Post-repair transcatheter tricuspid valve replacement for severe tricuspid regurgitation

Background Transcatheter tricuspid valve replacement (TTVR) may be a promising option for patients with residual or recurrent tricuspid regurgitation (TR) after prior surgical or transcatheter tricuspid valve (TV) repair, but evidence in this setting remains limited. Purpose This study assesses the safety and effectiveness of TTVR after prior repair versus primary TTVR in patients with severe TR. Methods Between 2024 and 2026, consecutive patients with severe TR undergoing either primary TTVR or TTVR after prior TV repair were included in this subanalysis of the Berlin registry of right heart interventions. Clinical and procedural data were prospectively collected at the time of the procedure, at hospital discharge, and at 30–60 days of follow-up. Results In this subanalysis, 69 patients with TR were included, of whom 9 patients (13%) underwent post-repair TTVR after prior tricuspid valve intervention or repair (tricuspid transcatheter edge-to-edge repair [T-TEER] n=1, percutaneous annuloplasty [PA] n=7, and surgical TV repair n=1). Median age, proportion of women, and baseline NYHA class III/IV were 82 (68-84) years, 78%, and 78% in the post-repair TTVR group versus 80 (76-83) years, 65%, and 78% in the primary TTVR group, respectively. Procedural success was achieved in all patients. In-hospital mortality was 1%, with no procedure-related deaths. In-hospital adverse events included bleeding in 11% of patients with post-repair TTVR and 3% of patients with primary TTVR, vascular complications in 0% and 2%, new pacemaker implantation in 22% and 20%, stroke in 0% and 2%, myocardial infarction in 0% and 0%, thromboembolic events in 0% and 2% as well as acute kidney injury in 0% and 3%, respectively. At discharge, TR severity was markedly reduced and comparable between groups (none/mild TR: 89% in post-repair TTVR vs. 98% in primary TTVR). At follow-up, NYHA functional class improved in both groups without significant intergroup differences: 33% (post-repair TTVR) versus 45% (primary TTVR) in class I/II at follow-up (vs. 22% in both groups at baseline). During follow-up, heart failure rehospitalization occurred in 11% in the post-repair TTVR group versus 3% in the primary TTVR group. Conclusion In this hypothesis-generating subanalysis of the Berlin registry of right heart interventions, post-repair TTVR was technically feasible and showed a favorable early safety and performance profile. Outcomes were broadly similar to those observed after primary TTVR in patients with significant TR.