Key result
Persistent postprocedure VExUS grade 3 is linked to ~5.5-fold higher mortality after tricuspid intervention.
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Why the study?
The utility of venous ultrasound and the VExUS score in assessing venous congestion and prognosis after transcatheter tricuspid valve intervention was undefined.
Does transcatheter tricuspid valve intervention improve hepatorenal congestion as measured by the VExUS score in patients undergoing intervention?
Cohort (n=64)
Yes
Does transcatheter tricuspid valve intervention improve hepatorenal congestion as measured by the VExUS score in patients undergoing intervention?
Hazard Ratio: 5.55 (95% CI 1.6–19.21)
p-value: p=0.007
Transcatheter tricuspid valve intervention yields rapid and durable improvements in hepatorenal congestion as measured by the VExUS score, and residual severe congestion at 24 hours strongly predicts mortality.
BACKGROUND Severe tricuspid regurgitation (TR) is associated with morbidity and mortality and linked to intravascular venous congestion. Venous ultrasound of the hepatic, portal, and intrarenal veins-often integrated via the Venous Excess Ultrasound (VExUS) score-offers prognostic insight in heart failure, but its utility in transcatheter tricuspid valve intervention (TTVI) remains undefined. OBJECTIVES The aim of this study was to evaluate changes in hepatic, portal, and intrarenal venous flow before vs after TTVI, assess their durability, and explore associations with prognosis and functional status. METHODS In this prospective multicenter cohort patients undergoing TTVI (2022-2024) were included. Venous ultrasound was performed 24 hours pre- and postprocedure. Functional status, frailty, biomarkers, venous ultrasound and echocardiography were assessed at baseline and at 1, 6, and 12 months. All-cause mortality and heart failure hospitalization were recorded. Survival was analyzed by Kaplan-Meier and Cox regression. RESULTS A total of 64 patients were included; mean age was 76.7 ± 8.1 years; 76.6% were women. Procedures included edge-to-edge repair (60.9%), percutaneous annuloplasty (18.7%), orthotopic replacement (14.1%), and heterotopic replacement (6.3%). At baseline, 70% had VExUS grade 3. Within 24 hours hepatic vein, portal pulsatility, and intrarenal venous flows improved, reclassifying 66% to VExUS ≤1, despite no change in diuretic dose or weight. Venous ultrasound improvements persisted during follow-up. Postprocedure VExUS grade 3 at 24 hours was a strong predictor of mortality (HR: 5.55; 95% CI: 1.60-19.21; P = 0.007). CONCLUSIONS TTVI improved hepatic, portal, and intrarenal venous flow within 24 hours, with sustained effects at 1 year. Postprocedure VExUS score was associated with mortality and may serve as a procedural success indicator.
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Pérez et al. (2026) conducted a cohort in Severe tricuspid regurgitation (TR) (n=64). Transcatheter tricuspid valve intervention (TTVI) vs. Pre-procedure baseline was evaluated on All-cause mortality associated with postprocedure VExUS grade 3 at 24 hours (HR 5.55, 95% CI 1.60-19.21, p=0.007). Transcatheter tricuspid intervention rapidly improved venous flow, but persisting postprocedure VExUS grade 3 at 24 hours was a strong predictor of mortality (HR 5.55; 95% CI 1.60-19.21; P=0.007).
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