Female sex was independently associated with higher procedural success (84% vs. 77%, OR 1.49) and better 2-year survival (77% vs. 64%, HR 0.81) after T-TEER for TR.
Does female sex improve procedural success and survival in patients undergoing transcatheter edge-to-edge repair for tricuspid regurgitation?
In patients undergoing transcatheter edge-to-edge repair for tricuspid regurgitation, female sex is associated with higher procedural success and better survival, likely due to earlier intervention with less severe disease and better right ventricular function.
Absolute Event Rate: 0% vs 0%
Abstract Background Although tricuspid regurgitation (TR) is more prevalent in women, little is known about the impact of sex and gender on the clinical course after transcatheter treatment. Purpose The aim of this study was to identify potential differences in the clinical and echocardiographic phenotypes of men and women with TR, and differences in outcomes after tricuspid valve transcatheter edge-to-edge repair (T-TEER). Methods and results A total of 2432 patients (53% female) from 20 European tertiary care centres, treated with T-TEER from 2016 to 2022, were included in this retrospective analysis. At baseline, women had less severe TR (p0.001), smaller effective regurgitant orifice area (EROA 0.64 ± 0.48 vs. 0.74 ± 0.64 cm², p0.001), less right ventricular (RV) dilatation (indexed RV end-diastolic diameter 26 ± 5 vs. 27 ± 5 mm/m², p=0.002), better RV function (fractional area change 40 ± 11 vs. 37 ± 11 %, p0.001) and smaller right atria (indexed RA area, 19 ± 8 vs. 21 ± 6cm²/m², p0.001). Aetiology of TR was comparable with 41% of women and 37% of men presenting with atrial functional TR (p=0.125). Burden of co-morbidities was comparable except for a lower prevalence of coronary artery disease (37 vs. 48%, p0.001), chronic obstructive pulmonary disease (14 vs. 18%, p=0.014) and the presence of a transvalvular lead (21 vs. 31%, p0.001) in women. At the time of intervention, women had less clinical signs of heart failure such as ascites (6 vs. 16%, p0.001), peripheral edema (49 vs. 54%, p= 0.02) and pleural effusion (21 vs. 29%, p0.001), and lower levels of NT-proBNP (4219 ± 7254 vs. 5519 ± 10798 pg/ml, p=0.001). Procedural success (TR reduction to moderate or less) was more often achieved in women (84 vs. 77%, p0.001). In a multivariate logistic regression including all baseline anatomical and clinical characteristics, female sex (p=0.006, OR 1.488 1.121-1-976), better right ventricular function according to TAPSE (p=0.016, OR 1.039 1.007-1.072), and less severe TR severity at baseline (p0.001, OR 4.168 3.055-5.686) were identified as independent predictors for procedural success. Survival at one and two years was significantly higher in women (85 vs. 80%, and 77 vs. 64%, respectively p0.001). In a multivariate Cox regression analysis, female sex was independently associated with reduced mortality (p=0.033, HR 0.805 0.659-0.982). Conclusions Female sex was associated with higher rates of procedural success and better survival after T-TEER. They seem to be treated earlier in the course of the disease with less severe TR, less RV dilatation, better RV function, as well as less pronounced classic heart failure signs. These observations are in part opposed to reports on patients treated for other valvular heart disease, calling for further research regarding the impact of sex and gender on pathophysiology and treatment of TR including sex-adjusted criteria for upcoming clinical guidelines.Kaplan-Meier curve for survival
Wild et al. (Sat,) reported a other. Female sex was independently associated with higher procedural success (84% vs. 77%, OR 1.49) and better 2-year survival (77% vs. 64%, HR 0.81) after T-TEER for TR.