Objective Assessment of Functional Capacity Improvement Following Transcatheter Tricuspid Valve Interventions

Transcatheter tricuspid valve interventions have recently emerged as effective therapeutic options for patients with severe tricuspid regurgitation (TR) and heart failure at high surgical risk. Despite evidence of post-procedural clinical improvement, data regarding changes in functional capacity remain limited. In this prospective, observational study, we enrolled high-risk patients with at least severe TR and heart failure undergoing transcatheter tricuspid valve repair by the PASCAL device or replacement with the EVOQUE system. Functional capacity was evaluated by cardiopulmonary exercise testing (CPET), in addition to clinical, laboratory, and echocardiographic parameters, at baseline and 3 months postprocedure. The primary endpoint was the change in peak oxygen consumption (VO₂) by CPET at 3 months versus baseline. Secondary endpoints included changes in other CPET parameters, TR severity by transthoracic echocardiography, New York Heart Association (NYHA) class, daily furosemide dose, and pro-brain natriuretic peptide (pro-BNP) levels. A total of 10 patients were enrolled, with successful device implantation obtained in all cases. Peak VO₂ improved significantly from 14.7 ± 3.7 at baseline to 16.4 ± 2.9 ml/kg/min at 3 months (p = 0.009). Peak oxygen pulse increased from 85.1 ± 20.2% to 103.7 ± 23.3% (p = 0.022), and ventilation maximum rose from 39.9 ± 10.3 L/min to 45.7 ± 10.9 L/min (p = 0.035). TR severity was reduced (p = 0.002), NYHA class improved (p = 0.016), and daily furosemide dose decreased (p = 0.016). Although pro-BNP levels declined, this reduction was not statistically significant. No adverse event occurred during follow-up. In conclusion, among patients with severe TR and heart failure, TR reduction by transcatheter tricuspid valve interventions was associated with improved CPET-derived functional capacity, better functional class, and reduced diuretic requirement during short-term follow-up.