of life and was associated with fewer deaths or heart-failure hospitalizations through 3 years. These results provide clinically relevant outcome data for this treatment strategy in the studied population.
What to keep in mind
The abstract does not report outcomes beyond 3 years; the 1-year primary end point was a hierarchical composite, and the 3-year result was a composite of death or heart-failure hospitalization.