Tricuspid Valve Repair Finally Proven to Keep HF Events At Bay

A recent trial suggests that transcatheter tricuspid valve repair can significantly reduce heart failure (HF) events and improve quality of life in patients with severe tricuspid regurgitation (TR) at high risk. In the TRIC-I-HF study conducted in Germany, researchers found that patients who underwent transcatheter repair had better outcomes compared to those receiving medical therapy alone.

At one year, the win ratio was 2.42, indicating a substantial reduction in all-cause death and hospitalization for HF, providing a win rate of 2.42 over medical therapy alone. This finding was further supported at three years, with combined death from any cause and HF hospitalization significantly favoring transcatheter repair (52.4% with tricuspid repair vs 21.0% with medical therapy, HR 0.40, 95% CI 0.29-0.55).

The results extend previous evidence from randomized trials, showing that the benefits of an interventional strategy extend beyond improvements in quality of life to meaningful differences in hard clinical outcomes. This translates to a number needed to treat of just four patients to prevent one death or HF hospitalization at one year in experienced operators.

The study, led by Jörg Hausleiter, MD of Ludwig-Maximilians-Universität München, Germany, demonstrated the procedural safety and sustained reduction in tricuspid regurgitation severity when transcatheter tricuspid-valve repair is performed at experienced heart-valve centers. Notably, the number of patients needed to treat to prevent one major adverse event was remarkably low.

The trial was conducted at 29 high-volume heart-valve centers in Germany, involving 360 patients with symptomatic severe TR. Participants were randomized 2:1 to either tricuspid valve repair or medical therapy. At baseline, tricuspid regurgitation was severe in 50.8% of the cohort, massive in 34.2%, and torrential in 10.3%. The average left ventricular ejection fraction was 54.3%, and three-quarters of participants had New York Heart Association class III or IV HF.

Of those who received transcatheter tricuspid intervention, 98.3% underwent transcatheter edge-to-edge repair (TEER), primarily using the CE-marked Pascal and TriClip systems.

While the study's success may not be generalizable to other countries, the findings provide a landmark study for informing patients and clinicians about the benefits of transcatheter repair therapy. The impact of healthcare hospitalizations and mortality reduction, alongside quality of life improvements, will likely strengthen arguments for treating more patients with this therapy.