Transcatheter Intervention Is Associated With Visceral Decongestion in Patients With Severe Tricuspid Regurgitation

Tricuspid regurgitation (TR) is frequently associated with severe venous congestion, increasingly recognized as a key factor in the development of cardiorenal syndrome. While transcatheter tricuspid valve intervention (TTVI) has shown to be effective in TR reduction, their impact on visceral venous congestion remains unknown. The aim of our study was to investigate visceral venous congestion in patients with severe TR undergoing TTVI.

We prospectively enrolled 30 patients undergoing TTVI for severe TR. Renal venous blood flow was assessed by Doppler ultrasound examination at baseline and 1 to 3 months after the procedure. A 5-grade rating scale was developed to categorize venous flow from continuous (Grade I°) through discontinuous to a pendulous venous flow (Grade V°) within the kidneys.

Transcatheter edge-to-edge repair (TEER, n = 24) was performed in 24 patients; 6 patients underwent heterotopic caval valve implantation. At baseline, severe renal congestion was present in most participants, with 20 patients showing venous flow profiles IV or V. Venous flow profiles strongly correlated with invasively measured right atrial mean pressure and V wave (p < 0.01). At follow-up, venous renal blood flow profiles improved significantly (p = 0.003), reducing patients with profiles IV or V from 20 to 9. Portal vein flow showed comparable decongestive changes. In TEER patients, reduction of TR ≥ 2 grades was associated with improved renal vein profile at follow-up (p = 0.002).

Successful TTVI leads to visceral decongestion. Renal venous flow currently represents a physiological marker of congestion that may complement conventional echocardiographic parameters; its role in guiding patient selection or timing of intervention remains to be determined in larger studies.