Novel approach to managing severe tricuspid regurgitation proves its value

The tricuspid transcatheter edge-to-edge repair (T-TEER) technique was associated with improved clinical outcomes compared with guideline-directed medical treatment (GDMT) in a population of patients with severe tricuspid regurgitation (TR).

“Right-sided heart failure [HF] and TR are associated with poor quality-of-life, and increased risks for hospitalisation and death,” said Prof. Erwan Donal (Rennes University Hospital, France) [1]. According to Prof. Donal, it remained unclear which patients may benefit from tricuspid valve interventions and the ideal timing for these procedures. “In the first academic randomised trial about transcatheter correction of TR, we randomised 300 patients with severe TR and signs and symptoms of HF in the previous 12 months to T-TEER, a percutaneous repair procedure using the TriClipTM device, plus GDMT, or to GDMT alone.” The primary endpoint of the TRI.Fr trial was a clinical composite score of major cardiovascular events, changes in NYHA class, or patient global assessment.

After 1 year of follow-up, the primary outcome measure showed that 74.1% of the participants in the T-TEER group improved, compared with 40.6% of those in the control group (HR 0.67; 95% CI 0.61–0.72; P<0.0001; see Figure). “We observed improvements across all elements of the clinical composite endpoint,” added Prof. Donal. In total, 93.2% of the participants in the experimental arm achieved a TR grade of less than 4+ compared with 46.5% of participants in the control arm (P<0.001).

Figure: Primary endpoint in the intention-to-treat population [1]

GDMT, guideline-directed medical treatment; T-TEER, tricuspid transcatheter edge-to-edge repair.

The investigators also reported a mean difference of 14.5 points in the Kansas City Cardiomyopathy Questionnaire(KCCQ) Overall Score between the study arms at 12 months in favour of the T-TEER group, reflecting a clinically meaningful improvement in quality-of-life for patients undergoing T-TEER plus GDMT (P<0.0001).

“T-TEER plus GDMT proved superior to GDMT alone with a significant reduction in TR severity,” concluded Prof. Donal.

1. 
   
   1. Donal E, et al. Multicentric randomised evaluation of a tricuspid valve percutaneous repair system (T-TEER) in the treatment of severe tricuspid regurgitation: TRI.Fr. HOTLINE 3, ESC Congress 2024, 30 Aug–02 Sept, London, UK.

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Posted on 7 November 20247 November 2024