Transcatheter Versus Medical Treatment of Patients With Symptomatic Severe Tricuspid Regurgitation.

Taramasso, Maurizio; Benfari, Giovanni; van der Bijl, Pieter; Alessandrini, Hannes; Attinger-Toller, Adrian; Biasco, Luigi; Lurz, Philipp; Braun, Daniel; Brochet, Eric; Connelly, Kim A; de Bruijn, Sabine; Denti, Paolo; Deuschl, Florian; Estevez-Loureiro, Rodrigo; Fam, Neil; Frerker, Christian; Gavazzoni, Mara; Hausleiter, Jörg; Ho, Edwin; Juliard, Jean-Michel; ... (2019). Transcatheter Versus Medical Treatment of Patients With Symptomatic Severe Tricuspid Regurgitation. Journal of the American College of Cardiology, 74(24), pp. 2998-3008. Elsevier 10.1016/j.jacc.2019.09.028

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BACKGROUND

Tricuspid regurgitation is associated with increased rates of heart failure (HF) and mortality. Transcatheter tricuspid valve interventions (TTVI) are promising, but the clinical benefit is unknown.

OBJECTIVES

The purpose of this study was to investigate the potential benefit of TTVI over medical therapy in a propensity score matched population.

METHODS

The TriValve (Transcatheter Tricuspid Valve Therapies) registry collected 472 patients from 22 European and North American centers who underwent TTVI from 2016 to 2018. A control cohort formed by 2 large retrospective registries enrolling medically managed patients with ≥ moderate tricuspid regurgitation in Europe and North America (n = 1,179) were propensity score 1:1 matched (distance ± 0.2 SD) using age, EuroSCORE II, and systolic pulmonary artery pressure. Survival was tested with Cox regression analysis. Primary endpoint was 1-year mortality or HF rehospitalization or the composite.

RESULTS

After matching, 268 adequately matched pairs of patients were identified. Compared with control subjects, TTVI patients had lower 1-year mortality (23 ± 3% vs. 36 ± 3%; p = 0.001), rehospitalization (26 ± 3% vs. 47 ± 3%; p < 0.0001), and composite endpoint (32 ± 4% vs. 49 ± 3%; p = 0.0003). TTVI was associated with greater survival and freedom from HF rehospitalization (hazard ratio [HR]: 0.60; 95% confidence interval [CI]: 0.46 to 0.79; p = 0.003 unadjusted), which remained significant after adjusting for sex, New York Heart Association functional class, right ventricular dysfunction, and atrial fibrillation (HR: 0.39; 95% CI: 0.26 to 0.59; p < 0.0001) and after further adjustment for mitral regurgitation and pacemaker/defibrillator (HR: 0.35; 95% CI: 0.23 to 0.54; p < 0.0001).

CONCLUSIONS

In this propensity-matched case-control study, TTVI is associated with greater survival and reduced HF rehospitalization compared with medical therapy alone. Randomized trials should be performed to confirm these results.

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