Computed tomography based analyses for predicting procedural outcomes of transcatheter tricuspid valve annuloplasty

Background Transcatheter tricuspid valve annuloplasty (TTVA) is an established treatment for functional tricuspid regurgitation (TR). The proximity of the right coronary artery to the tricuspid anulus plays a key role in determining anatomical feasibility, but other computed tomography (CT)-based factors influencing procedural success remain poorly understood Objectives The aim of this study was to develop a computed tomography (CT) based score to predict procedural outcomes of TTVA. Methods All patients (n = 136) who underwent TTVA between October 2018 and July 2023 at 3 centers were included. CT scans were evaluated using artificial intelligence. A scoring system was derived using receiver operator curves and regression analyses. The endpoint was TR grade moderate or less at discharge. Results The median age was 79.5 years (Q1-Q3: 76-83 years); 72% of patients were women; and patients presented with severe (32%), massive (29%), and torrential (43%) TR. Five variables (right ventricular dilatation, right atrial dilatation, septo-lateral anulus diameter, distance between inferior vena cava and anulus and septal systolic annular excursion) were identified as best predicting procedural outcome (Table 1). TR at discharge ≤2 was observed in 70% of all patients. In patients with a score of 0 (17%), >96% of the patients had TR≤2 at discharge and only 22% of those with scores ≥4 (P<0.001). Conclusions In a patient cohort with predominantly torrential TR, TTVA reduced TR to TR≤2 at discharge in 70% of all patients. The CT-Score is a 5-component score that can predict successful TTVA.