T-TEER for Tricuspid Valve Regurgitation: A Sex-Based Real-World Analysis from the TRI-SPA Registry

Background Impact of sex-related differences on clinical outcomes after tricuspid transcatheter edge-to-edge repair (T-TEER) for severe tricuspid regurgitation (TR) remains underexplored. Methods This sub-analysis of the Transcatheter Tricuspid Valve Repair in Spain (Tri-SPA) registry includes patients who underwent T-TEER for severe TR between June 2020 and May 2023 in Spain. Outcomes were compared by sex. The primary composite endpoint included all-cause mortality, heart failure-related hospitalization, and tricuspid valve reintervention at 12 months. Secondary endpoints included significant TR recurrence and functional improvement. Results Among 310 patients (mean age 75.5 ± 9.1 years) with severe TR treated with T-TEER, 70% were females. Males exhibited more prevalent coronary artery disease (30.4% vs. 12.8%; p < 0.001) and reduced right ventricular (RV) function compared to females (RV fractional area change 34.5% vs. 42.0%; p < 0.001). Women had larger left atrial volume (45.7 ml/m2 vs. 40.8 ml/m², p = 0.038). Procedural success was high and comparable among sexes (90.7% vs. 89.3% in females and males, respectively; p = 0.71). No significant difference emerged in relation to the primary composite endpoint (absolute event rate in males 27.5% vs. 16.3% in females; adjusted HR 0.61, 95% CI: 0.31-1.18; p = 0.142). At 12 months, comparable sustained TR reduction (grade ≤2+) rates (67.3% in males vs. 73.5% in females; p = 0.40) and functional improvement (NYHA I/II class 75.0%vs. 82.3%; p = 0.78) were observed. Conclusion In a real-world setting T-TEER was equally safe and effective in both sexes, achieving comparable procedural success and durable TR reduction.