Transcatheter tricuspid valve repair in the setting of heart failure with preserved or reduced left ventricular ejection fraction

Aims: Severe tricuspid regurgitation (TR) impairs prognosis in patients with left-sided heart failure (HF) with preserved (≥50%, HFpEF) and reduced ejection fraction (<50%, HFrEF). Transcatheter tricuspid valve edge-to-edge repair (TTVR) potentially improves prognosis among patients with severe TR. We sought to assess the impact of left-sided HF types on outcomes of TTVR.

Methods and results: In this retrospective study, 71 HFpEF and 40 HFrEF patients, defined according to the European Society of Cardiology criteria, with isolated TR treated by TTVR in two tertiary care centres between 2016 and 2019 were analysed. The primary outcome was a composite outcome of all-cause mortality and HF hospitalization at 12 months [median follow-up 238 (interquartile range 175-365) days]. Additionally, a propensity score matching with a conservatively treated cohort of 914 patients with severe TR was performed. Procedural success did not differ between HFpEF (mean age 75.9 ± 9.3 years) or HFrEF (mean age 74.7 ± 9.1 years) patients (86% vs. 78%, P = 0.299). The primary endpoint occurred more frequently in patients with HFrEF as compared to HFpEF (50% vs. 30%, P = 0.016). Procedural success was associated with a reduced occurrence of the primary endpoint among patients with HFpEF (P < 0.001) but not HFrEF (P = 0.813), while both groups showed improvement in New York Heart Association functional class (both P < 0.001). After matching for age, EuroSCORE II, presence of a right ventricular lead and systolic pulmonary artery pressure, successful TTVR was associated with lower mortality as compared to conservative therapy in HFpEF patients (P = 0.020), but not in HFrEF patients (P = 0.274).

Conclusion: Transcatheter tricuspid valve edge-to-edge repair might be a treatment option in patients with severe TR and HFpEF compared to conservative therapy.