Heart Valve Centre Approach to Severe Tricuspid Regurgitation: Real-World Data and Outcomes

Severe tricuspid regurgitation (TR) is associated with significant morbidity and mortality but remains markedly undertreated. Optimal management strategies and the timing of intervention are still unclear.

We retrospectively analysed 476 patients with isolated symptomatic severe TR treated at our heart valve centre from 2018 to 2023. Patients were categorised into 3 groups: conservative management (n = 323), surgery (n = 76), and transcatheter edge-to-edge repair (T-TEER) (n = 77). Risk stratification was performed using the TRI-SCORE, classifying patients into low/intermediate (< 6) and high (≥ 6) risk categories. The primary end point was a composite of all-cause mortality and heart failure hospitalisation.

Over 20 ± 7 months of follow-up, the primary end point occurred in 35.8% of patients in the conservative group, 19.7% in the surgical group, and 18.2% in the T-TEER group. Stratification by TRI-SCORE revealed 349 patients (73%) in the low/intermediate risk category, of whom 46 (13%) underwent T-TEER, 63 (18%) surgery, and 240 (69%) conservative management; and 127 patients (27%) in the high risk category, of whom 32 (25%) underwent T-TEER, 13 (10%) surgery, and 82 (65%) conservative management. Both surgery (hazard ratio [HR] 0.49, 95% confidence interval [CI] 0.28-0.84; P = 0.01) and T-TEER (HR 0.50, 95% CI 0.29-0.88; P = 0.02) were associated with a significantly lower incidence of the primary end point compared with conservative management. In low/intermediate risk patients, invasive treatments (surgery or T-TEER) significantly reduced the primary end point, whereas no significant benefit was observed in high risk patients. Multivariable regression analysis identified high TRI-SCORE (adjusted HR 2.32, 95% CI 1.66-3.26; P = 0.03) and conservative management (adjusted HR 2.66, 95% CI 1.70-4.16; P < 0.01) as the only predictors of the primary end point.

In patients with symptomatic severe TR managed through a modern heart valve centre approach, invasive treatments (surgery or T-TEER) may provide a prognostic benefit over conservative management, particularly in early disease stages (TRI-SCORE < 6).