Transcatheter treatment improves survival of patients with severe tricuspid regurgitation
Transcatheter tricuspid valve interventions (TTVI), compared with medical therapy alone, appears to improve survival and reduce rehospitalization due to heart failure (HF), as shown in this propensity-matched, case-control study.
A total of 472 patients from 22 European and North American centres who underwent TTVI from 2016 to 2018 were included in the TriValve (Transcatheter Tricuspid Valve Therapies) registry. A control cohort from two large retrospective registries that enrolled patients with moderate to severe tricuspid regurgitation in Europe and North America (n=1,179) was propensity-score matched 1:1 on the basis of age, EuroSCORE II and systolic pulmonary artery pressure.
Cox regression analysis was used to examine survival. One-year mortality or HF rehospitalization or the composite was the primary endpoint.
Propensity-score matching identified 268 pairs. TTVI patients had lower 1-year mortality (23±3 percent vs 36±3 percent; p=0.001), rehospitalization (26±3 percent vs 47±3 percent; p<0.0001) and composite endpoint (32±4 percent vs 49±3 percent; p=0.0003) than controls.
TTVI correlated with better survival and freedom from HF rehospitalization (hazard ratio [HR], 0.60, 95 percent confidence interval [CI], 0.46–0.79; p-unadjusted=0.003), and this association persisted even after adjusting for sex, New York Heart Association functional class, right ventricular dysfunction and atrial fibrillation (HR, 0.39, 95 percent CI, 0.26–0.59; p<0.0001) and after further adjustment for mitral regurgitation and pacemaker/defibrillator (HR, 0.35, 95 percent CI, 0.23–0.54; p<0.0001).
“Randomized trials should be performed to confirm these results,” the investigators said.