Key result
Discharge tricuspid gradient ≥3.5 mm Hg after TTVR is linked to ~77% higher 3-year mortality or HF hospitalization.
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Why the study?
Although transprosthetic gradients are established prognostic markers after left-sided valve interventions, the prognostic significance of discharge tricuspid gradient after transcatheter tricuspid valve replacement remained unclear.
Does an elevated discharge transprosthetic tricuspid gradient (≥3.5 mm Hg) increase the risk of all-cause mortality and heart failure hospitalization in patients undergoing transcatheter tricuspid valve replacement?
Cohort (n=474)
Yes
Does an elevated discharge transprosthetic tricuspid gradient (≥3.5 mm Hg) increase the risk of all-cause mortality and heart failure hospitalization in patients undergoing transcatheter tricuspid valve replacement?
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“A discharge landmark analysis by Matteo Biroli, MD, and colleagues of 474 patients (mean age, 76 years; 64% women) from the international, multicenter TRIPLACE registry found that an elevated discharge tricuspid valve gradient (dTVG) identified patients at increased risk of adverse outcomes. Larger indexed inner valve diameter was associated with lower odds of an elevated gradient and was the only identified factor that could potentially be modified.”
A discharge transprosthetic tricuspid gradient ≥3.5 mm Hg after TTVR independently predicts worse 1- and 3-year mortality and heart failure hospitalization, with indexed inner valve diameter serving as a potentially modifiable determinant.
BACKGROUND: Although transprosthetic gradients are established prognostic markers after left-sided valve interventions, the prognostic significance of discharge tricuspid gradient (dTVG) after transcatheter tricuspid valve replacement (TTVR) remains unclear. OBJECTIVES: This study sought to evaluate the association between dTVG and clinical outcomes after TTVR and identify high dTVG determinants. METHODS: TRIPLACE (Global Multicenter Registry on Transcatheter Tricuspid Valve Replacement) is an international, multicenter TTVR registry. A discharge landmark analysis was performed, excluding patients with in-hospital mortality, lack of TTVR technical success, missing dTVG, or unavailable follow-up at any time point. Endpoints included all-cause mortality and the composite of all-cause mortality or heart failure hospitalization. The optimal dTVG cutoff was identified through quartile-based survival analysis and confirmed by log-rank maximization. Multivariable Cox models were developed using cross-validated candidate variable selection. RESULTS: Among 526 patients, 474 were included. Median follow-up was 208.5 days (Q1-Q3: 54-474 days). A data-driven dTVG cutoff of 3.5 mm Hg identified 122 of 474 patients (25.7%) with high dTVG. dTVG ≥3.5 mm Hg was associated with higher 1- and 3-year mortality (HR: 2.07; 95% CI: 1.14-3.75; P = 0.017 and HR: 2.07; 95% CI: 1.24-3.48; P = 0.006, respectively) and composite endpoint events (HR: 1.99; 95% CI: 1.31-3.03; P = 0.001 and HR: 1.96; 95% CI: 1.33-2.88; P < 0.001). After multivariable adjustment, dTVG ≥3.5 mm Hg remained associated with 3-year mortality (adjusted HR: 1.84; 95% CI: 1.09-3.10; P = 0.022) and the composite endpoint at 1 and 3 years (adjusted HR: 1.77; 95% CI: 1.16-2.70; P = 0.009 and adjusted HR: 1.77; 95% CI: 1.20-2.60; P = 0.004, respectively). Indexed inner transcatheter tricuspid valve diameter was the only potentially modifiable independent predictor of high dTVG (OR: 0.79 per 1 mm/m CONCLUSIONS: Elevated dTVG after TTVR independently identifies patients at increased risk of adverse outcomes. A 3.5 mm Hg threshold may support postprocedural risk stratification, whereas inner valve diameter represents a potentially modifiable determinant of elevated dTVG. (TRIPLACE [Global Multicenter Registry on Transcatheter Tricuspid Valve Replacement]; NCT06033274).
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Biroli et al. (2026) conducted a cohort in Transcatheter tricuspid valve replacement (TTVR) (n=474). Discharge transprosthetic tricuspid gradient (dTVG) ≥3.5 mm Hg vs. dTVG <3.5 mm Hg was evaluated on Composite of all-cause mortality or heart failure hospitalization at 3 years (adjusted HR 1.77, 95% CI 1.20-2.60, p=0.004). Discharge tricuspid gradient ≥3.5 mm Hg after TTVR was independently associated with higher 3-year mortality or HF hospitalization (adjusted HR 1.77; 95% CI 1.20-2.60; P=0.004).
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