Key result
Transcatheter tricuspid valve repair was associated with a 2.2% in-hospital mortality rate, with acute kidney injury (OR 5.25) and major bleeding (OR 2.81) as significant predictors of mortality.
Why the study?
Severe tricuspid regurgitation carries elevated surgical risk leading to increased use of transcatheter therapies like TTVR, but data remain limited.
Observational (n=925)
Yes
TTVR demonstrates acceptable in-hospital mortality (2.2%) in a high-risk population, though vascular complications and major bleeding remain notable risks.
AKI and major bleeding predict TTVR mortality; hypothesis-generating for prevention trials before practice implications.
Background Patients with severe tricuspid regurgitation carry an elevated surgical risk resulting in increasing adoption of less invasive transcatheter therapies such as transcatheter tricuspid valve repair (TTVR); however, data are limited. This study aimed to describe patient characteristics and predictors of poor outcomes among those undergoing TTVR. Methods The National Inpatient Sample was queried (2016-2019) to identify all patients undergoing TTVR ( International Classification of Diseases, Tenth Revision code 02UJ3JZ) alone or in combination with mitral transcatheter edge-to-edge repair (MTEER) (code 02UG3JZ). The primary aim was to define clinical characteristics, time trends, in-hospital outcomes, and predictors of all-cause in-hospital mortality (mortality). The secondary outcomes included predictors of increased hospitalization costs and length of stay (greater than the 75th percentile). Results We identified 925 patients who underwent TTVR (460 [49.7%] who underwent TTVR alone and 465 [50.3%] who underwent TTVR in combination with MTEER). There was a 6.5-fold increase in TTVR adoption ( P < .001). Patients were older (78 ± 10 years), female (63.2%), and White (72.7%), with frequent comorbidities. Mortality occurred in 2.2%, vascular complications occurred in 10.3%, and major bleeding occurred in 3.3%. The predictors of mortality were acute kidney injury (odds ratio [OR], 5.25; 95% CI, 5.24-5.26; P < .001), major bleeding (OR, 2.81; 95% CI, 2.80-2.83; P < .001), pericardiocentesis (OR, 2.15; 95% CI, 2.11-2.18; P < .001), and chronic liver disease (OR, 1.40; 95% CI, 1.39-1.40; P < .001). The predictors of increased length of stay or hospitalization costs included coronary artery disease, atrial arrhythmias, pulmonary hypertension, chronic liver disease, and procedural complications. Conclusions TTVR showed increased adoption with elevated but acceptable mortality and complications considering this high-risk population. The results of randomized trials are awaited.
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Torres et al. (2022) conducted an observational in Severe tricuspid regurgitation (n=925). Transcatheter tricuspid valve repair (TTVR) was evaluated on All-cause in-hospital mortality. Transcatheter tricuspid valve repair was associated with a 2.2% in-hospital mortality rate, with acute kidney injury (OR 5.25) and major bleeding (OR 2.81) as significant predictors of mortality.
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