TRICUSPID transcatheter edge-to-edge repair (T-TEER) combined with optimised medical therapy (OMT) significantly improves a composite outcome of patient-reported measures and clinical events compared to OMT alone in patients with severe, symptomatic tricuspid regurgitation.
Tricuspid regurgitation (TR), a condition marked by backward blood flow into the right atrium, is associated with significant morbidity and mortality. This trial aimed to evaluate the effectiveness of adding T-TEER to guideline-directed OMT in improving patient-reported outcomes and clinical results for individuals suffering from severe, symptomatic TR. Conducted across 24 centres in France and Belgium, the study included 300 patients aged 78 years on average, most of whom were women.
Patients were randomly assigned to either the T-TEER plus OMT group (152 participants) or the OMT-alone group (148 participants). At the one-year follow-up, 74.1% of the T-TEER group showed improvement in a composite score encompassing changes in New York Heart Association (NYHA) class, patient global assessment, and major cardiovascular events, compared to 40.6% in the OMT-alone group. Additionally, the prevalence of massive or torrential TR was markedly lower in the T-TEER group (6.8%) than in the OMT-alone group (53.5%). Patient quality of life, assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ), was also notably better in the T-TEER group (mean score: 69.9 vs 55.4, P < .001). A secondary composite outcome including all-cause death, valve surgery, KCCQ improvements, or heart failure hospitalisation yielded a win ratio of 2.06 (95% CI, 1.38-3.08; P < .001).
The findings highlight the clinical value of T-TEER as an adjunct to OMT for severe TR. By reducing TR severity and enhancing quality of life, T-TEER addresses both symptomatic and structural aspects of the disease. Future research should explore long-term outcomes and refine patient selection to optimise results. In clinical practice, T-TEER offers a promising therapeutic pathway for patients with limited options beyond pharmacological management.
Reference
Donal E et al. Transcatheter edge-to-edge repair for severe isolated tricuspid regurgitation: the Tri.Fr randomized clinical trial. JAMA. 2024;DOI:10.1001/jama.2024.21189.
