Real-World Suitability of Patients for Transcatheter Tricuspid Valve Replacement

Transcatheter tricuspid valve replacement (TTVR) has shown therapeutic promise for patients with severe tricuspid regurgitation (TR). However, some patients may not be eligible due to anatomic limitations. We sought to describe the outcomes of patients who were referred for transcatheter tricuspid valve intervention (TTVI) and were ineligible for TTVR. This was a single-center, retrospective study of 251 patients referred for TTVI from February 2024 to August 2025. All patients were considered by a multidisciplinary heart team and assessed for feasibility of commercial tricuspid valve repair or replacement, with a strategy to proceed with replacement if anatomically feasible. Data on demographics, clinical characteristics, and outcomes were collected from medical records. Of 251 patients evaluated, 43 (17.1%) were unsuitable for TTVR. Compared with suitable patients, unsuitable patients were more frequently male (67.4% vs 33.2%, p <0.01) and more likely to have implanted electronic device (53.5% vs 32.2%, p = 0.01) or prior tricuspid interventions (7.9% vs 1.6%, p = 0.03). The leading reason for unsuitability was large annular dimensions (60.5%), followed by leaflet tethering (14.0%) and small annular size (11.6%). Of the unsuitable cohort, 10 patients (23.3%) underwent T-TEER and 33 (76.7%) received medical therapy alone. T-TEER resulted in significant reduction in TR severity (p = 0.034), though 80% had residual moderate or greater TR. In conclusion, this commercial experience, rates of TTVR ineligibility were lower than previously described with large annular dimensions serving as the most frequent exclusion criterion. For those ineligible, T-TEER may provide a feasible approach in appropriately selected patients.