Clinical Profile and Outcomes of Patients Deemed Ineligible for Transcatheter Tricuspid Valve Intervention

BACKGROUND: Transcatheter tricuspid valve intervention (TTVI) has expanded therapeutic options for tricuspid regurgitation (TR); however, a substantial proportion of patients remain ineligible because of anatomical and clinical constraints. We sought to characterize patients screened out from TTVI and evaluate their clinical outcomes. METHODS: In this single-centre retrospective cohort study (January 2021 to May 2025), we included consecutive patients with symptomatic severe TR referred for TTVI evaluation who were deemed ineligible by a multidisciplinary heart team. Patients were identified through institutional logs and clinical trial screening databases. Baseline clinical, echocardiographic, and hemodynamic data were collected. Outcomes included 1-year all-cause mortality, heart failure hospitalization (HFH), and their composite. RESULTS: Among 205 patients evaluated, 83 (40.5%) were deemed ineligible. The mean age was 72.2 years, with a high burden of comorbidities. Severe or torrential TR was present in 84.4% of patients. The most frequent reasons for exclusion were unfavourable anatomy, including significant tricuspid annular dilation (69.5%) and a coaptation gap ≥ 7-10 mm (59.8%). Patients who died within 1 year had higher right-sided filling pressures on invasive hemodynamic assessment. At 1 year, all-cause mortality was 20.5%, HFH occurred in 31.3%, and the composite end point in 51.8%. Kaplan-Meier estimates showed survival of 77.5% and freedom from HFH of 58.3% at 12 months. CONCLUSIONS: Patients deemed ineligible for TTVI represent a high-risk cohort with substantial morbidity and mortality at 1 year. These findings underscore the importance of earlier referral, optimized screening strategies, and continued device innovation to expand treatment eligibility.