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TRIC-I-HFStructural HeartNew England Journal of Medicine
Transcatheter Tricuspid-Valve Repair in Severe Regurgitation and Heart Failure
Tricuspid-Valve Intervention in Heart Failure
View Full PaperWhy the trial?
Significant tricuspid regurgitation is common in heart failure and carries a poor prognosis, but whether intervening on the valve improves outcomes beyond medical therapy remains uncertain. TRIC-I-HF tested tricuspid valve intervention in this population.
Does transcatheter tricuspid-valve repair plus medical therapy improve a composite of death, heart failure hospitalization, and quality of life in patients with symptomatic severe tricuspid regurgitation?
Population
360 patients, severe symptomatic TR + high HF-event risk (age 80.3; 56.4% women)
Comparison
Transcatheter tricuspid-valve repair + medical therapy vs medical therapy alone
Design
Randomized (2:1) trial; hierarchical win-ratio first primary endpoint
Follow-up
1 year (first primary); through 3 years (second primary)
Key result
Transcatheter tricuspid-valve repair was superior to medical therapy for a composite of death, heart failure hospitalization, and quality of life (Win Ratio 2.42; 95% CI 1.76-3.33; P<0.001).
Authors
Discussion
Key questions
Member takes
Key expert perspectives
Captured external expert commentary on this trial, strongest first. Original sources linked on every quote.
TRIC-I-HF is an investigator-initiated, randomized controlled trial that demonstrated transcatheter tricuspid-valve repair plus optimal medical therapy significantly improved a hierarchical composite of death, heart failure hospitalization, and quality of life at 1 year (win ratio 2.42; p<0.001) and reduced death or hospitalization through 3 years (HR 0.40; p<0.001) in heart failure patients with severe tricuspid regurgitation. The trial was presented as a Hot Line at ESC Congress 2026 by Jörg Hausleiter, with key subgroup results also presented at TCT 2026.
2 takes classified by contention axis so far — the map appears as more land.
“Randomized controlled trials are the cornerstone of evidence-based cardiovascular medicine because they provide the highest level of evidence to guide clinical practice. This year, ESC Congress received a record number of submissions of late-breaking clinical trials, reflecting the remarkable pace of innovation across cardiology. We rigorously selected the studies with the greatest scientific quality and potential clinical impact.”
“@MAnisHaider @jtsaxon One important correction. Baseline TR severity was greater in TRILUMINATE than in TRICI-HF… by a good amount.”
“#ESC2026 TRIC-I-HF Trial: Key Findings: Significant reduction in HF hospitalizations Marked improvement in NYHA & QoL (KCCQ) Favorable safety profile A major step forward in managing severe tricuspid regurgitation in HF patients”
Overview
Supports transcatheter tricuspid repair plus medical therapy in symptomatic severe tricuspid regurgitation; delivers first randomized evidence of hard-endpoint benefit.
Key Points
- To evaluate the efficacy and safety of transcatheter tricuspid-valve repair added to medical therapy versus medical therapy alone in patients with symptomatic severe tricuspid regurgitation at high risk for heart failure events.
- Randomized, controlled trial assigning 360 patients in a 2:1 ratio to transcatheter tricuspid-valve repair plus medical therapy (N=237) or medical therapy alone (N=123; NCT04634266).
- Evaluated a first primary hierarchical composite endpoint (all-cause death, heart-failure hospitalization, and quality-of-life improvement at 1 year via win ratio) and a second primary endpoint of all-cause death or heart-failure hospitalization through 3 years.
- Tricuspid-valve repair significantly improved the 1-year hierarchical primary composite outcome compared with medical therapy alone (win ratio, 2.42; 95% CI, 1.76 to 3.33; P<0.001).
- Through 3 years, freedom from all-cause death or heart failure hospitalization was 52.4% (95% CI, 43.2 to 63.6) with repair versus 21.0% (95% CI, 12.7 to 34.6) with medical therapy alone (HR, 0.40; 95% CI, 0.29 to 0.55; P<0.001).
- Major adverse events occurred in 14 patients (5.9%) within 30 days of the tricuspid-valve repair procedure.
Evidence details
What drove the result?
| Outcome | TV repair | Medical |
|---|---|---|
| Death, HF hospitalization, QoL improvement (hierarchical, 1 yr) | ||
| First primary · win ratio 2.42 (95% CI 1.76–3.33; p<0.001) favoring repair; per-arm values not reported | ||
| Freedom from death or HF hospitalization through 3 years | 52.4% | 21.0% |
| Second primary · HR 0.40 (95% CI 0.29–0.55; p<0.001) for death or HF hospitalization | ||
Limitations & tradeoffs
Safety
Major adverse events within 30 days occurred in 14/237 (5.9%) in the repair arm.
Statistical certainty
2:1 randomization left a modest medical-therapy arm of 123 patients, and 3-year Kaplan–Meier estimates carry wide confidence intervals (52.4% [43.2–63.6] vs 21.0% [12.7–34.6]).
Design limitations
The first primary endpoint includes patient-reported quality of life, and blinding is not described in the record.
Structured PICO
Does transcatheter tricuspid-valve repair plus medical therapy improve a composite of death, heart failure hospitalization, and quality of life in patients with symptomatic severe tricuspid regurgitation?
P
Population
360 patients (mean age 80.3 years, 56.4% women) with symptomatic severe tricuspid regurgitation and increased risk of future heart-failure events, followed for up to 3 years.
I
Intervention
Transcatheter tricuspid-valve repair plus medical therapy
C
Comparator
Medical therapy alone
O
Outcome
First primary end point: hierarchical composite of death from any cause, hospitalization for heart failure, and quality-of-life improvement at 1 year. Second primary end point: composite of death from any cause or hospitalization for heart failure through 3 years.composite
Transcatheter tricuspid-valve repair added to medical therapy significantly improves a hierarchical composite of death, heart failure hospitalization, and quality of life at 1 year, and reduces death or heart failure hospitalization through 3 years in patients with severe tricuspid regurgitation.
Main Result
Effect estimate: Win Ratio 2.42 (95% CI 1.76-3.33)
p-value: p=<0.001
Coverage & sources
Journal, society, and media accounts. Useful signal, not independent expert judgment.
Cite This Study
Hausleiter et al. (2026) conducted an RCT in symptomatic severe tricuspid regurgitation (n=360). transcatheter tricuspid-valve repair plus medical therapy vs. medical therapy alone was evaluated on hierarchical composite of death from any cause, hospitalization for heart failure, and quality-of-life improvement at 1 year (Win Ratio 2.42, 95% CI 1.76-3.33, p=<0.001). Transcatheter tricuspid-valve repair was superior to medical therapy for a composite of death, heart failure hospitalization, and quality of life (Win Ratio 2.42; 95% CI 1.76-3.33; P<0.001).