Key result
T-TEER in high-risk tricuspid regurgitation patients yielded lower HFH-free survival than appropriate candidates (58.7% vs 74.3%; P<0.001) but comparable NYHA class improvement (56.2% vs 59.5%).
Why the study?
Guidelines prefer optimal medical therapy over TTVI in severe tricuspid regurgitation with severe LVD, RVD, or precapillary pulmonary hypertension due to potential futility, but outcomes in these patients required evaluation.
Does T-TEER provide symptomatic and clinical benefit in high-risk "OMT candidate" patients with severe tricuspid regurgitation compared to "TTVI appropriate" patients?
Observational (n=1,626)
Yes
Does T-TEER provide symptomatic and clinical benefit in high-risk "OMT candidate" patients with severe tricuspid regurgitation compared to "TTVI appropriate" patients?
Answers are grounded in this paper and cite their sources.
T-TEER provides comparable symptomatic relief in high-risk patients with severe LVD, RVD, or pcPH compared to guideline-appropriate patients, despite lower overall heart failure hospitalization-free survival.
Background According to the 2025 ESC/EACTS guidelines for the management of valvular heart disease, transcatheter tricuspid valve interventions (TTVI) have received a Class IIa recommendation (Level of Evidence: A) for the treatment of patients with severe symptomatic tricuspid regurgitation. However, in patients with severe left ventricular dysfunction (LVD) or right ventricular dysfunction (RVD) or precapillary pulmonary hypertension (pcPH), optimal medical therapy (OMT) is preferred because of the potential risk for futility.Objectives The aim of this study was to evaluate clinical and symptomatic outcomes in such "OMT candidate" patients.Methods Using data from EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation), guideline-based thresholds for LVD, RVD, and pcPH were applied to patients undergoing tricuspid valve transcatheter edge-to-edge repair (T-TEER). Patients meeting ≥1 exclusion criterion ("OMT candidates") were compared with those meeting current recommendations ("TTVI appropriate") regarding NYHA functional class improvement and 2-year survival free from heart failure hospitalization (HFH).Results Among 1,626 T-TEER patients, 213 (13.1%) met ≥1 exclusion criterion (4.2% of those with LVD, 6.8% of those with RVD, and 3.6% of those with pcPH). Severe LVD, RVD, and pcPH were each associated with significantly lower 1-year HFH-free survival (LVD, 54.6% vs 72.9% [P < 0.001]; RVD, 59.0% vs 73.2% [P = 0.003]; pcPH, 56.2% vs 73.4% [P = 0.021]; median survival follow-up 446 days [Q1-Q3: 192-805 days]). Despite higher NYHA functional class at baseline and follow-up, the rate of ≥1-class improvement was comparable across subgroups (LVD, 51.1% vs 59.4% [P = 0.25]; RVD, 59.7% vs 59.0% [P = 0.90]; pcPH, 51.3% vs 59.4% [P = 0.31]). Overall, "OMT candidates" had lower HFH-free survival than "TTVI-appropriate" patients (58.7% vs 74.3%; P < 0.001) but showed comparable symptomatic relief (≥1 NYHA functional class in 56.2% vs 59.5%; P = 0.68).Conclusions T-TEER may provide symptomatic benefit in selected high-risk patients with severe LVD, RVD, or pcPH. In the absence of randomized evidence, multidisciplinary evaluation at experienced heart valve centers remains essential to balance potential benefit against procedural futility. Further studies are warranted to refine patient selection and optimize outcomes in this challenging cohort.
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Stolz et al. (2026) conducted an observational in Severe tricuspid regurgitation (n=1,626). Tricuspid valve transcatheter edge-to-edge repair (T-TEER) in 'OMT candidates' (≥1 exclusion criterion) vs. T-TEER in 'TTVI-appropriate' patients (meeting current recommendations) was evaluated on Heart failure hospitalization-free survival (p=<0.001). T-TEER in high-risk tricuspid regurgitation patients yielded lower HFH-free survival than appropriate candidates (58.7% vs 74.3%; P<0.001) but comparable NYHA class improvement (56.2% vs 59.5%).
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