Sex-based differences in candidacy for transcatheter tricuspid valve intervention

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Women exhibit higher prevalence and advanced stages of tricuspid regurgitation (TR) compared to men.
• Transcatheter tricuspid valve interventions (TTVI) offer a promising alternative to high-mortality tricuspid valve (TV) surgery.
• Exploration of sex-based differences in significant TR patients eligible for TTVI is crucial.

Purpose of the Study:

• To investigate sex-based disparities in eligibility for transcatheter tricuspid valve interventions (TTVI) among patients with significant tricuspid regurgitation (TR).
• To identify clinical and echocardiographic factors influencing TTVI eligibility across different sexes.

Main Methods:

• Retrospective analysis of 12,677 adult transthoracic echocardiograms (March 2021-2022).
• Inclusion of patients with more than moderate TR, defining eligibility for TTVI, TV surgery, or medical therapy based on 2021 ESC guidelines.
• Comparison of sex-based characteristics and TTVI eligibility using statistical tests and Cox regression for survival analysis.

Main Results:

• Of 569 patients with significant TR, 52% were female.
• Women presented with more isolated TR and TR due to pulmonary hypertension; men showed more left ventricular dysfunction and heart failure signs.
• A significant majority (over 75%) in both sexes were ineligible for TTVI or TV surgery due to advanced disease; 10.8% of women and 9.2% of men were TTVI-eligible (p=0.511).

Conclusions:

• The majority of patients with significant TR at tertiary centers are not candidates for TTVI.
• Sex is not a determining factor for TTVI eligibility in patients with significant TR.
• Further research is needed to optimize treatment strategies for the large proportion of TR patients ineligible for current interventions.