Transcatheter Tricuspid Valve Replacement Reduces Heart Failure Hospitalization: Insights From the Canadian Evoque...

Severe tricuspid regurgitation (TR) causes high morbidity and recurrent heart failure hospitalization (HFH). Transcatheter tricuspid valve replacement (TTVR) consistently eliminates TR, but real-world data on HFH reduction are limited. We therefore evaluated the effect of TTVR on HFH and clinical outcomes in a diverse cohort of compassionate-use and trial patients.

This prospective, multicentre Canadian registry included 75 high-risk patients (Society of Thoracic Surgeons [STS] score 8.2% ± 5.9%) who underwent TTVR with the EVOQUE system (Edwards Lifesciences, Irvine, CA). The primary end point was a composite of all-cause death or HFH within 1 year after TTVR. Secondary end points included the annualized HFH rate 12 months before vs after TTVR, symptoms, quality of life (using the Kansas City Cardiomyopathy Questionnaire [KCCQ]), and functional capacity.

Procedural success was high (technical: 97.3%; device: 93.3%), with sustained TR reduction to ≤ mild (94.3%), and a 6.7% 1-year mortality. TTVR resulted in a 76.1% relative reduction in HFH (P < 0.001). New York Heart Association class III-IV decreased from 76% to 10% (P < 0.001). Significant improvements were observed in 6-minute walk distance (260.8 ± 104.7 to 334.5 ± 103.5 m; P < 0.001) and KCCQ score (56.2 ± 15.2 to 73.5 ± 19.2 points; P = 0.001). Multivariable analysis identified baseline New York Heart Association class IV (odds ratio, 3.96; P = 0.003) and previous HFH (odds ratio, 2.31; P = 0.033) as independent predictors of the composite end point (HFH and/or death). Comparative analysis showed that although compassionate-use patients (n = 24) had a higher-risk profile than trial patients (n = 51), both cohorts achieved comparable and significant clinical improvements.

In a diverse, high-risk cohort, TTVR dramatically reduced HFH and significantly improved quality of life. These results reinforce the therapeutic benefits of TTVR in high-risk patients with severe TR.